“I was sent to this clinic for HIV care after I asked my primary care provider to screen me for STIs and my HIV test came back positive”
History of Present Illness
This patient is newly diagnosed with HIV and requires initiation of antiretroviral therapy and additional prophylactic medications as needed based on available lab data.
Drug Therapy Problems
Care Plan (by Problem)
Are there any drug interactions with the patient’s current medications or supplements that would impact your antiretroviral regimen choice?
Hint: See Table 87-7 in PPP
Which initial antiretroviral regimen option would you recommend based upon this patient’s lab results and history?
Hint: See Tables 87-3 and 87-6 in PPP. See Treatment Pharmacologic Therapy for Antiretroviral-Naive Patients section in PPP
Based upon this patient’s CD4 count and history, would you recommend primary prophylaxis for any opportunistic infections? If so, which medication(s) would you recommend for prophylaxis?
Hint: See Treatment in PPP. See DHHS Opportunistic Infection Guidelines: https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection
What follow up and laboratory monitoring for HIV would you recommend for this patient?
Hint: See Table 87-1, Treatment, and Outcome Evaluation in PPP
What information would you provide to the patient about HIV and his antiretroviral regimen?
Hint: See Table 87-6, Treatment, and Outcome Evaluation in PPP
The patient returns to the clinic 6 weeks later for follow-up after beginning ARV therapy. He reports some nausea immediately after starting the medication but that this improved after a couple of weeks of consistently taking it. He reports having grown closer to his current partner who has been supportive of him during this difficult time and is curious about the risk of transmitting HIV to him. He had laboratory tests drawn 4 weeks after starting ART. His HIV RNA was 256, SCr was 1.21, AST/ALT was 21/14.
How would you answer this patient’s questions about HIV transmission?
HIV continues to be a global pandemic with large numbers of the population infected in many African countries (Eswatini, Lesotho, Botswana, and South Africa, for example). Individuals seeking care in these countries may often have to travel several miles to reach dedicated facilities for managing HIV though newer and safer antiretroviral agents are becoming more widespread in their use at these locations. The disease continues to be heavily stigmatized in most of these countries with HIV criminalization laws potentially deepening fear and stigma about the infection.