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🔥 Just PUBLISHED 🔥
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults
2022 Recommendations of the International Antiviral Society–USA Panel
#IDTwitter #hivtwitter
jamanetwork.com/journals/jama/…
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults
2022 Recommendations of the International Antiviral Society–USA Panel
#IDTwitter #hivtwitter
jamanetwork.com/journals/jama/…
Initiation of ART is recommended as soon as possible after diagnosis, ideally within 7 days, including on the same day as diagnosis or at the first clinic visit if the patient is ready and there is no suspicion for a concurrent opportunistic infection (evidence rating: AIII)
Recommended for Most People With HIV
The following are recommended (in alphabetical order) for most people with HIV:
BIC/TAF/FTC (evidence rating: AIa)
Dolutegravir plus TXF/XTC (evidence rating: AIa)
The following are recommended (in alphabetical order) for most people with HIV:
BIC/TAF/FTC (evidence rating: AIa)
Dolutegravir plus TXF/XTC (evidence rating: AIa)
🧵1/5 #IDtwitter, this is our weekly #IDtrivia 📚
39y/M with no PMH, presents to the ED for evaluation of fatigue, anorexia, and diarrhea of 3 weeks duration. ROS is positive for weight loss, night sweats and an intermittent maculopapular rash located on his chest
39y/M with no PMH, presents to the ED for evaluation of fatigue, anorexia, and diarrhea of 3 weeks duration. ROS is positive for weight loss, night sweats and an intermittent maculopapular rash located on his chest
2/5 Patient denies recent travel, sick contacts. He works as a bus driver. Sexually active with cis male partners, no condom use, takes PrEP occasionally. Hx of treated syphilis, last HIV and QuantiFERON-TB 6 months ago negative
3/5 On presentation BP88/68 HR90 RR20, T98.7,lethargic, AOx3. Chest clear to auscultation,normal heart sounds, abdomen tender to palpation of mesogastrium. He also had a diffuse rash (pic)
1/ #IDTwitter #HIVTwitter
Today we will review some of the common types of #HIVDrugResistance tests.
Today we will review some of the common types of #HIVDrugResistance tests.
2/ I first break down testing into 2 broad categories of resistance tests:
1/ #IDTwitter #HIVTwitter #HIVDrugResistance
To keep the momentum going, let’s move on to transmitted drug resistance. For those just joining, we previously discussed that #HIVDrugResistance is important yet challenging for learners.
To keep the momentum going, let’s move on to transmitted drug resistance. For those just joining, we previously discussed that #HIVDrugResistance is important yet challenging for learners.
2/ We also reviewed the basic principle that HIV resistance develops when HIV replicates in the setting of subtherapeutic drug levels. Virions containing resistance mutations are selected for in this case.
3/ Today we’ll define transmitted drug resistance (TDR) (vs acquired drug resistance). TDR = acquisition of drug-resistant HIV at the time of new HIV infection. We identify TDR when we do a baseline HIV genotype (recommended for all patients who are newly diagnosed with HIV).
1/
Mini-review of three high yield NNRTI mutations! Continued learning from yesterday.
#IDTwitter #MedTwitter #HIVTwitter
Mini-review of three high yield NNRTI mutations! Continued learning from yesterday.
#IDTwitter #MedTwitter #HIVTwitter
2/
🧬🧬K103N🧬🧬
💠selected by efavirenz (EFV), nevirapine (NVP)
💠high resistance to EFV, NVP
💠low barrier
🧬🧬K103N🧬🧬
💠selected by efavirenz (EFV), nevirapine (NVP)
💠high resistance to EFV, NVP
💠low barrier
3/
🧬🧬Y181C🧬🧬
💠selected by NVP
💠high resistance to NVP; essentially knocks out all NNRTI (except Doravorine, DOR)
🧬🧬Y181C🧬🧬
💠selected by NVP
💠high resistance to NVP; essentially knocks out all NNRTI (except Doravorine, DOR)
1/
Mini-review of three high yield NRTI mutations from rounds today -- Keep scrolling for more!
Mini-review of three high yield NRTI mutations from rounds today -- Keep scrolling for more!
2/
🧬🧬M184V🧬🧬
💠selected by Emtricitabine (FTC), Lamivudine (3TC)
💠High resistance to: FTC/3TC
⬇️viral fitness
⬆️susceptibility tenofovir (TDF/TAF), zidovudine (AZT)
💠Pt may stay on FTC or 3TC with M184V in order to maintain ⬇️fitness + hypersusceptibility to TAF/TDF
🧬🧬M184V🧬🧬
💠selected by Emtricitabine (FTC), Lamivudine (3TC)
💠High resistance to: FTC/3TC
⬇️viral fitness
⬆️susceptibility tenofovir (TDF/TAF), zidovudine (AZT)
💠Pt may stay on FTC or 3TC with M184V in order to maintain ⬇️fitness + hypersusceptibility to TAF/TDF
3/
🧬🧬K65R🧬🧬
💠selected by TDF/TAF
💠High resistance to tenofovir; cross-class resistance except for AZT
⬆️AZT susceptibility
⬇️viral fitness*
*additive with M184C
🧬🧬K65R🧬🧬
💠selected by TDF/TAF
💠High resistance to tenofovir; cross-class resistance except for AZT
⬆️AZT susceptibility
⬇️viral fitness*
*additive with M184C
1/ I did my first telehealth (by phone) clinic for people living with HIV. It’s hard to discuss fears and give guidance with such uncertainty on #COVID19. I made myself a template, but am interested in what others are doing. #IDTwitter #HIVTwitter Here’s mine:
2/First I asked: What questions do you have about the new coronavirus or the COVID-19 illness?
I made sure their questions answered first but also used this as a knowledge/health literacy assessment and reviewed mechanisms of spread
I made sure their questions answered first but also used this as a knowledge/health literacy assessment and reviewed mechanisms of spread
3/ Social distancing: discussed what they are doing currently; encouraged 6-foot social distancing, avoiding crowds; assessed access to food, shelter, and medications; reviewed some risk mitigation strategies for work for those who are still working
