HIV/AIDS in Practice An Expert Commentary with Myron Cohen, MD A Clinical Context Report
Clinical Context: HIV/AIDS in Practice Expert Commentary Jointly Sponsored by: and
Clinical Context: HIV/AIDS in Practice Expert Commentary This activity is supported by an independent educational grant from Abbott.
HIV/AIDS in Practice Clinical Context Series The goal of this series is to provide up-todate information and multiple perspectives on the pathogenesis, symptoms, risk factors, and complications of HIV/AIDS, as well as current and emerging treatments and best practices in the management of HIV/AIDS.
HIV/AIDS in Practice Clinical Context Series Target Audience HIV/AIDS specialists, virologists, infectious disease specialists, primary care physicians, nurses, nurse practitioners, physician assistants, pharmacists, and other healthcare professionals involved in the management of HIV/AIDS
Upon successful completion of this educational program, participants should be able to: l Activity Learning Objective Review the relevance and significance of the activity in the broader context of clinical care
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Discussant Myron Cohen, MD Associate Vice Chancellor for Global Health J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology Public Health Director, Institute for Global Health and Infectious Diseases Chief, Division of Infectious Diseases Director, Center for Infectious Diseases University of North Carolina (UNC) Chapel Hill Chapel Hill, North Carolina
Disclosure Information Myron Cohen, MD, has disclosed no relevant financial relationships.
Disclosure Information Robert Jasmer, Associate Clinical Professor of Medicine, University of California, San Francisco; Michael Smith; and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. The staffs of Projects In Knowledge and MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
New Treatment Guidelines 2012
Immediate Start to Therapy l Treatment initiation previously guided by CD4 cell count l New guidelines urge offering treatment to all newly diagnosed patients without regard to CD4 status
Rationale for Change l All patients may benefit from antiretroviral therapy. l Key randomized controlled trial showed that antiretroviral therapy reduces risk of HIV transmission.
Considerations l Patient must be willing, able to adhere to therapy l Adherence must be supported with education l Benefit of ART not clear in patients already controlling HIV l Benefit also unclear in patients without symptoms
Considerations l Side effects of therapy l Concurrent conditions may affect timing of initiation
Recommended Initial Regimens l Efavirenz/tenofovir/emtricitabine or efavirenz plus abacavir/lamivudine in HLA-B*5701 negative patients high baseline viral load l Darunavir/r plus tenofovir/emtricitabine, atazanavir/r plus tenofovir/ emtricitabine, or atazanavir/r plus abacavir/lamivudine (in HLA-B*5701 negative patients high baseline viral load)
Recommended Initial Regimens l Raltegravir plus tenofovir/emtricitabine
Considerations l Ability of patients to tolerate certain side effects l Ability of regimen to lower viremia rapidly l Skill and experience of clinician still important in managing HIV
Summary At the end of this activity, participants should understand: That therapy should be offered to all patients newly diagnosed with HIV regardless of CD4 count That adherence to therapy has clinical benefits to the patient despite side effects That adherence to therapy renders a patient almost completely noncontagious That new options for treatment continue to evolve