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Kathryn Snyder and Quinton Taylor


  • New HIV Diagnosis
    • ID consult if pt is not on Rogers ID service (important for initiation, follow up [CCC], social work assistance)
    • ART is indicated for all HIV+ pts, regardless of CD4; however, starting ART requires appropriate outpt follow up
    • Lab evaluation
      • HIV viral load and genotype
      • T cell subsets (CD4 Count), CBC with differential, CMP, UA
      • HLA*B5701 testing before using abacavir containing regimen
      • QuantiFERON Gold
      • Pregnancy testing
      • Viral hepatitis serologies
      • Toxoplasma serologies
      • CMP, CBC with differential, urinalysis
      • Other STI screening (Syphilis, Gonorrhea/Chlamydia)
  • Timing of ART initiation
    • Factors affecting timing of initiation
      • Drug toxicity and interactions, risks for resistance, adherence barriers
      • Treatment of opportunistic infections may delay initiation of ART given associated risk of immune reconstitution inflammatory syndrome (IRIS)
  • Delay ART for several weeks after initiation of therapy for cryptococcal meningitis, tuberculosis, and CMV retinitis
  • IRIS is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of antiretroviral therapy (ART) in HIV-infected individuals. Symptoms are associated with underlying disease.
  • ART plan for overnight admits: okay to continue home ART, special consideration for:
    • Pts with hepatic or renal dysfunction may need dose adjustment
    • Interactions with other newly initiated medications
    • If there is concern for non-adherence, can hold morning dose
    • Combination pills may need to be ordered as separate components
    • Close attention to medication reconciliation to ensure the pt’s complete ART regimen is ordered
  • Common key regimens for initiation
    • Most regimens consist of an NRTI backbone (2 agents) plus a 3rd agent
    • Some dual therapy regimens (such as Dovato@) are non-inferior to standard 3-drug therapy
    • Many pts are started on combination pill regimens, including Integrase Inhibitor based regimens: Biktarvy®, Dovato®, Triumeq®, Genvoya®, dolutegravir + Descovy®