B3.072 HIV Cases

Question 1

guidelines for genotyping in HIV patients

Answer 1

HIV drug resisitance testing is recommended for persons with HIV infection at entry into care to guide selection of ART regimen
genotypic testing is preferred form of resistance testing

Question 2

guidelines for initiating HIV treatment

Answer 2

generally 2 NRTIs with a 3rd drug from 1 of 3 classes (integrase inhibitor, NNRTA, or protease inhibitor w/ pharmacokinetic booster)

Question 3

what factors should guide selection of HIV treatment regimen

Answer 3

virologic efficacy, toxicity, pill burden, dosing frequency, drug drug interaction potential, resistance testing results, comorbid conditions, access, cost

Question 4

initial characteristics to consider in all patients

Answer 4

pretreatment HIV RNA level
pretreatment CD4 count
HIV genotypic drug resistance testing results
HLA-B*5701 status
patient preferences
anticipated adherence to the regimen

Question 5

monitoring test frequency

Answer 5

VL 2-8 weeks after initiation of therapy
CMP 2-8 weeks after starting therapy
after 3mo (then every 3-6 mo) CBC, CD4 count (for 1st two years), VL, CML