Treatment Guidelines Flashcards
What is the benefit for elite controllers in taking ARVs?
Even though suppressed VL high levels of immune activation ? Increased risk non aids related diseases ? Progressive CD4 loss
This could decline with ARV
French cohort 30% progressed over 15 years
Also removes small risk of transmission
Dtg/3TC used as first line caveats -
VL <500,000
Cd4 > 200
Hep b neg
No TDF
No documented archived or suspected M184 mutations
Not with hiv cog impairment
Why is doravirine with Kivexa not recommended in first line tx
Limited experience
What to start in TDR
Tdf/TAF 3TC/ftc
Plus DTG, bic, drv/r or drv/c
Can you switch to an NNNRTI based regime if there is any NNRTI resistance?
Not recommended
Failure on injectables at 1yr 2 yr 3yr
1 in 70
1 in 60
1 in 40
If switching from efavirenz with detectable VL what should be used
PI boosted
If switching from ETR to dtg what needs to be done
Double dose dtg 2 weeks
What needs doing if switching from ETR/EFV/NVP to cab/RPV?
NVP 4 weeks oral lead in
EFV/ETR
2 weeks double dose rpv 2 weeks normal
Or 4 weeks normal doses RPV and cab but with 2 NRTI backbone
Definition blip
VL between 50 and 200 which comes back down when repeated
Definition incomplete virological response
VL >200 in two consecutive tests after 24 weeks
Definition virological failure
Incomplete virological response after commencing treatment or confirmed rebound to >200 copies
Definition rebound
2 or more consecutive VLs greater than 100
What to do if failing with NNRTI resistance
DTG plus 2 NNRTIs - DAWNING study showed dtg superior to lop/r, NADIA study dtg as effective as DRV/r and less potential DDIs
Boosted PI plus 2 NNRTI - Nadia study and 3 RCT
Boosted PI plus raltegravir
What to do if failing on PI based regime
Can continue if no resistance and adherence a concern and close monitor rot VL 4 weeks
Switch to DRV/r, DTG/BIC or different PI plus insti
