University:
West Coast University
Course:
PHAR 837 | IPC Infectious Diseases I
Academic year:

2024
Views:

486

Pages:

3
Author:

Asal A.

Patient 1: James 48 y/o male diagnosed with HIV 02/2000 Viral load: 15,784 copies/mL (9/20/2019), last undetectable (2/1/2019) CD4+ count: 742 cells/ML HLA-B*5701(-) Resistance testing: K101P(+) - All NNRTIs affected Patients reports 6 months nonadherence due to financial situation. Temporary lack of employment and insurance now resolved. Current medication regimen: • Atripla* 1 tablet PO daily • Recommendation:  d/c Atripla → switch to Biktarvy If:  Started on dofetilide o Switch Genvoya due to C/I w/ Biktarvy Patient 2: Jerry 26 y/o male with the following HIV test results: 4™ gen HIV test (+), HIV-1/HIV-2 differentiation assay (Indeterminate)  Do a 3rd test… Viral load: 90,213 copies/mL (10/01/2020) Diagnosed HIV(+) CD4+ count: 1200 cells/ul HLA-B*5701(+) Resistance testing: no mutations identified Patient reports sharing needles with strangers when homeless 4 months ago Current medication regimen:  None Recommendation:  Biktarvy, Tivicay, + something → if Q148H(+) All INSTIs affected (resistance) → get ID consult (out of practice scope) ID Consult (e.g., NNRTI + 2 NRTIs) Patient #3: Lisa 32 y/o female diagnosed HIV(+) 01/17 VL: undetectable (<50 copies/mL) CD4* count: 1000 cells/uL. Current ART: Stribild® Recently started Zocor® 40mg Wants to know it recent "high cholesterol* is from years of taking HIV medication. DDI? → Lipitors Wants to keep low pill burden Recommendation:  Switch Stribild → Biktarvy o TAF could be contributing factor to lipid increase  or Switch Zocor → Atorvastatin If patient has: → TB 6 months later → started on RIPE RIPE: [tx for TB – rifampin (RIF), isoniazid (INH), pyrazinamide (PZA), and ethambutol (EMB)]  Tivicay (DTG) 50 mg BID or Truvada Patient 4: Kirt 40 y/o male diagnosed with HIV 02/2018 VL: undetectable (<50 copies/mL) CD4* count: 700 cells/ul. HLA-B* 5701(-) Resistance testing: (-) Diagnosed HBV (+) 9/2024 (results arrived) → VL2200 IU/mL. Current medication regimen: • Triumeq® 1 tablet PO daily Recommendation  Biktarvy o Treats both HIV and HBV  Has TNF (tenofovir) and FTC component After giving the patient presents with: →HBV VL increasing currently at 9700 IU/mL VL: undetectable (< 50 copies/mL) CD4* count: 700 cells/uL  Use FTC or 3TC w/ Entecavir and a suppressive ART regimen → Add entecavir