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Updates in HIV and AIDS: Part I, An Issue of Infectious Disease Clinics, E-Book

Updates in HIV and AIDS: Part I, An Issue of Infectious Disease Clinics, E-Book

Michael S. Saag

(2014)

Additional Information

Abstract

This first part of a 2-part issue of Infectious Disease Clinics, edited by Michael S. Saag, MD and Henry Masur, MD, is devoted to HIV/AIDS. This issue will cover global epidemiology; testing, staging, and evaluation; linkage to care, retention in care; antiretroviral therapy: current drugs, when to start, what to start, failure; update on opportunistic infections; HIV co-morbidities; and co-infection Hepatitis B and Hepatitis C.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Updates in HIV andAIDS: Part I i
Copyright\r ii
Contributors iii
Contents vii
Infectious disease clinics\rOf north america\r x
Erratum xi
Dedication xiii
A Tribute to Dr Robert C. Moellering Jr (1937–2014) xiii
Preface xv
HIV/AIDS xv
Global Epidemiology of HIV 323
Key points 323
Introduction 323
Sub-Saharan Africa 326
Asia 329
North Africa and the Middle East 330
Latin America and the Caribbean 330
North America, Western Europe, and Oceania 331
Eastern Europe and Central Asia 332
Discussion and Program Implications 333
References 334
HIV Testing, Staging, and Evaluation 339
Key points 339
Introduction 339
Race and Ethnicity 340
MSM 341
Pregnant Women and Perinatally Acquired HIV 342
Youth 342
Staging 342
Acute HIV Infection 342
Chronic HIV Infection 344
AIDS 344
Testing 345
Screening Recommendations 345
Diagnostic Tools 345
Initial evaluation and care 347
Initial Evaluation 347
Clinical Testing and Case Management 347
Summary 352
References 352
Engagement in Human Immunodeficiency Virus Care 355
Key points 355
Introduction 355
Improved HIV outcomes with combination ART 356
Linkage and Retention in Care 356
Early entry into care 356
Attendance to clinic visits 358
Monitoring and measuring retention in care 358
Interventions to improve entry and retention in care 360
Adherence to ART 360
Monitoring ART adherence 360
Improving adherence 361
Adherence reminders 361
Behavioral interventions 362
Additional Interventions 363
Case management, supportive services (housing, food, transportation), and pharmacy support 363
Nursing-based and community-based counselor care 363
Priority Populations 364
Pregnancy 364
Substance use disorders 364
Mental illness 364
Incarceration, homelessness, and marginally housed individuals 365
Children, adolescents, and young adults 365
Future Research 366
References 366
Antiretroviral Therapy 371
Key points 371
Introduction 371
Goals and principles of antiretroviral therapy 373
HIV life cycle and targets of antiretroviral drug therapy 375
Rationale for combination antiretroviral therapy 375
NRTIs 376
Abacavir 377
Emtricitabine and Lamivudine 380
Tenofovir Disoproxil Fumarate (or Tenofovir) 380
Zidovudine 380
NNRTIs 381
Efavirenz 381
Etravirine 384
Nevirapine 384
Rilpivirine 385
PI 385
Atazanavir 386
Darunavir 387
Fosamprenavir 387
Lopinavir 391
Saquinavir 391
Tipranavir 392
Integrase inhibitors 392
Dolutegravir 393
Elvitegravir 393
Raltegravir 396
CCR5 antagonist 396
Fusion inhibitor 398
Summary 398
References 398
Antiretroviral Therapy 403
Key points 403
Introduction 403
HIV treatment guidelines 404
Evidence informing the question of when to start ART 406
Observational Data 407
Clinical Trials 410
Studies of Pathogenesis and End-Organ Disease 410
Treatment as Prevention 411
ART Toxicity 411
Antiretroviral Resistance 412
Conditions strongly favoring ART initiation 412
Pregnancy 413
Acute Opportunistic Infections 413
Other Comorbid Conditions 413
Acute HIV Infection 414
Challenges and considerations 414
Summary 414
References 415
Beginning Antiretroviral Therapy for Patients with HIV 421
Key points 421
Introduction 421
Pharmacologic strategies 422
Recommended initial regimens: Tenofovir versus ABC 423
Tenofovir 423
ABC 424
Recommended initial ART regimens: Single-tablet, once-daily regimens 424
EFV/TDF/FTC 424
EVG/COBI/TDF/FTC 426
RPV/TDF/FTC 427
DTG/ABC/3TC 427
Recommended initial ART regimens: Multiple-tablet regimens 427
Boosted PI-Based Regimens 427
INSTI Options 430
NNRTI with ABC Option 431
Alternative initial regimens 432
NRTI-sparing or NRTI-limiting options 432
Summary and future directions 433
References 433
Antiretroviral Therapy 439
Key points 439
Introduction 439
Art-experienced individuals with suboptimal virologic response 440
Causes of Suboptimal Virologic Response 441
Suspected Drug Resistance 441
Management of Suboptimal Virologic Response 442
Clinical scenario: suboptimal virologic response on first-line therapy 442
NRTIs plus NNRTI 442
NRTIs plus pharmacologically boosted PIs 443
NRTIs plus InSTI 443
Clinical scenario: suboptimal virologic response after having failed multiple regimens with drug-resistant virus 444
Treatment strategies when a fully suppressive regimen is likely to be achievable 444
Treatment strategies when a fully suppressive regimen is unlikely to be achievable 445
Clinical scenario: drug resistance testing cannot be performed 445
Clinical scenario: drug resistance testing shows no significant mutations 446
Clinical scenario: individuals with a history of suboptimal virologic response who have been off therapy for months 446
ART-experienced individuals with virologic suppression 446
Switching NRTIs 447
Switching NNRTIs 447
Switching a Pharmacologically Boosted PI 448
Switching from an InSTI 449
Switching ART in Patients Virologically Suppressed with Underlying Multidrug Resistance 449
Monitoring After Antiretroviral Switch 449
Summary/Discussion 450
References 450
HIV-Related Metabolic Comorbidities in the Current ART Era 457
Key points 457
Introduction 457
CVD 459
Epidemiology 459
HIV-Related Factors 459
Traditional Risk Factors 460
Prevention 460
Renal 460
Epidemiology 460
Prevention 461
Bone disease 462
Epidemiology 462
Risk Factors for Low BMD 462
Fracture Risk 463
Screening for Low BMD 463
Diabetes mellitus 464
Epidemiology 464
Risk Factors 464
Obesity and HIV 465
Summary 466
References 466
Human Immunodeficiency Virus and Coinfection with Hepatitis B and C 477
Key points 477
Background 477
Epidemiology and risk factors 478
HBV and HBV/HIV 478
HCV and HCV/HIV 479
Genotypes 479
HBV 479
HCV 479
IL28B 480
Natural history of coinfected states 480
HBV in HIV 480
HIV with HBV 481
HCV in HIV 481
HIV with HCV 482
Diagnosis and screening: in the HIV-infected population 483
Treatment 484
HBV: Treatment of Monoinfection Compared with Coinfection: Limitations and Considerations 484
Treatment of HBV Only 484
Treatment of Both HIV and HBV 485
Monitoring Treatment of HBV in the Coinfected Patient 485
HCV: treatment of monoinfection compared with coinfection: limitations and considerations 486
PEG/RBV 487
Protease inhibitor + PEG/RBV (telaprevir, boceprevir, SMV) 487
Nucleotide inhibitors (SOF) 488
Other agents in development (coformulations) 488
Case selection for HCV therapy and ART 489
Practice guidelines recommendations 489
Monitoring treatment outcome and managing adverse events 489
Other issues 490
Cost and Access to Care 490
Primary and Secondary Prevention 491
Summary 491
References 492
Update on Opportunistic Infections in the Era of Effective Antiretroviral Therapy 501
Key points 501
Introduction 501
TB in HIV-Infected Patients 502
Epidemiology 502
Latent TB infection 502
Treatment of LTBI 503
Diagnosis of Active TB 503
GeneXpert 503
Lipopolysaccharide antigen lipoarabinomannan 504
Treatment of TB in HIV-infected patients 504
When to start ART in an HIV-infected patient with TB 504
TB meningitis 506
Antiretroviral medication choice in patients with HIV/TB 506
Cryptococcus 507
Epidemiology 507
Diagnosis 507
CrAg LFA 507
Treatment of CM: the induction phase 508
Consolidation and maintenance therapy 508
When to start ART 508
Cryptococcal IRIS 509
PML 509
Treatment of PML 509
PML-IRIS 510
PCP 510
Diagnosis 510
When to start ART in a patient with PCP 510
Recommendations for PCP prophylaxis 511
Vaccine-Preventable OIs 511
HPV 511
Epidemiology 511
HPV vaccine 511
Varicella and zoster vaccines 512
Epidemiology 512
Vaccination in HIV-infected patients 512
Acknowledgments 512
References 512
Index 519