AntiretroviraltherapyandPrimaryCare-Wikispaces：抗逆转录病毒疗法和初级护理Wikispaces.pptVIP

Drug-Drug Interactions Methadone PIs and NNRTIs may decrease methadone serum concentrations Drug-Drug Interactions /drug-interactionchecker /InSite Case 56 yo man tests positive for HIV after you initiate routine HIV testing during your first clinic visit. He feels well. He has a PMH of hyperlipidemia, GERD and seasonal allergies. He is highly motivated to initiate ARVs. You check HIV intake labs, including a CD4, viral load and resistance panel. Labs are significant for a CD4=496 and VL=6500, with wild type virus. You discuss his options and he prefers a once-a-day regimen, but doesn’t otherwise care if he has to take multiple pills. He is worried about that pill that makes you “go crazy”. He is taking daily Omeprazole and Simvastatin 40mg PO daily for an LDL of 160 with multiple CAD risk factors. What do you choose? Darunavir/ritonavir + Tenofovir/Emtricitabine!! ...and change his statin to Atorvastatin or Rosuvastatin . Exciting New Directions New (possibly 1st line) ARVs Dolutegravir (next generation highly potent, mutation resistant, integrase inhibitor) Elvitegravir (once-a-day integrase inhibitor which is just around the corner) Will be coformulated with TDF/FTC and new boosting agent cobisistat into a once-a-day “quad pill” Rilpivirene (new FDA approved once-a-day NNRTI without the bad CNS side effects) Also, rilpivirene coformulated with Truvada (B-tripla!)...it’s actually called Complera Randomized trial of when to start Strategic Timing of Antiretroviral Treatment (START) trial…however becoming a moot point as we move towards treatment for all. Pre-exposure prophylaxis Not clear what role this will have, but likely more of an argument for earlier treatment Summary 1) Why primary care doctors should care about HIV care 2) The important societies making the rules for ARV management 3) Historical context to “when to start” 4) Reviewed the studies which are pushing the field towards earlier treatment 5) Important drugs to know 6) Important concepts o