HIV Essentials

by Paul E. Sax, Melanie Berry

Overview

HIV Essentials incorporates the latest clinical guidelines into a step-by-step guide to the diagnosis, evaluation, management, and prevention of HIV infection and its complications. Topics include opportunistic infections and other HIV complications, treatment of HIV and pregnancy, antiretroviral drug summaries, post-exposure and pre-exposure prophylaxis, as well as commercially available dosage forms for all ARVs. The Tenth Edition was revised and updated to focus on treatment and prevention and has removed HCV content.

Product Details

ISBN-13:	9781284301069
Publisher:	Jones & Bartlett Learning
Publication date:	12/15/2023
Sold by:	Barnes & Noble
Format:	eBook
Pages:	384
File size:	31 MB
Note:	This product may take a few minutes to download.

About the Author

Dr. Paul E. Sax is Clinical Director of the Division of Infectious Diseases at Brigham and Women’s Hospital (BWH), where he holds the Bruce A. Beal and Robert L. Beal Distinguished Chair in Infectious Diseases, and Professor of Medicine at Harvard Medical School. Dr. Sax received his MD from Harvard Medical School, completed his residency in Internal Medicine at BWH, then fellowship in Infectious Diseases at Massachusetts General Hospital. He is Editor-in-Chief of Clinical Infectious Diseases, the flagship journal of the Infectious Diseases Society of America, and is Section Editor of HIV/AIDS in UpToDate. He writes HIV and ID Observations for NEJM Journal Watch, and is on the Antiretroviral Guidelines Panel of the International Antiviral Society – USA. Dr. Sax teaches regularly on HIV and infectious diseases locally, nationally, and internationally. In addition to his clinical practice, writing, and teaching, his ongoing areas of research include clinical trials of antiretroviral therapies, cost-effectiveness of management strategies for HIV, and toxicity of antiretroviral therapy.

Melanie Berry, PharmD, BCACP, AAHIVP, is a Clinical Pharmacy Specialist at Boston Medical Center (BMC). Dr. Berry graduated with her Doctorate in Pharmacy from University of Missouri-Kansas City School of Pharmacy. She completed a PGY1 residency in Community Pharmacy at Cleveland Clinic and a PGY2 residency in Ambulatory Care at Boston Medical Center. She is a board certified Ambulatory Care pharmacist and credentialed HIV Pharmacist through the American Academy of HIV Medicine. Dr. Berry’s focus is in HIV and Pre-Exposure Prophylaxis (PrEP). She practices in the Center for Infectious Diseases and Sexual Health Clinics at Boston Medical Center.

Table of Contents

1 Overview of HIV Disease 1

Overview of HIV Disease 2

Stages of HIV Disease 2

Viral Transmission 2

Acute (Primary) HIV 3

Seroconversion 3

Early Symptomatic HIV 3

AIDS 3

Acute (Primary) HIV 4

Description 4

Differential Diagnosis 4

Signs and Symptoms 4

Laboratory Findings 4

Confirming the Diagnosis of Acute HIV 5

Management of Acute HIV 5

2 Testing for HIV and Baseline Evaluation 7

HIV Diagnostic Testing 8

Whom to Test 8

Testing for HIV 8

HIV Antibody Tests 10

Selected Licensed HIV Diagnostic Tests 11

Summary 11

Quantitative Plasma HIV RNA (HIV Viral Load Assays) 13

Uses of HIV RNA Assay 13

Assays and Interpretation 13

Indications for HIV RNA Testing 14

Initial Assessment of People with HIV 14

Clinical Evaluation 14

Baseline Laboratory Testing 15

CD4 Cell Count (Lymphocyte Subset Analysis) 17

3 Treatment of HIV Disease 25

Initiation of Antiretroviral Therapy 26

Selection of an Optimal Initial Antiretroviral Regimen 33

Antiretroviral Therapy Adverse Effects 52

4 Management of the Treatment-Experienced Patient 73

Antiretroviral Treatment Failure 74

Virologic Response Definitions 74

Evaluation of Virologic Failure 75

Important Genotypic Resistance Patterns 83

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) 83

Non-Nudeoside Reverse Transcriptase Inhibitors (NNRTIs) 85

Protease Inhibitors (PIs) 86

Integrase Inhibitors 87

Poor CD4 Recovery Despite Virologic Suppression 88

Regimen Switching in the Setting of Virologic Suppression 88

General Principles of Regimen Switching 89

Regimen Switching Strategies in the Setting of Drug Toxicity 90

Special Considerations When Switching to Long-acting Cabotegravir and Rilpivirine 95

5 Prophylaxis and Treatment of Opportunistic Infections 97

Prophylaxis of Opportunistic Infections 98

Treatment of Opportunistic Infections 109

Aspergillosis, Invasive 110

Bartonella Infections 111

Campylobacteriosis 112

Candidiasis (Mucosal) 113

Chagas Disease (American Trypanosomiasis) 116

Clostridium difficile Infection 116

Coccidioidomycosis 117

Community-Acquired Pneumonia 120

Cryptococcal Meningitis 123

Cryptosporidiosis 125

Cystohosporiasis (formerly Isosporiasis) Infection 126

Cytomegalovirus (CMV) Disease 127

Hepatitis B Virus (HBV) 131

Hepatitis C Virus (HCV) 132

Herpes Simplex Virus (HSV) Disease 142

HHV-8 Infection 144

Histoplasma capsulatum 144

Human Papillomavirus (HPV) Disease 147

Leishmaniasis, Cutaneous 148

Malaria 149

Microsporidiosis 149

Mycobaterium Avium Complex (MAC) Disease 151

Mycobaterium tuberculosis (TB) 152

Pneumocystis Pneumonia (PCP) 154

Progressive Multifocal Leukoencephalopathy (PML) 157

Salmonellosis 158

Shigellosis 160

Talaromycosis (Penicilliosis) 161

Toxoplasma gondii Encephalitis 163

Treponema pallidum (Syphilis) 165

Varicella-Zoster Virus (VZV) Disease 167

6 Complications of HIV Disease 169

Hematologic Complications 170

Thrombocytopenia 170

Anemia 170

Neutropenia 171

Eosinophil 172

Oncologic Complications 172

Kaposi's Sarcoma 172

Non-Hodgkin's Lymphoma (NHL) 173

Primary CNS Lymphoma 173

Cervical Cancer 174

Anal Cancer 174

Endocrine Complications 174

Disorders of Adrenal Function 174

Hypogonadism 175

Thyroid Disease 176

Pancreatitis 176

Hyperglycemia 176

Hypoglycemia 177

Ovarian Complications 177

Bone Disease 177

Morphologic Complications of Therapy 178

Lipoatrophy 178

Fat Accumulation and Weight Gain 179

Lipid Abnormalities 179

Gastrointestinal Tract Complications 181

Anorexia 181

Nausea/Vomiting 181

Diarrhea 182

Oral or Esophageal Ulcers 182

HIV Cholangiopathy 183

Renal Complications 183

HIV-Associated Nephropathy 183

Medication-Related Renal Disease 184

HCV-Associated Renal Disease 185

Heroin Nephropathy 185

Inhibition of Tubular Secretion of Creatinine 185

Cardiac Complications 185

HIV-Related Cardiomyopathy 185

Pericarditis/Pericardial Effusion 186

Tricuspid Valve Endocarditis 186

Pulmonary Complications 186

Lymphocytic Interstitial Pneumonitis (LIP) 186

Emphysema 187

Pulmonary Kaposi's Sarcoma 187

HEENT Complications 187

Aphthous Ulcers 187

Oral Hairy Leukoplakia 187

Salivary Gland Enlargement 187

Lymphoepithelial Cysts 188

Gingivitis/Periodontitis 188

Musculoskeletal Complications 188

HIV Arthropathy 188

Reiter's Syndrome 188

Pyomyositis 188

HIV Myopathy and NRTI-Related Myopathy 189

Rhabdomyolysis 189

Neurologic Complications 189

Distal Sensory Neuropathy 189

Other Forms of Neuropathy 190

HIV-Associated Dementia (AIDS dementia, HIV encephalitis/encephalopathy) 191

Psychiatric Complications 192

Depression 192

Mania 192

Insomnia 192

Dermatologic Complications 193

Viral Infections 193

Bacterial Infections 194

Fungal Infections 195

Miscellaneous Skin Conditions 196

7 HIV and Pregnancy 197

Overview 198

Initial Evaluation 198

Reproductive Options for HIV Serodiscordant Couples 198

Initiation of Antiretroviral Therapy in Pregnancy 200

Goals of Therapy and Monitoring 201

Preferred and Alternative Treatments for Pregnant Women 201

Intrapartum Care 215

Postpartum Management 217

8 Post-Exposure and Pre-Exposure Prophylaxis 218

Occupational Post-Exposure Prophylaxis (PEP) 219

Nonoccupational Post-Exposure Prophylaxis (nPEP) 227

Pre-Exposure Prophylaxis (PrEP) 231

9 Antiretroviral, Anti-HBV, and Anti-HCV Drug Summaries 238

Appendix 1 313

a IAS-USA Drug Resistance Mutations in HIV-1: September 2019 314

b IAS-USA Drug Resistance Mutations in HIV-1: User Notes 320

References to the User Notes 325

Appendix 2 334

Selected Key Internet Resources 335

Index 336