Patient Profile: Nico
Patient Case: Nico
Treatment Naïve, Rapid Initiation
Model portrayal
Model portrayal
Nico, a 25-year-old African American male,* reports that he developed an unexplained body rash shortly after learning that a friend was diagnosed with HIV. This prompted him to visit an STD clinic. At that visit, 2 weeks ago, he was diagnosed with HIV-1.
*This is a hypothetical patient
CD4+ = cluster of differentiation 4; STD = sexually transmitted disease
Model portrayal
Sexual history: MSM
Occupation: Retail clothing store manager; recently asked to cover other stores out of state, which will require frequent overnight travel
Lifestyle:
MSM = men who have sex with men
Model portrayal
25-year-old MSM with HIV-1 who is willing to start treatment but is at risk for suboptimal adherence:
Busy lifestyle
Social history
Baseline HIV laboratory results are pending
No renal or hepatic concerns
MSM = men who have sex with men
Model portrayal
DHHS guidelines recommend ART for all individuals with HIV, regardless of CD4 T lymphocyte cell count, to reduce the morbidity and mortality associated with HIV infection. The guidelines state that acute/early infection is one of the conditions that increase the urgency to initiate ART. Genotypic drug resistance testing should be performed before initiation of ART, but ART can be initiated before drug resistance test results are available.
ART=antiretroviral treatment; CD4=cluster of differentiation 4
http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed November 8, 2018.
DHHS guidelines cite the following considerations for clinical scenarios in which ART should be started before HIV drug resistance results are available or in which rapid initiation of therapy is warranted:
ABC=abacavir; ART=antiretroviral treatment; c=cobicistat; DRV=darunavir; DTG=dolutegravir; FTC= emtricitabine; HBV=hepatitis B virus; INSTI=integrase strand transfer inhibitor; NNRTI=non-nucleoside reverse transcriptase inhibitor; PI=protease inhibitor; r=ritonavir; TAF=tenofovir alafenamide; TDF=tenofovir disoproxil fumarate
http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed November 8, 2018.