HIV-1 probably emerged around 1910 in Cameroon before spreading to Kinshasa
After reaching Kinshasa, the virus spread across Central Africa and to the coast for 40 years before exploding across the globe
Send the patients from the nursery to a pediatric HIV clinic
That clinic will typically do all well child visits and acute care
The pediatric HIV clinic at NCH is called FACES
PrEP Coverage, by State, United States, 2018 For this figure, PrEP coverage is represented as a percentage and calculated by the number of persons prescribed PrEP (n = 219,691 in 2018) divided by estimated number of persons with indications for PrEP (n = 1,211,777 in 2017).
When used consistently, condoms are ~80% effective at preventing HIV transmission
Truvada - Tenofovir Disoproxil Fumarate + Emtricitabine
Descovy - Tenofovir Alafenamide + Emtricitabine
|Laboratory Test||Baseline||Every 3 Months||Every 6 Months||Extra|
|HIV screening||x||x||May need PCR test|
|HBV and HCV screening||x||x||Consider HBV vaccine|
|Creatinine||x||x||May need to stop if increases|
|STI Screening||x||x||Include oral and rectal prn|
"All states now have HIV testing laws that are consistent with CDC recommendations for consent (e.g. opt-out testing, part of the general medical consent form, and oral consent acceptable) and counseling (e.g. prevention counseling not required prior to HIV testing)."
Screen with Ag-Ab test
If acute symptoms, just add the viral load
If recent exposure, just add the viral load
They are usually scared and angry.
Try to make their appointment if less than 7 days.
Be very concrete about where to go.
If we cannot link them to care, making the diagnosis is essentially useless.
Suppression: A response to antiretroviral therapy with an HIV RNA level below the lower level of detection of available assays
Incomplete Virologic Response: Failure to suppress HIV RNA to undetectable levels after 24 weeks on an antiretroviral regimen, as documented by two consecutive HIV RNA levels greater than or equal to 200 copies/mL in a person who has not previously achieved virologic suppression
Failure: The inability to achieve or maintain HIV RNA levels less than 200 copies/mL
In any event, you need more data
Typically will stay on the same therapy and check VL every 3 months
Some people will get genotype and switch to a regimen that includes either an integrase or a protease inhibitor
Should be referred to specialist
Frequently associated with resistance
If VL 500-1000
Needs a genotype
If no resistance mutations, it is probably an adherence problem
If there are resistance mutations, they need a specialist
NCH - FACES Clinic
AIDS Health Foundation