I. Jean Davis, PhD, PA, AAHIVS

Manager - Clinical ServicesDesert AIDS Project

Discuss the benefits of Antiretroviral Therapy in reducing mortality and/or AIDS-related morbidity.

Discuss the role of ART in reducing the risk of disease progression in individuals infected with HIV.

Discuss the role of  ART in the prevention of transmission of HIV for individuals infected with HIV.

Mr. Wilson is a 35 year old Black male, diagnosed with HIV 5 years ago. He initiated a medication regimen at the time of diagnosis, but returned to IV drug abuse 3 years ago and was lost to care. The patient denies a history sexual activity with men. He states that he acquired HIV while injecting drugs. He does not recall the name of the ART, but states he was taking at least 2 medications.

Patient has been married for 1 year. His wife is a case manager at the substance abuse center where he “resolved his need to use drugs”, 2 years ago.

Mr. Wilson states he has mild high blood pressure and started taking Dyazide over a year ago. He was told he had borderline diabetes. He states he has never taken medication for his diabetes. He has a family history of cardiovascular disease, diabetes and cancer. His eldest brother had both

legs amputated 4 years ago at age 62 and died last year due to complications.

Inpatient Management

Serologic OI HAART Testing Prophylaxis

Outpatient Management

Less than one-third of HIV-infected individuals in the United States have suppressed viral loads.

Despite remarkable improvements in HIV treatment and prevention, economic and social barriers resulting in: Morbidity Mortality HIV infections persist

The evaluation of Initiating or Restarting Therapy should include: a discussion on the benefits of antiretroviral therapy (ART)

The following laboratory tests performed during patient visits can be used to stage HIV disease and to assist in the selection of ARV drug regimens: HIV antibody testing CD4 T-cell count (CD4 count) Plasma HIV RNA (viral load) Complete blood count, chemistry profile, transaminase levels, blood

urea nitrogen (BUN), and creatinine, urinalysis, and serologies for hepatitis A, B, and C viruses

Fasting blood glucose and serum lipids Genotypic resistance testing

ART has dramatically reduced HIV-associated morbidity and mortality and has transformed HIV disease into a chronic, manageable condition.

Patients should also be told that untreated HIV infection will eventually lead to immunological deterioration and increased risk of clinical disease and death.

HIV-associated immune deficiency, the direct effects of HIV on end organs, and the indirect effects of HIV associated inflammation on these organs all most likely contribute to HIV-related morbidity and mortality.

Untreated HIV infection may have detrimental effects at all stages of infection.

ART is beneficial even when initiated later in infection.

Sustaining viral suppression and maintaining higher CD4 count may delay, prevent, or reverse some non-AIDS-defining complications: HIV associated kidney disease Liver disease CVD Neurologic complications Malignancies

In addition, effective treatment of HIV-infected individuals with ART is highly effective at preventing transmission to sexual partners.

Clinicians should also inform patients that viral suppression from effective ART can reduce the risk of sexual transmission to others.

Mr. Wilson is a 35 year old Black male, diagnosed with HIV 5 years ago. He initiated a medication regimen at the time of diagnosis, but returned to IV drug abuse 3 years ago and was lost to care. The patient denies a history sexual activity with men. He states that he acquired HIV while injecting drugs. He does not recall the name of the ART, but states he was taking at least 2 medications.

Patient has been married for 1 year. His wife is a case manager at the substance abuse center where he “resolved his need to use drugs”, 2 years ago.

Mr. Wilson states he has mild high blood pressure and started taking Dyazide over a year ago. He was told he had borderline diabetes. He states he has never taken medication for his diabetes. He has a family history of cardiovascular disease, diabetes and cancer. His eldest brother had both

legs amputated 4 years ago at age 62 and died last year due to complications.

What additional history do we need?What lab tests should we order?What co-morbidities are our

concerns?What impact would ART have on his

quality of life and health?What health promotion, disease

prevention education would you provide for Mr. Wilson?