I. Jean Davis, PhD, PA, AAHIVS Manager - Clinical Services Desert 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?

Howard University HURB th Street NW, 2 nd Floor Washington, DC (Office) (Fax)