HIV treatment - Revision history

Aidan at 02:07, 2 April 2023

2023-04-02T02:07:19Z

← Older revision		Revision as of 02:07, 2 April 2023
Line 28:		Line 28:
	*Refer to [[HIV medications]] for information about specific medications		*Refer to [[HIV medications]] for information about specific medications
	*In general, use two nucleoside reverse-transcriptase inhibitors (NRTIs) and one non-NRTI (usually an integrase inhibitor)		*In general, use two nucleoside reverse-transcriptase inhibitors (NRTIs) and one non-NRTI (usually an integrase inhibitor)
			**New evidence in favour of two-drug regimens that include an integrase inhibitor
	*Preference for [[single-tablet regimens for HIV]], which improve adherence		*Preference for [[single-tablet regimens for HIV]], which improve adherence
	*Recommended first-line regimens include:		*Recommended first-line regimens include:
Line 33:		Line 34:
	*[[Dolutegravir]]/[[abacavir]]/[[lamivudine]] (Triumeq), only for individuals who are HLA-B5701 negative and without chronic hepatitis B virus (HBV) coinfection		*[[Dolutegravir]]/[[abacavir]]/[[lamivudine]] (Triumeq), only for individuals who are HLA-B5701 negative and without chronic hepatitis B virus (HBV) coinfection
	**[[Dolutegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])		**[[Dolutegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])
	**[[Dolutegravir]]/[[lamivudine]] (Dovato), except for individuals with HIV RNA >500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available.		**[[Dolutegravir]]/[[lamivudine]] (Dovato), except for individuals with HIV RNA >500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available
	**[[Raltegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])

	==Special Populations==		==Special Populations==
Line 43:		Line 43:
	*NRTI backbone: [[abacavir]]/[[lamivudine]], [[tenofovir]]/[[emtricitabine]], or [[tenofovir]]/[[lamivudine]]		*NRTI backbone: [[abacavir]]/[[lamivudine]], [[tenofovir]]/[[emtricitabine]], or [[tenofovir]]/[[lamivudine]]
	*3rd agent		*3rd agent
			**[[Dolutegravir]] is preferred given preponderance of data
		⚫	**[[Raltegravir]]
	**Protease inhibitor: ATV/r or DRV/r		**Protease inhibitor: ATV/r or DRV/r
⚫	**Raltegravir
	*Avoid dolutegravir, may cause neural tube defects when on it at the time of conception (but not if started during pregnancy)

	===Hepatitis B Coinfection===		===Hepatitis B Coinfection===

	*~~Absolutely~~ ~~prefer~~ ~~regimen containing~~ [[tenofovir]]		*Regimen should contain [[tenofovir]] plus another HBV-active agent
	*Ideally, use [[tenofovir]], [[lamivudine]] or [[emtricitabine]], and a third agent		*Ideally, use [[tenofovir]], [[lamivudine]] or [[emtricitabine]], and a third agent
	**[[Tenofovir]]/[[lamivudine]] + other		**[[Tenofovir]]/[[lamivudine]] + other

Aidan: /* Special Populations */ added CKD

2023-01-16T16:46:10Z

Special Populations: added CKD

← Older revision		Revision as of 16:46, 16 January 2023
Line 82:		Line 82:
	* Good pick is [[Truvada]] + [[raltegravir]]		* Good pick is [[Truvada]] + [[raltegravir]]
	* See also [https://www.hivclinic.ca/main/drugs_extra_files/Crushing%20and%20Liquid%20ARV%20Formulations.pdf HIVClinic.ca list of crushable and liquid formulations]		* See also [https://www.hivclinic.ca/main/drugs_extra_files/Crushing%20and%20Liquid%20ARV%20Formulations.pdf HIVClinic.ca list of crushable and liquid formulations]

			=== Chronic Kidney Disease ===

			* In general, try to avoid starting [[tenofovir disoproxil fumarate]] with eGFR <60 mL/min and [[TAF]] if <30 mL/Min; avoid [[ATV]]
			* Can use TAF on hemodialysis

	==Switching Regimens==		==Switching Regimens==

Aidan at 16:38, 16 January 2023

2023-01-16T16:38:10Z

← Older revision		Revision as of 16:38, 16 January 2023
Line 1:		Line 1:
			* See also [[HIV medications]]

	==When to Start==		==When to Start==

Aidan: /* Special Populations */

2021-12-14T14:27:11Z

Special Populations

← Older revision		Revision as of 14:27, 14 December 2021
Line 74:		Line 74:

	*Delay treatment for risk of [[Immune reconstitution inflammatory syndrome\|IRIS]]		*Delay treatment for risk of [[Immune reconstitution inflammatory syndrome\|IRIS]]

			=== Patients with Feeding Tubes ===

			* Needs crushable or dissolvable medications
			* Good pick is [[Truvada]] + [[raltegravir]]
			* See also [https://www.hivclinic.ca/main/drugs_extra_files/Crushing%20and%20Liquid%20ARV%20Formulations.pdf HIVClinic.ca list of crushable and liquid formulations]

	==Switching Regimens==		==Switching Regimens==

Aidan: /* Hepatitis B Coinfection */

2020-10-22T14:25:36Z

Hepatitis B Coinfection

← Older revision		Revision as of 14:25, 22 October 2020
Line 51:		Line 51:
	**[[Tenofovir]]/[[lamivudine]] + other		**[[Tenofovir]]/[[lamivudine]] + other
	**[[Tenofovir]]/[[emtricitabine]] + other		**[[Tenofovir]]/[[emtricitabine]] + other
			*If cannot use [[tenofovir]] (severe renal or hepatic dysfunction), then add [[entecavir]] to the HIV regimen

	===Hepatitis C Coinfection===		===Hepatitis C Coinfection===
Line 72:		Line 73:
	===Cryptococcal Meningitis===		===Cryptococcal Meningitis===

	*Delay treatment for risk of IRIS		*Delay treatment for risk of [[Immune reconstitution inflammatory syndrome\|IRIS]]

	==Switching Regimens==		==Switching Regimens==

Aidan at 21:51, 13 September 2020

2020-09-13T21:51:02Z

← Older revision		Revision as of 21:51, 13 September 2020
Line 45:		Line 45:
	*Avoid dolutegravir, may cause neural tube defects when on it at the time of conception (but not if started during pregnancy)		*Avoid dolutegravir, may cause neural tube defects when on it at the time of conception (but not if started during pregnancy)

	===Hepatitis B ~~coinfection~~===		===Hepatitis B Coinfection===

	*Absolutely prefer regimen containing [[tenofovir]]		*Absolutely prefer regimen containing [[tenofovir]]
Line 52:		Line 52:
	**[[Tenofovir]]/[[emtricitabine]] + other		**[[Tenofovir]]/[[emtricitabine]] + other

	===Hepatitis C ~~coinfection~~===		===Hepatitis C Coinfection===

	*See also [[HIV-Hepatitis C coinfection]] for details		*See also [[HIV-Hepatitis C coinfection]] for details
Line 70:		Line 70:
	*If using PI, [[rifabutin]] can be used instead of [[rifampin]]		*If using PI, [[rifabutin]] can be used instead of [[rifampin]]

	===Cryptococcal ~~meningitis~~===		===Cryptococcal Meningitis===

	*Delay treatment for risk of IRIS		*Delay treatment for risk of IRIS

Aidan at 21:48, 13 September 2020

2020-09-13T21:48:50Z

← Older revision		Revision as of 21:48, 13 September 2020
Line 2:		Line 2:

	*Start in all viremic patients regardless of CD4 count and in all patients with declining CD4 regardless of viremia		*Start in all viremic patients regardless of CD4 count and in all patients with declining CD4 regardless of viremia
			**Decreased AIDS-related morbidity, non-AIDS-related morbidity, and mortality[[CiteRef::2015in]][[CiteRef::2015a]]
	*Start as soon as possible in patients with acute HIV, as it decreases the HIV reservoir		*Start as soon as possible in patients with acute HIV, as it decreases the HIV reservoir
	**Less loss-to-follow-up, time-to-virologic-suppression decreased		**Less loss-to-follow-up, time-to-virologic-suppression decreased
Line 7:		Line 8:
	*Do not stop treatment		*Do not stop treatment
	*Unclear whether treatment needed for elite controllers		*Unclear whether treatment needed for elite controllers
	*Only delay treatment in ~~cryptococcal meningitis, which should be delayed by 2 to 10 weeks~~		*Only delay treatment in:
			**[[Cryptococcal meningitis]], which should be delayed by 2 to 10 weeks
			**[[Tuberculosis]]
			***CD4 <50 cells/mL: start within 2 weeks
			***CD4 ≥50 cells/mL: start within 8 weeks
			***[[Tuberculous meningitis]]: start within 2 to 8 weeks

	==Starting Treatment==		==Starting Treatment==

Aidan: /* When to Start */

2020-09-13T21:39:52Z

When to Start

← Older revision		Revision as of 21:39, 13 September 2020
Line 7:		Line 7:
	*Do not stop treatment		*Do not stop treatment
	*Unclear whether treatment needed for elite controllers		*Unclear whether treatment needed for elite controllers
	*Only delay treatment in cryptococcal meningitis		*Only delay treatment in cryptococcal meningitis, which should be delayed by 2 to 10 weeks

	==Starting Treatment==		==Starting Treatment==

Aidan at 01:06, 28 July 2020

2020-07-28T01:06:41Z

Show changes

Aidan: /* Antiretroviral therapy (ART) regimens */

2020-02-12T14:38:15Z

Antiretroviral therapy (ART) regimens

← Older revision		Revision as of 14:38, 12 February 2020
Line 25:		Line 25:
	** [[Dolutegravir]]/[[abacavir]]/[[lamivudine]] (Triumeq), only for individuals who are HLA-B*5701 negative and without chronic hepatitis B virus (HBV) coinfection		** [[Dolutegravir]]/[[abacavir]]/[[lamivudine]] (Triumeq), only for individuals who are HLA-B*5701 negative and without chronic hepatitis B virus (HBV) coinfection
	** [[Dolutegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])		** [[Dolutegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])
	** [[Dolutegravir]]/[[lamivudine]], except for individuals with HIV RNA >500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available.		** [[Dolutegravir]]/[[lamivudine]] (Dovato), except for individuals with HIV RNA >500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available.
	** [[Raltegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])		** [[Raltegravir]] plus ([[emtricitabine]] or [[lamivudine]]) plus ([[tenofovir alafenamide]] or [[tenofovir disoproxil fumarate]])