Viremic – Cases in HIV
Hosted by Eileen Scully, MD, PhD, and Christopher Hoffmann, MD, MSC, MPH, both HIV specialists at Johns Hopkins, Viremic explores quandaries in adult HIV care. Each case discussion includes medical history and diagnoses, challenges in care and treatment, and key evidence and guidelines that informed clinical decision‑making. All clinical discussions presented on Viremic are for informational purposes only and are not offered as medical or clinical practice advice for patients or clinicians. Viremic is produced by the Clinical Guidelines Program, a collaborative effort of the New York State Department of Health AIDS Institute and the Johns Hopkins University Division of...
Case 1. Returning to Care – Is Biktarvy Always the Answer?
48-yr-old man with HIV for 12 years presented 1 year after his last visit with a history of methamphetamine use, inconsistent engagement in care, and a new diabetes diagnosis. He reported no recent ART and no meth use for about 8 months. On returning to care, his viral load was 250,000 copies/mL, the CD4 count was 230 cells/mm3, creatinine levels were elevated, and genotype testing found a K103N mutation. He was motivated to resume ART. Drs. Scully and Hoffmann open with news about HIV cure and measles vaccination, then delve into the case to evaluate the patient’s new ART options in...
Case 2. How Low Can You Go? A Case of Non‑Suppressible Viremia
Mid-50s-yr-old man with HIV since the early 1990s presented for evaluation of persistent low-level viremia, despite consistent engagement in care and ART. Genotypic testing found only a variety of minor mutations. The patient and his care provider were concerned about the health consequences, including the risk of inflammatory diseases in the future, and about implications for U=U. After a brief discussion of the good news on lenacapavir for HIV prevention and a reminder about mpox vaccination, Drs. Scully and Hoffmann delve into the patient’s history to uncover the source of his LLV and treatment options.
→...
Case 4. Under Pressure: Cryptococcus, ART Initiation and the Threat of IRIS
46-year-old woman, profoundly immunosuppressed after no ART for 6 to 12 months, was diagnosed with cryptococcal meningitis, with a high potential for morbidity and mortality. Medical management is complicated by the risk of IRIS after ART initiation. Drs. Scully and Hoffman begin the episode with comments on HIV vaccine research, then turn their attention to the complexities of treating cryptococcal meningitis, the role of immune reconstitution in that treatment, and mitigating risk in this patient’s care.
→ Read transcript
References Cited
Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptoc...Case 3. The Heart of the Matter: Cardiovascular Disease Risk in HIV
Late-40s-yr-old woman with long-term viral suppression, kidney disease, and CVD had not been identified as a candidate for statins before a significant cardiac event. With no family history of CVD, her risks included exposure to older ARVs and smoking 1 to 3 cigarettes/day. After brief comments about COVID-19 vaccination and proviral DNA sequencing, Drs. Scully and Hoffmann turn their attention to non-infectious comorbidities associated with HIV, risk factors, and adjusted CVD risk calculation for women and African Americans.
→ Read transcript
References Cited
