Hello,
I wonder if you might be able to comment about one of my challenging patients:
JL is an AA M in his early 50's, Dx'd with HIV in or before 2012 (as far as current records are available). nonadherence to HIV meds.
CD4s most recently 75, but have ranged from 166 (in 2019) to 4 (in 2017); HIV Viral Loads most recently 329,000, and ranging from ~100-300k, with a nadir of 120 in 2019, and Not Detectable in 2017. VL bounce back up due to his non-adherence to meds. Most recent HBG 10.9. C-RP pending.
Besides OI suppressive therapy (azithro for MAC, bactrim for PCP/PJ, fluconazole for crypto, and valacyclovir for HSV/VZ. ARTs over the last 10 years have included: Norvir, Reyataz, Truvada, Stribild, Prezista, Isentress, and most recently, Prezcobix & Tivicay. He also takes amlodipine and atorvastatin for HTN and DLD, respectively, and misses doses as well (with less severe consequences!).
Just completed his HAV/HBV and pneumo 23 vax series, but has not yet had COVID vax, but uncertain of it's effectiveness due to his immune status. Nonetheless, will try to schedule him for injection.
We are concerned about potential risk for IRIS, if we can actually get him to remain on meds (such as Biktarvy) consistently. He has "no time" for hospitalization for induction of therapy, but since IRIS can occur anytime up to 6 months following reinstitution of ART, am not sure whether that represent a significant concern.
Any suggestions for an effective approach? Should we subject him to therapy given his risk for IRIS? He is also resistant to behavioral therapy.
Best wishes,
--Mark P Behar, PA-C
------------------------------
Mark Behar
Milwaukee Health Services
Milwaukee WI
------------------------------
Original Message:
Sent: 09-15-2020 11:10
From: Jeffrey Kirchner
Subject: IRIS Risk Factors in People with Advanced HIV - Clinical Research Update 9.15.2020
A study about the risk factors for Immune Reconstitution Inflammatory Syndrome in people with advanced HIV disease is the subject of this week's Clinical Research Update. While we are seeing fewer patients with advanced AIDS, this study suggests some strategies for identifying risk for IRIS for those that do present to our clinics.
------------------------------
Jeffrey Kirchner
Lancaster General Health Physicians (LGHP) - Comprehensive Care
Lancaster PA
------------------------------