I agree with Dr. Pincus and some others here that this is an exceptional time and we need to change the way we approach everything we are doing. Obtaining labs should only be done for urgent/emergent cases (i.e., preventing hospital admission) to limit exposures as much as possible; I operate under the assumption that ALL of my patients are COVID-19 positive as this is the safest way to proceed at this point in time.
PrEP refills are neither urgent nor emergent. The risk of acquiring HIV while an individual is adherent to PrEP as we know is INCREDIBLY low (referring primarily to rectal exposures) and driven by transmitted resistance and/or repeated (high) viral exposures which are not common, and we are putting our patients at risk of COVID-19 acquisition when asking them to leave their home and obtain labs. That being said, if there is concern for poor adherence AND potential exposure to HIV, or acute HIV then it is resonable to have a patient stop PrEP and obtain labs (of course trying to do this with least amount of human interaction/exposures as possible).
I have been able to obtain labs via home health for some patients (not always covered, requires skilled need as well), again only being for urgent/emergent cases that would prevent hospital admissions, I have not yet done this for any of my patients on PrEP or with HIV.
Hope you all stay safe and healthy!!
Best,
Josh
Josh Khalili MD, AAHIVS
UCLA Extensivist Physician
Ambulatory HIV Specialist
Clinical Instructor of Medicine
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Joshua Khalili
Los Angeles CA
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Original Message:
Sent: 04-02-2020 11:11
From: Gina Simoncini
Subject: PrEP starts vs. maintenance in times of COVID quarantine
Hi AAHIVM friends!
Just wondering what you're doing for patients on PrEP or who want to start PrEP in these times without recent HIV lab monitoring.
Personally, I'm screening for acute HIV, if negative, continuing PrEP and scheduling a one-month appt (hopefully).
Initiating PrEP (without recent HIV testing) though causes me some pause...what has been your experience and/or strategy?
Thanks,
Gina Simoncini
Temple, Philly
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Gina Simoncini MD MPH FACP AAHIVM
Lewis Katz School of Medicine at Temple University
Philadelphia PA
@gina_simoncini
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