Case Study
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Question 1 of 8
1. Question
Clinical Decision Point A
Using current terminology, how would you classify the patient’s heroin use?
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Question 2 of 8
2. Question
The patient reports that she is troubled by her drug use and is noticing the toll it is taking on her life. She is interested in seeking treatment before it “ruins her life.” She reports that she recently used drugs all day and all night and stopped taking her antiretroviral regimen. She is not interested in inpatient treatment, as she cares for her g 3 days per week. She desires to limit the number of visits to a practitioner or clinic and prefers a treatment plan that includes medication.
Clinical Decision Point B
What is the best treatment plan for this patient?
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Question 3 of 8
3. Question
The patient decides she would like to initiate treatment with buprenorphine in the HIV clinic. She has restarted her antiretroviral regimen without incident. She recalls that when she was taking methadone she was required to attend daily group therapy sessions.
Clinical Decision Point C
She asks you what she should expect during treatment with buprenorphine. What do you tell her?
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Question 4 of 8
4. Question
Clinical Decision Point D
Which statement about the consequences of drug interaction(s) that should be considered when prescribing antiretroviral medications with buprenorphine is correct?
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Question 5 of 8
5. Question
Clinical Decision Point E
The patient visits the clinic to initiate buprenorphine treatment. What baseline laboratory testing should be performed?
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Question 6 of 8
6. Question
Clinical Decision Point F
What do you recommend for this patient?
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Question 7 of 8
7. Question
The patient is successfully inducted onto buprenorphine treatment and achieves clinical stability (abstinence from illicit opioid use and improved functioning) on 16 mg sublingually daily. After 3 months of treatment, she requests a work-up and treatment for her HCV infection. She does not want her kids to experience losing another parent to end-stage liver disease. She has never received treatment for her HCV infection. Her laboratory results reveal: ALT level of 36 IU/L, AST level of 49 IU/L, white blood cell count of 6.0 cells/µL, hemoglobin and hematocrit (H and H) values of 14 g/dL and 46%, respectively, and platelet count of 215 × 103/µL. Her quantitative HCV RNA level is 700,000 IU/mL and her HCV genotype is 1a. Noninvasive testing of liver parenchyma reveals that patient has minimal fibrosis.
Clinical Decision Point G
Which regimen would you suggest to treat this patient’s HCV infection?
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Question 8 of 8
8. Question
The patient begins treatment with ledipasvir/sofosbuvir for 12 weeks.
Clinical Decision Point H
Which medication interactions should the practitioner be mindful of for this patient?
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