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Topics in Antiviral Medicine
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December 2020/January 2021
Volume 28, Issue 3
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Perspective
Vaccination and Immunoprotection in People with HIV
Steven C. Johnson, MD
Physical Function and Frailty in HIV
Kristine M. Erlandson, MD, MS
Management and Prevention of HIV Among Transgender Adults
Asa E. Radix, MD, PhD, MPH
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Home
Activities
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Earn CME From On-Demand Webcasts
The virtual 2021 Ryan White HIV/AIDS Program CLINICAL CONFERENCE
Coming Soon: 2022 Ryan White HIV/AIDS Program CLINICAL CONFERENCE
Conference on Retroviruses and Opportunistic Infections
About IAS–USA Courses
Webinars
Upcoming Webinars
2021 On-Demand Webinars
Earn CME From On-Demand Webinars
About Webinars
COVID-19 Dialogue Series
Upcoming Dialogues
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Topics in Antiviral Medicine
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HIV Drug Resistance Mutations
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Slides
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Practice Question of the Week
December 6, 2021: Switching Antiretroviral Therapy After Nucleotide Reverse Transcriptase Inhibitor and Nonnucleoside Reverse Transcriptase Inhibitor Mutations
M.J. is a 30-year-old Hispanic cisgender woman who was diagnosed with HIV when she developed oropharyngeal candidiasis. Her initial CD4+ count was 110 cells/μL. Her treatment, which is antiretroviral therapy (ART) containing efavirenz (EFV) plus abacavir (ABC)/lamivudine (3TC), has poor adherence. Her current viral load is 140,000 copies/mL, and her CD4+ count is 75 cells/μL. HIV genotype shows nucleotide reverse transcriptase inhibitor (nRTI) mutations (M184V, L74V) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) mutation (K103N). According to the results of the NADIA (Nucleosides and Darunavir/Dolutegravir in Africa) study, which of the following is correct?
A. Virologic suppression was not achieved in treatment-experienced patients with low CD4+ count (<200 cells/μL) when they were switched to dolutegravir (DTG) vs darunavir/ritonavir (DRV/r) each with tenofovir/emtricitabine (TDF/FTC) or zidovudine (ZDV)/3TC
B. After NNRTI therapy failure, DTG or DRV boosted with ritonavir (RTV) plus TDF/FTC would be efficacious, regardless of the amount of nRTI resistance
C. Virologic suppression was not achieved in treatment-experienced patients with high baseline viremia (>100,000 copies/mL) when switched to DTG vs DRV/r each with TDF/FTC or ZDV/3TC
D. There should be a minimum of 1 predicted active nRTI for her to achieve virologic suppression on DTG plus TDF/FTC
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