Do you need a baseline hiv genotype in this patient

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Reference no: EM133639073

Assignment:

Mr. Thomas is a 27-year-old male who was recently infected with HIV by his long-term partner when a condombroke during sex. He presents today to the clinic with his partner. His partner's viral load was "high" as his HIV medication was recently switched, as his partner notes, "due to resistance."Mr. Thomas was not aware that he could seek post-exposure prophylaxis (PEP) and is now presenting as a newpatient for evaluation in your office after two weeks from exposure. He denies other sexual partners and is otherwise healthy. As part of your preparation for Mr. Thomas in preparation for referral to see an HIV provider, you obtainblood work including an HIV genotype.

a. Is it possible that Mr. Thomas was infected with resistant HIV? If so, support this with data.

b. Mr. Thomas has never had ART in the past. Do you need a baseline HIV genotype in this patient If so, why?

c. Please detail what additional blood work you will obtain during this initial visit in preparation for treatment give the rationale for each

d. What information from the partner's HIV history would be important to review for preparation of Mr. Thomas' care?

e. During your discussion, Mr. Thomas states, "Well, at least we don't have to worry about condomsanymore". Based on your knowledge of HIV transmission and HIV resistance please describe what education you would provide this couple regarding this statement?

2. Mr. Thomas' partner's genotype includes the following three mutations:

1. K65R; 2) K103N; 3) L63P

a. Based on these mutations, what medications are no longer effective in the management of his partner's HIV disease? (HINT: Use the Stanford HIV database)

b. Which of the following regimens would still be considered active in this patient? Circle all that apply:

efavirenz (Sustiva) + lamivudine (3TC) + tenofovir (Viread) - ATRIPLA
darunavir (Prezista) + ritonavir (Norvir) + dolutegravir (Tivicay) + etravirine (Intelence)
dolutegravir (Tivicay) + abacavir (Ziagen) + lamivudine (3TC)
etravirine (Intelence) + zidovudine (AZT) + lamivudine (3TC)
cabotegravir + rilpivirine (Apretude) long-acting injectable

c. You explain to Mr. Thomas what his partner's resistance pattern may mean to him and his new infection. He is anxious to start therapy now. Do you feel comfortable doing so without his genotype results? Explain your answer.

d. Given the regimen options available, how do you explain to Mr. Thomas his results in the context of the following statement, "I have heard from TV about a 1 pill once per day HIV therapy. I would prefer to take that regimen, because I hate taking pills"? Be clear about why these regimens are necessary and what this means for future therapy.

e. Mr. Thomas' genotype results come back 10 days later. He is noted to have wild type virus with no resistance noted. Please design an initial regimen for him using the principles Explain why you would choose the specific regimen you have selected.

Reference no: EM133639073

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