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Schedule Update07 Jul 202600:00:42

Hello Viremic listeners. We are taking a break for the month of July. Please check out our past episodes and catch up on any cases you may have missed.

We love hearing from our listeners, so please send us comments or potential case topics to viremicpodcast@jh.edu. Don’t forget to give us a like and follow us wherever you access podcasts. We’ll be back on Tuesday, August 4 with a new case to discuss.

Thank you.

Case 25. A Few of Our Favorite Vaccines23 Jun 202600:38:42

A new-to-you patient—51-yr-old man with HIV since the early 2000s—has spotty vaccine records. How to educate, make recommendations, and avoid too many vaccinations at once? Listen as Chris and Eileen from Johns Hopkins make the case argue for their favorite vaccines among the many recommended for adults with HIV and describe their approaches to patient education, prioritizing based on specific patient needs, and strategizing vaccination schedules.

Reference: 

  • Marks KM, Kang M, Umbleja T, et al. HepB-CpG vs HepB-Alum Vaccine in People With HIV and Prior Vaccine Nonresponse: The BEe-HIVe Randomized Clinical Trial. JAMA. 2025 Jan 28;333(4):295-306. PMID: 39616603.

Related Guidelines and Resources from the NYSDOH AI Clinical Guidelines Program:

Case 16. Mpox After the Outbreak17 Feb 202600:31:59

A 33-year-old man with HIV presents with a flu-like syndrome and a disseminated vesicular rash after sexual contact with a new partner. Differential diagnosis includes mpox, syphilis, other STIs, HSV and disseminated VZV. Listen as Eileen and her guest, Dr. Shauna Gunaratne work through the mpox diagnosis, and discuss the 2022 mpox outbreak, along with evidence-based recommendations for testing, treatment, and prevention.

References Cited:

  • Akter F, Hasan TB, Alam F, et al. Effect of prior immunisation with smallpox vaccine for protection against human Mpox: A systematic review. Rev Med Virol. 2023 Jul;33(4):e2444. Epub 2023 Mar 30. PMID: 36999223.
  • CDC. Monkeypox. Tecovirimat (TPOXX) for Treatment of Monkeypox. Available at https://www.cdc.gov/monkeypox/hcp/clinical-care/tecovirimat.html
  • Dalton AF, Diallo AO, Chard AN, et al. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023. MMWR Morb Mortal Wkly Rep. 2023 May 19;72(20):553-558. PMID: 37200229.
  • Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023 Mar 18;401(10380):939-949. Epub 2023 Feb 21. Erratum in: Lancet. 2023 Apr 8;401(10383):1158. doi: 10.1016/S0140-6736(23)00584-6. PMID: 36828001.
  • PALM007 Writing Group; Ali R, Alonga J, Biampata JL, et al. Tecovirimat for Clade I MPXV Infection in the Democratic Republic of Congo. N Engl J Med. 2025 Apr 17;392(15):1484-1496. PMID: 40239067.
  • Titanji BK, Eick-Cost A, Partan ES, et al. Effectiveness of Smallpox Vaccination to Prevent Mpox in Military Personnel. N Engl J Med. 2023 Sep 21;389(12):1147-1148. PMID: 37733313.

Related Guidelines and Guidance:

Resources:


Case 15. A Pain in the Butt: Anal Cancer Screening and Prevention03 Feb 202600:36:19

Chris presents the case of a 42-yr-old gay man at high risk of anal cancer to guest Dr. Bruce Hirsch, and they work through the best course for screening and prevention of a disease with high rates of morbidity and mortality that disproportionately affects people with HIV. Listen as Chris and Bruce talk about who to vaccinate and when, who and when to screen, and what screening entails, while acknowledging the difficulties.

References Cited:

  • Palefsky JM, Lee JY, Jay N, et al. Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer. N Engl J Med. 2022 Jun 16;386(24):2273-2282. PMID: 35704479.
  • Barnell GM, Merchant M, Lam JO, Silverberg MJ. Early Outcomes of a High-Resolution Anoscopy-Based Anal Cancer Screening Program Among People With HIV Enrolled in an Integrated Health Care System. J Acquir Immune Defic Syndr. 2019 Jul 1;81(3):292-299. PMID: 30964759.
  • Deshmukh AA, Lin YY, Damgacioglu H, et al. Recent and projected incidence trends and risk of anal cancer among people with HIV in North America. J Natl Cancer Inst. 2024 Sep 1;116(9):1450-1458. PMID: 38713084.


Related NYSDOH AI Guidelines and Guidance:


Case 14. “AIDS Is Not My Worst Problem”: Caring for Women with HIV20 Jan 202600:38:51

The case of a 28-year-old diagnosed with HIV when she became pregnant prompts Eileen and guest Dr. Jean Anderson to explore many of the challenges of HIV care in pregnancy: managing a new diagnosis, disclosure, stigma, partner involvement, antiretroviral therapy, perinatal transmission prevention, breastfeeding, harm reduction, and postpartum care. Their wide-ranging discussion opens with Jean’s perspective on care of women with HIV, which is informed by 40 years of ground-breaking work in the field.

References Cited:

  • Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994 Nov 3;331(18):1173-80. PMID: 7935654.
  • Sibiude J, Le Chenadec J, Mandelbrot L, et al. Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery. Clin Infect Dis. 2023 Feb 8;76(3):e590-e598. PMID: 36037040

Related Guidelines and Guidance:

Resources:


Case 13. Got PrEP? HIV Adjacent Care06 Jan 202600:31:41

Like many in HIV, Chris is also a PrEP provider. In this episode, he presents a case to Dr. Rona Vail to work through the best approach to PrEP for a young, gay Black man. They work through the issues of oral vs injectable PrEP, dosing schedules for oral PrEP, the studies that support each approach, and this patient’s eligibility for each to determine the best recommendations. They end by discussing barriers to PrEP and the importance of choices now that there are so many PrEP options.

References Cited: 

  • Bekker LG, Das M, Abdool Karim Q, et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024 Oct 3;391(13):1179-1192. PMID: 39046157.
  • Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30;363(27):2587-99. PMID: 21091279. 
  • Kiweewa FM, Ahmed K, Nair G., et al. Adherence to F/TAF in cisgender women prevents HIV with low risk of resistance or diagnostic delay. Abstract 194. CROI; 2025 Mar 9-12; San Francisco, CA. https://www.croiconference.org/abstract/1937-2025/. 
  • Koss CA, Ayieko J, Kabami J, et al. Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda. AIDS. 2024 Mar 1;38(3):339-349. PMID: 37861683. 
  • Marrazzo J, Tao L, Becker M, et al. HIV Preexposure Prophylaxis With Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women. JAMA. 2024 Mar 19;331(11):930-937. PMID: 38427359. 
  • Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020 Jul 25;396(10246):239-254. PMID: 32711800.
  • Molina JM, Ghosn J, Assoumou L, et al. Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study. Lancet HIV. 2022 Aug;9(8):e554-e562. PMID: 35772417.
  • Molina JM, Capitant C, Spire B, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med. 2015 Dec 3;373(23):2237-46. PMID: 26624850.

Related NYSDOH AIDS Institute Clinical Guidelines and Guidance:


Holiday Greetings23 Dec 202500:00:41

Hello Viremic listeners. We are taking a break this week and encourage you to take a look back at our past episodes and catch up on any cases you may have missed. We'll be back on January 6, 2026 with a new case to discuss!

From all of us at Viremic we hope you have a peaceful, healthy and joyous holiday season! 

Case 12. Injectable ART Failure: Minor Risk of a Major Event09 Dec 202500:29:13

After 3 years on injectable CAB/RPV, a patient develops viremia, with a viral load of ~1,300 copies/mL. Failure of injectable CAB/RPV occurs in 1% to 2%, despite adherence. What factors have been associated with CAB/RPV failure? Can regimen failure be predicted or prevented? Listen as Chris and Eileen discuss the data, their advice to patients considering a switch to injectable CAB/RPV, and their response when failure occurs.

References Cited:

  • Orkin C., Arasteh K., Gorgolas Hernandez-Mora M., et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. N Engl J Med 2020;382(12):1124-35. PMID: 32130806.
  • Overton E. T., Richmond G., Rizzardini G., et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with human immunodeficiency virus 1 type 1 infection: 152-week results from ATLAS-2M, a randomized, open-label, phase 3b, noninferiority study. Clin Infect Dis 2023;76(9):1646-54. PMID: 36660819.
  • Swindells S., Andrade-Villanueva J. F., Richmond G. J., et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med 2020;382(12):1112-23. PMID: 32130809.
  • van Welzen BJ, Van Lelyveld SFL, Ter Beest G, et al. Virological Failure After Switch to Long-Acting Cabotegravir and Rilpivirine Injectable Therapy: An In-depth Analysis. Clin Infect Dis. 2024 Jul 19;79(1):189-195. PMID: 38207125.

Related Guideline:


Case 11. Unfolding Stories to Untangle Syphilis Testing25 Nov 202500:37:13

A 32-year-old man with well-controlled HIV, seen after a recent relationship split and sexual activity with new partners, is screened and diagnosed with syphilis. Eileen discusses this case with guest Dr. Matthew Hamill, who reviews his approach to STI screening and risk reduction, emphasizing an approach that normalizes screening. Matthew then reviews syphilis testing, diagnosis, and staging, including neurosyphilis assessment, and treatment.

Related Guidelines and Guidance

Centers for Disease Control and Prevention:

NYSDOH AI Clinical Guidelines Program: 


Clinical Resources


Case 10. A Growing Problem: ART-Associated Weight Gain11 Nov 202500:30:11

A 54-year-old woman with longstanding HIV and obesity is stable on ART, but concerned that it is causing weight gain. How best to address this growing concern? Listen as Chris and Eileen decipher the evidence related to weight gain and ART and weigh the best strategies for addressing this increasingly common and social media inflected concern for patients with HIV and their care providers?

References Cited:

  • Abelman RA, Ma Y, Mehta CC, et al. Switch to Integrase Strand Transfer Inhibitors During the Menopausal Transition Is Associated With Accelerated Body Composition Change in Women With HIV. Clin Infect Dis. 2025 Jun 4;80(5):1125-1132. PMID: 39495675.
  • Caniglia EC, Shapiro R, Diseko M, et al. Weight gain during pregnancy among women initiating dolutegravir in Botswana. EClinicalMedicine. 2020 Nov 5;29-30:100615. PMID: 33437946.
  • Elion J, Gruber J, Radtchenko M, et al. Predictors of weight gain among people with HIV (PWH) over 3-year period. Abstract Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 - 17 July, Kigali, Rwanda & Virtual. J Int AIDS Soc. 2025 Jul;28 Suppl 4(Suppl 4):e26518. PMID: 40657994. 
  • Glidden DV, Mulligan K, McMahan V, et al. Metabolic Effects of Preexposure Prophylaxis With Coformulated Tenofovir Disoproxil Fumarate and Emtricitabine. Clin Infect Dis. 2018 Jul 18;67(3):411-419. PMID: 29415175.
  • Griesel R, Maartens G, Chirehwa M, et al. CYP2B6 Genotype and Weight Gain Differences Between Dolutegravir and Efavirenz. Clin Infect Dis. 2021 Dec 6;73(11):e3902-e3909. Erratum in: Clin Infect Dis. 2022 Mar 1;74(4):755. PMID: 32960272.
  • Koethe J. ACTG A5391: A Randomized Multicenter 3-arm Controlled Trial for People with Obesity on Integrase Inhibitors and Tenofovir Alafenamide switching to Doravirine, with or without Tenofovir Disoproxil Fumarate (The DO-IT Trial). Abstract. Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 - 17 July, Kigali, Rwanda & Virtual. J Int AIDS Soc. 2025 Jul;28 Suppl 4(Suppl 4):e26518. PMID: 40657994.
  • Lake JE, Wu K, Bares SH, et al. Risk Factors for Weight Gain Following Switch to Integrase Inhibitor-Based Antiretroviral Therapy. Clin Infect Dis. 2020 Dec 3;71(9):e471-e477. PMID: 32099991.
  • Landovitz RJ, Zangeneh SZ, Chau G, et al. Cabotegravir Is Not Associated With Weight Gain in Human Immunodeficiency Virus-uninfected Individuals in HPTN 077. Clin Infect Dis. 2020 Jan 2;70(2):319-322. PMID: 31125395.
  • Norwood J, Turner M, Bofill C, et al. Brief Report: Weight Gain in Persons With HIV Switched From Efavirenz-Based to Integrase Strand Transfer Inhibitor-Based Regimens. J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):527-531. PMID: 28825943. 
  • Ogbuagu O, Ruane PJ, Podzamczer D, et al. Long-term safety and efficacy of emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV-1 pre-exposure prophylaxis: week 96 results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet HIV. 2021 Jul;8(7):e397-e407. Erratum in: Lancet HIV. 2021 Dec;8(12):e734. PMID: 34197772.
  • Sax PE, Erlandson KM, Lake JE, et al. Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials. Clin Infect Dis. 2020 Sep 12;71(6):1379-1389. PMID: 31606734.
  • Venter WDF, Moorhouse M, Sokhela S, et al. Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV. N Engl J Med. 2019 Aug 29;381(9):803-815. Epub 2019 Jul 24. PMID: 31339677. [ADVANCE Trial]
  • Short WR, Ramgopal M, Hagins DP, Lee J, Simonson J, Hsu T-H, Xu P, Anderson D. DEFINE Study A prospective, randomized trial to assess a protease inhibitor–based regimen switch strategy to manage integrase inhibitor–related weight gain 12th IAS Conference on HIV Science, 23 - 26 July,  Brisbane, Australia & Virtual Abstract 5962

Related Guideline:

  • Clinical Info HIV.gov: Weight Gain in People With Treated HIV. Cardiovascular and Metabolic Complications in People With HIV. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV, September 2025.


Case 9. A New TRIO to Reduce ART Complexity28 Oct 202500:26:12

A 62-year-old patient with HIV for ~40 yrs presents on the life-saving TRIO regimen after a beloved care provider retires. Will a switch improve his quality of life? Eileen and Chris suspect that a change to a once-a-day regimen with fewer pills will maintain his viral suppression and make life easier, but the TRIO regimen inspires dedication in many long-term patients. Would he be open to a switch? Would it confer other benefits? Listen as Eileen and Chris consider the necessity of switch and plot a treatment course.

References and Resources Cited:

Related NYSDOH AIDS Institute Clinical Guidelines: 


Case 8. Charting a Path Forward14 Oct 202500:29:41

Subspecialists request simplified ART for a 56-year-old woman with a long ART history, who is taking a DOAC, has evolving renal function, and some drug resistance. Which factors to prioritize? Eileen and Chris have some, but not a complete medical history. Listen as they work through the information they do have, consider 7 questions key in making an ART switch, and evaluate the available options.

References and Resources Cited:

Related NYSDOH AIDS Institute Clinical Guidelines: 


Case 24. A Violaceous Situation: Kaposi Sarcoma09 Jun 202600:31:17

A 42-yr-old man with AIDS presents feeling unwell, with white spots in his mouth, and scattered violaceous macules on his upper extremities; he has never taken ART. Listen as hosts Eileen Scully and Chris Hoffmann from Hopkins describe their initial work-up for a patient with a CD4 count of 10; discuss symptoms, diagnosis, and treatment of Kaposi sarcoma and other HHV8-related diseases; and remember the historical stigma of KS and the lingering effects of that stigma as they confirm the need to remain KS-aware even in 2026 in the U.S.

References Cited:

  • Bettuzzi T, Lebbe C, Grolleau C. Modern Approach to Manage Patients With Kaposi Sarcoma. J Med Virol. 2025 Mar;97(3):e70294. PMID: 40119751.
  • Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America. Human Herpesvirus-8 Disease. Updated April 23, 2025. Available online here. Accessed 5/21/2026.

Related Guidelines
NYSDOH AI Clinical Guidelines Program:

Clinical Info HIV.gov: 

Resource: 


Case 7. Newer Kids on the Block: Novel ARVs for Multidrug Resistance30 Sep 202500:31:43

How to formulate an effective ART regimen acceptable to 56-year-old man, with unsuppressed HIV, 20+ yr. ART history, extensive drug resistance, and adherence challenges? Listen as Eileen and Chris interpret resistance testing results, discuss barriers to treatment and adherence for this patient, and evaluate the possibility of using one of the novel agents—fostemsavir, ibalizumab, and lenacapavir. What would you do?

References and Resources Cited:

Related NYSDOH AIDS Institute Clinical Guidelines:


Case 6. Is More Really More? Optimizing Options for a Healthy Patient16 Sep 202500:34:54

Healthy 48-year-old man with HIV for 15 years, stable viral suppression, looking to optimize health—diet, exercise, immune-boosting supplements, safest HIV and HTN meds. Listen as Chris and Eileen discuss their approach to giving patients the good news about their health, health maintenance, supplement use, and whether to stay the course or switch ART regimens in patients who are doing well.

Resources:

Related NYSDOH AIDS Institute Clinical Guidelines: 


Case 5. The Heart of the Matter: Cardiovascular Disease Risk in HIV02 Sep 202500:33:12

New COVID-19 vaccine policy, proviral DNA testing, then the case of a woman with 10+ years viral suppression, CKD, and CVD, identified as a statin candidate after a significant cardiac event. With no family history of CVD, her risks included exposure to older ARVs and smoking 1 to 3 cigarettes/day. Listen as Drs. Scully and Hoffmann delve into non-infectious comorbidities associated with HIV, risk factors, and adjusted CVD risk calculation for women and African Americans.


References Cited

  • Beavers C, Pau AK, Glidden D, et al. Statin Therapy as Primary Prevention for Persons With HIV: A Synopsis of Recommendations From the U.S. Department of Health and Human Services Antiretroviral Treatment Guidelines Panel. Ann Intern Med. Published online May 27, 2025. PMID: 40418812
  • D:A:D Study Group, Sabin CA, Worm SW, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration [published correction appears in Lancet. 2008 Jul 26;372(9635):292]. Lancet. 2008;371(9622):1417-1426. PMID: 18387667
  • Elion RA, Althoff KN, Zhang J, et al. Recent Abacavir Use Increases Risk of Type 1 and Type 2 Myocardial Infarctions Among Adults With HIV. J Acquir Immune Defic Syndr. 2018;78(1):62-72. PMID: 29419568
  • Fichtenbaum CJ, et al “Abacavir is associated with elevated risk for cardiovascular events in the REPRIEVE trial” IAC 2024; Abstract OAB3406LB.
  • Grinspoon SK, Zanni MV, Triant VA, et al. Performance of the pooled cohort equations and D:A:D risk scores among individuals with HIV in a global cardiovascular disease prevention trial: a cohort study leveraging data from REPRIEVE. Lancet HIV. 2025;12(2):e118-e129. PMID: 39832519
  • SMART Study Group, El-Sadr WM, Lundgren J, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355(22):2283-2296. PMID: 171355583 
  • Prasad V, Makary MA. An Evidence-Based Approach to Covid-19 Vaccination. N Engl J Med. Published online May 20, 2025. PMID: 40392534
  • Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207. PMID: 18997196
  • Selinger S. In adults with HIV and low-to-moderate CV risk, pitavastatin reduced MACE over a median 5.1 y. Ann Intern Med. 2023;176(11):JC130. PMID: 37931263
  • Wensing AM, Charpentier C, Calvez V, et al. Utilizing HIV Proviral DNA to Assess for the Presence of HIV Drug Resistance. Clin Infect Dis. Published online April 3, 2025. doi:10.1093/cid/ciaf161. PMID: 40176204.

Related Guidelines from the NYSDOH AI Clinical Guidelines Program


Case 4. Under Pressure: Cryptococcus, ART Initiation, and the Threat of IRIS19 Aug 202500:40:55

After brief mention of an HIV vaccine, the hosts turn to the challenges of treating cryptococcal meningitis in a 46-year-old woman with profound immune suppression after being off ART for 6-12 months. Emphasizing the high potential for morbidity and mortality, Chris and Eileen focus on the complexities of cryptococcal meningitis medical management, including the role of immune constitution, timing of ART initiation, and the risk of IRIS. Listen as they work through the treatment requirements and clinical decisions involved in this complicated case.    

References Cited

  • Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014;370(26):2487-2498. PMID: 24963568
  • Chang CC, Dorasamy AA, Gosnell BI, et al. Clinical and mycological predictors of cryptococcosis-associated immune reconstitution inflammatory syndrome. AIDS. 2013;27(13):2089-2099. PMID: 23525034
  • Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2025;333(7):609-628. PMID: 39616604
  • Ingle SM, Miro JM, May MT, et al. Early Antiretroviral Therapy Not Associated With Higher Cryptococcal Meningitis Mortality in People With Human Immunodeficiency Virus in High-Income Countries: An International Collaborative Cohort Study. Clin Infect Dis. 2023;77(1):64-73. PMID: 36883578
  • Kwizera R, Kiiza TK, Akampurira A, Kimuda S, Mugabi T, Meya DB. Evolution of Laboratory Diagnostics for Cryptococcosis and Missing Links to Optimize Diagnosis and Outcomes in Resource-Constrained Settings. Open Forum Infect Dis. 2024;11(9):ofae487. Published 2024 Aug 27. PMID: 3928635
  • Makadzange AT, Ndhlovu CE, Takarinda K, Reid M, Kurangwa M, Gona P, Hakim JG. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in sub-saharan Africa. Clin Infect Dis. 2010 Jun 1;50(11):1532-8. PMID: 20415574.
  • Srichatrapimuk S, Sungkanuparph S. Integrated therapy for HIV and cryptococcosis. AIDS Res Ther. 2016;13(1):42. Published 2016 Nov 29. PMID: 27906037


Related Guidelines


Case 3. Preserving the Beans: New Renal Failure and New HIV05 Aug 202500:30:24

After presenting with fatigue, malaise, and muscle cramps, a 28-yr-old man with history of STIs is diagnosed with new renal failure (Cr >9 mg/dL) and HIV (VL ~3 mil. copies/mL). Drs. Scully and Hoffmann note the missed opportunities for HIV prevention, then review HIV-associated kidney disease and evaluate regimens safe for rapid ART initiation.

References Cited

  • Bahr NC, Yarlagadda SG. Fanconi Syndrome and Tenofovir Alafenamide: A Case Report. Ann Intern Med. 2019;170(11):814-815. PMID: 30690644 
  • Diana NE, Naicker S. The changing landscape of HIV-associated kidney disease. Nat Rev Nephrol. 2024;20(5):330-346. PMID: 38273026
  • Gallant JE, Parish MA, Keruly JC, Moore RD. Changes in renal function associated with tenofovir disoproxil fumarate treatment, compared with nucleoside reverse-transcriptase inhibitor treatment. Clin Infect Dis. 2005;40(8):1194-1198. PMID: 15791522 
  • Jiang SX, Duncan J, Ko HH. Acquired Fanconi Syndrome from Tenofovir Treatment in a Patient with Hepatitis B. Case Reports Hepatol. 2023;2023:6158407. Published 2023 Jun 17. PMID: 37362623
  • Karris MY. Short Communication: Resolution of Tenofovir Disoproxil Fumarate Induced Fanconi Syndrome with Switch to Tenofovir Alafenamide Fumarate in a HIV-1 and Hepatitis B Coinfected Patient. AIDS Res Hum Retroviruses. 2017;33(7):718-722. PMID: 28403627 


Related Guidelines from the NYSDOH AI Clinical Guidelines Program


Case 2. How Low Can You Go? A Case of Non‑Suppressible Viremia22 Jul 202500:32:02

Mid-50s-yr-old man with HIV since the early 1990s presented for evaluation of persistent low-level viremia, despite consistent engagement in care and ART. Genotypic testing found only a variety of minor mutations. The patient and his care provider were concerned about the health consequences, including the risk of inflammatory diseases in the future, and about implications for U=U. After a brief discussion of the good news on lenacapavir for HIV prevention and a reminder about mpox vaccination, Drs. Scully and Hoffmann delve into the patient’s history to uncover the source of his LLV and treatment options. 

References Cited

  • Broyles LN, Luo R, Boeras D, Vojnov L. The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review. Lancet. 2023;402(10400):464-471. PMID: 37490935.
  • Esber A, Polyak C, Kiweewa F, et al. Persistent Low-level Viremia Predicts Subsequent Virologic Failure: Is It Time to Change the Third 90? Clin Infect Dis. 2019;69(5):805-812. PMID: 30462188
  • Fleming J, Mathews WC, Rutstein RM, et al. Low-level viremia and virologic failure in persons with HIV infection treated with antiretroviral therapy. AIDS. 2019 Nov 1;33(13):2005-2012. PMID: 31306175
  • Hillus D, Le NH, Tober-Lau P, et al. Safety and effectiveness of MVA-BN vaccination against mpox in at-risk individuals in Germany (SEMVAc and TEMVAc): a combined prospective and retrospective cohort study. Lancet Infect Dis. Published online March 18, 2025. PMID: 40118087
  • Jatt LP, Mgodi NM, Buchbinder SP, Gray GE, Kublin JG. An HIV Vaccine in the Era of Twice-Yearly Lenacapavir for PrEP - Essential or Irrelevant? N Engl J Med. 2025;392(16):1561-1563. PMID: 40260855
  • White JA, Wu F, Yasin S, et al. Clonally expanded HIV-1 proviruses with 5'-leader defects can give rise to nonsuppressible residual viremia. J Clin Invest. 2023;133(6):e165245. Published 2023 Mar 15. PMID: 36602866.


Related Guidelines 


Case 1. Returning to Care – Is Biktarvy Always the Answer?08 Jul 202500:37:03

48-yr-old man with HIV for 12 years presented 1 year after his last visit with a history of methamphetamine use, inconsistent engagement in care, and a new diabetes diagnosis. He reported no recent ART and no meth use for about 8 months. On returning to care, his viral load was 250,000 copies/mL, the CD4 count was 230 cells/mm3, creatinine levels were elevated, and genotype testing found a K103N mutation. He was motivated to resume ART. Drs. Scully and Hoffmann evaluate the patient’s new ART options in light of his clinical viremia and comorbidities. 

References Cited

  • Andreatta K, D’Antoni ML, Chang S, et al. High efficacy of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in Black adults in the United States, including those with pre-existing HIV resistance and suboptimal adherence. J Med Virol. 2024;96(10):e29899. PMID: 39370775.
  • Denyer R, Zemskova J, Benator DA. HIV treatment with dolutegravir and doravirine: rationale for selection and clinical outcomes in a highly treatment experienced population. Int J STD AIDS. 2022;33(12):1073-1077. PMID: 36113042
  • Figueroa MI, Sued O, Cecchini D, et al. Dual therapy based on co-formulated darunavir/ritonavir plus lamivudine for initial therapy of HIV infection: The ANDES randomized controlled trial. Int J Antimicrob Agents. 2024;64(4):107301. PMID: 39151647
  • Kabra M, Barber TJ, Allavena C, et al. Virologic Response to Dolutegravir Plus Lamivudine in People With Suppressed Human Immunodeficiency Virus Type 1 and Historical M184V/I: A Systematic Literature Review and Meta-analysis. Open Forum Infect Dis. 2023;10(11):ofad526. Published 2023 Oct 27. PMID: 38033982
  • Paton NI, Musaazi J, Kityo C, et al. Dolutegravir or Darunavir in Combination with Zidovudine or Tenofovir to Treat HIV. N Engl J Med. 2021 Jul 22;385(4):330-341. PMID: 34289276.
  • Rolle CP, Berhe M, Singh T, et al. Dolutegravir/lamivudine as a first-line regimen in a test-and-treat setting for newly diagnosed people living with HIV. AIDS. 2021;35(12):1957-1965. PMID: 34115650
  • Rossotti R, D'Amico F, Bana NB, et al. Durability of doravirine with dolutegravir dual regimen compared with other dolutegravir-based dual combinations. HIV Med. 2024;25(6):675-683. PMID: 38263787
  • Sax PE, Rockstroh JK, Luetkemeyer AF, et al. Switching to Bictegravir, Emtricitabine, and Tenofovir Alafenamide in Virologically Suppressed Adults With Human Immunodeficiency Virus. Clin Infect Dis. 2021;73(2):e485-e493. PMID: 32668455


Related Guidance and Guidelines

NYSDOH AI Clinical Guidelines Program:

Clinical Info HIV.gov:


Case 23. Managing Directly (Inter)Acting Medications26 May 202600:36:12

Chris presents a 62-yr-old man with HIV for >30 yrs, with viral suppression and many drug resistance mutations, whose ART must be changed due to a drug-drug interaction, but also for simplification. As part of their discussion, Chris and Eileen review reasons to change ART regimens, and work through the evidence-based options for this patient based on his history and resistance mutations profile.

References Cited:

  • Ciaffi L, Koulla-Shiro S, Sawadogo AB, et al. Boosted protease inhibitor monotherapy versus boosted protease inhibitor plus lamivudine dual therapy as second-line maintenance treatment for HIV-1-infected patients in sub-Saharan Africa (ANRS12 286/MOBIDIP): a multicentre, randomised, parallel, open-label, superiority trial. Lancet HIV. 2017 Sep;4(9):e384-e392. Epub 2017 May 28. PMID: 28566227.
  • Hocqueloux L, Raffi F, Prazuck T, et al. Dolutegravir Monotherapy Versus Dolutegravir/Abacavir/Lamivudine for Virologically Suppressed People Living With Chronic Human Immunodeficiency Virus Infection: The Randomized Noninferiority MONotherapy of TiviCAY Trial. Clin Infect Dis. 2019 Oct 15;69(9):1498-1505. PMID: 30601976.
  • Paton NI, Musaazi J, Kityo C, et al. Efficacy and safety of dolutegravir or darunavir in combination with lamivudine plus either zidovudine or tenofovir for second-line treatment of HIV infection (NADIA): week 96 results from a prospective, multicentre, open-label, factorial, randomised, non-inferiority trial. Lancet HIV. 2022 Jun;9(6):e381-e393. Epub 2022 Apr 20. PMID: 35460601.
  • Raffi F, Babiker AG, Richert L, et al. Ritonavir-boosted darunavir combined with raltegravir or tenofovir-emtricitabine in antiretroviral-naive adults infected with HIV-1: 96 week results from the NEAT001/ANRS143 randomised non-inferiority trial. Lancet. 2014 Nov 29;384(9958):1942-51. Epub 2014 Aug 4. PMID: 25103176.
  • Severe P, Pierre S, Homeus F, et al. Bictegravir, emtricitabine, and tenofovir alafenamide versus ritonavir-boosted protease inhibitor-based antiretroviral therapy in people with HIV and viral suppression on second-line therapy in Haiti: an open-label, randomised, non-inferiority trial. Lancet HIV. 2025 Sep;12(9):e616-e626. Erratum in: Lancet HIV. 2026 Feb;13(2):e84. Erratum in: Lancet HIV. 2026 Feb 24:S2352-3018(26)00037-8. PMID: 40883049.

Related NYSDOH AI Guidelines:


Case 22. Sex with Drugs: Talking About Chemsex and Harm Reduction12 May 202600:31:07

With guest Dr. Jeremy Kidd, Chris reviews the case of a 27-yr-old man with HIV who reports using methamphetamine to enhance sex and has unsuppressed HIV. Is this chemsex? Is the unsuppressed viral load related? How should Chris discuss this with his patient, and what should he recommend? How should he approach the topic of harm reduction if the patient is not going to stop using chemsex?

References Cited:

  • Kidd JD, Smiley SL, Coffin PO, et al. Sexual orientation differences among men in a randomized clinical trial of extended-release naltrexone and bupropion for methamphetamine use disorder. Drug Alcohol Depend. 2023 Sep 1;250:110899. Epub 2023 Jul 17. PMID: 37478502.
  • Reback CJ. The Social Construction of a Gay Drug: Methamphetamine Use Among Gay and Bisexual Males in Los Angeles. 1997. Available online here. Accessed February 24, 2026.
  • Trivedi MH, Walker R, Ling W, et al. Bupropion and Naltrexone in Methamphetamine Use Disorder. N Engl J Med. 2021 Jan 14;384(2):140-153. PMID: 33497547.

Documentaries Mentioned:

Related NYSDOH AI Guidelines and Guidance:


Case 21. If You’ve Seen One, You Haven’t Seen Them All: Elite Controllers28 Apr 202600:26:20

Eileen welcomes Dr. Joel Blankson to review the case of 28-year-old man who is an elite controller. They discuss elite control characteristics, monitoring, and treatment, while also touching upon patient education and shared ART decision-making.

References Cited:

  • Hatano H, Yukl SA, Ferre AL, et al. Prospective antiretroviral treatment of asymptomatic, HIV-1 infected controllers. PLoS Pathog. 2013;9(10):e1003691. Epub 2013 Oct 10. PMID: 24130489.
  • Kwaa AK, Blankson JN. Immune Responses in Controllers of HIV Infection. Annu Rev Immunol. 2024 Jun;42(1):21-33. Epub 2024 Jun 14. PMID: 37827174.
  • Li JZ, Blankson JN. How elite controllers and posttreatment controllers inform our search for an HIV-1 cure. J Clin Invest. 2021 Jun 1;131(11):e149414. PMID: 34060478.
  • Li JZ, Segal FP, Bosch RJ, et al. Antiretroviral Therapy Reduces T-cell Activation and Immune Exhaustion Markers in Human Immunodeficiency Virus Controllers. Clin Infect Dis. 2020 Apr 10;70(8):1636-1642. doi: 10.1093/cid/ciz442. PMID: 31131858. 


Case 20. New Options for Treating Pharyngeal Gonorrhea14 Apr 202600:36:21

How to treat pharyngeal gonorrhea in a 32-year-old gay man with HIV who has a documented cephalosporin allergy? Chris presents this case to guest Dr. Marguerite (Margie) Urban, director of the NYSDOH CEI Sexual Health Center of Excellence and longtime member of the Adult HIV Guidelines Committee of Clinical Guidelines Program. They explore options for treatment and consider the role of gepotidacin and zoliflodacin, two new first-in-class drugs approved by the FDA in December 2025 for treatment of uncomplicated gonorrhea.

References Cited: 

  • Barbee LA, Soge OO, Khosropour CM, et al. The Duration of Pharyngeal Gonorrhea: A Natural History Study. Clin Infect Dis. 2021 Aug 16;73(4):575-582. PMID: 33513222.
  • Hutt DM, Judson FN. Epidemiology and treatment of oropharyngeal gonorrhea. Ann Intern Med. 1986 May;104(5):655-8. PMID: 2938529.
  • Kirkcaldy RD, Workowski KA. Gentamicin as an alternative treatment for gonorrhoea. Lancet. 2019 Jun 22;393(10190):2474-2475. Epub 2019 May 2. Erratum in: Lancet. 2019 Jun 29;393(10191):2590. PMID: 31056292.
  • Luckey A, Balasegaram M, Barbee LA, et al. Zoliflodacin versus ceftriaxone plus azithromycin for treatment of uncomplicated urogenital gonorrhoea: an international, randomised, controlled, open-label, phase 3, non-inferiority clinical trial. Lancet. 2026 Jan 10;407(10524):147-160. Epub 2025 Dec 11. PMID: 41391465.
  • Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections. N Engl J Med. 2023 Apr 6;388(14):1296-1306. PMID: 37018493. 
  • Ross JDC, Wilson J, Workowski KA, et al. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1): a phase 3 randomised, open-label, non-inferiority, multicentre study. Lancet. 2025 May 3;405(10489):1608-1620. Epub 2025 Apr 14. PMID: 40245902.
  • St Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020 Dec 18;69(50):1911-1916. PMID: 33332296.

Related Guidelines and Guidance:

Resources for New York State Clinicians: 

  • Conversations With CEI Podcast: Two New Treatments for Gonorrhea; one is available now! 
  • CEI Sexual Health Center of Excellence: The Sexual Health Center of Excellence provides sexual health clinical education, trainings, preceptorships, and additional clinical tools for community providers in NYS. The Center educates clinicians on the latest NYS guidelines on the management of patients with STIs. Phone number: 585-274-3045.
  • CEI Clinical Consultation Line: 866-637-2342. This is a toll-free service for NYS clinicians offering real-time clinical consultations with specialists on HIV, sexual health, hepatitis C, and drug user health.


Case 19. Similar, but Not the Same: HIV-2 Diagnosis and Treatment31 Mar 202600:27:24

Eileen presents the case of a 32-yr-old woman newly diagnosed with HIV-2 and invites guest Dr. Sanjiv Shah to discuss HIV-2 epidemiology, diagnosis, treatment, and monitoring. Listen as they explore the difficulties in diagnosing HIV-2, the complexity of treatment, including in pregnant women, and resources available to clinicians.

Reference Cited: 

  • Peruski AH, Wesolowski LG, Delaney KP, et al. Trends in HIV-2 diagnoses and use of the HIV-1/HIV-2 differentiation test - United States, 2010-2017. MMWR Morb Mortal Wkly Rep 2020;69(3):63-66. PMID: 31971928. 

Related NYSDOH AI Guidelines and Guidance:

Resources for New York State Clinicians: 

Resources for Clinicians Outside of New York State:


Case 18. What’s New from CROI 2026 with Dr. Paul Sax17 Mar 202600:43:23

Dr. Paul Sax, author of an annual “Really Rapid Review of the Conference on Retroviruses and Opportunistic Infections (CROI),” joins host Eileen Scully to review CROI 2026 abstracts of particular interest to clinicians taking care of patients with HIV.

CROI 2026 abstracts:
Abstracts are cited within the transcript text and those cited are listed below in numerical order, with the abstract number, authors, and title for each. If you attended CROI 2026, you have access to the abstracts online now through the CROI website; if you were not an attendee, check the CROI website late April/early May for access to the abstracts through the CROI searchable abstract database.

  • Abstract 126. Kapoor, Y. MK-8527 Phase III Dose Selection for Monthly Oral HIV-1 Preexposure Prophylaxis. 
  • Abstract 128. Ndlovu, N et al, Twice-Yearly Subcutaneous Lenacapavir for PrEP: Updated HIV-1 Incidence and Safety Data in PURPOSE 1.
  • Abstract 129. Cantos Lucio, VD. Lenacapavir for PrEP: HIV-1 Incidence and Safety From PURPOSE 2 at End of Randomized Blinded Phase.
  • Abstract 134. Edgar, J. Altered Viral Kinetics at ATI After Dual LS-bNAbs Plus ART: A Preliminary Analysis of RIO Arm B.
  • Abstract 140. Pires Dos Santos, AG., Immune-Mediated Viral Control With Budigalimab ± Trosunilimab: First Results of Phase II Global RCT.
  • Abstract 142. Haser, G et al., Hepatitis B Reactivation/Infection in People With HIV on Tenofovir-Sparing Antiretroviral Therapy.
  • Abstract 177. Rockstroh, JK et al., DOR/ISL (100/0.25 mg) vs BIC/FTC/TAF for Initial HIV-1 Therapy: Week 48 Results of a Phase III Study.
  • Abstract 181. Cantos Lucio, VD. Lenacapavir for PrEP: HIV-1 Incidence and Safety From PURPOSE 2 at End of Randomized Blinded Phase.
  • Abstract 529. Spinelli, M. et al, Virologic Outcomes After LA ART Initiation With and Without Viremia in 2 Large US Clinic Cohorts.
  • Abstract 530. Chan, NY, et al. Week-24 Outcomes of Long-Acting Injectable ART in People With HIV and Suboptimal Viral Suppression.
  • Abstract 593. Dieterich, DT et al., HIV-HBV Coinfection and Long-Acting Cabotegravir + Rilpivirine in the US: HBV and HIV Outcomes.
  • 513: Meissner, E. et al. Phase III Efficacy and Safety of Switch From B/F/TAF to Single-Tablet BIC/LEN in ARTISTRY-2.
  • 197: Seib, KL, Meningococcal B (4CMenB) Vaccination for the Prevention of Gonorrhea in Men Who Have Sex With Men.

References Cited:

  • Bekker LG, Das M, Abdool Karim Q, et al; PURPOSE 1 Study Team. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024 Oct 3;391(13):1179-1192. Epub 2024 Jul 24. PMID: 39046157.
  • Kelley CF, Acevedo-Quiñones M, Agwu AL, et al; PURPOSE 2 Study Team. Twice-Yearly Lenacapavir for HIV Prevention in Men and Gender-Diverse Persons. N Engl J Med. 2025 Apr 3;392(13):1261-1276. Epub 2024 Nov 27. PMID: 39602624.
  • Ombajo LA, Penner J, Nkuranga J, et al. Second-Line Switch to Dolutegravir for Treatment of HIV Infection. N Engl J Med. 2023 Jun 22;388(25):2349-2359. PMID: 37342923.
  • Paton NI, Musaazi J, Kityo C, et al; NADIA Trial Team. Dolutegravir or Darunavir in Combination with Zidovudine or Tenofovir to Treat HIV. N Engl J Med. 2021 Jul 22;385(4):330-341. PMID: 34289276.
  • Rockstroh JK, Kassim S, Paredes Ret al. Fixed-dose daily doravirine (100 mg) with islatravir (0·25 mg) versus bictegravir, emtricitabine, and tenofovir alafenamide for initial HIV-1 therapy: 48-week results of a phase 3, randomised, controlled, double-blind, non-inferiority trial. Lancet HIV. 2026 Feb 25:S2352-3018(26)00033-0. Epub ahead of print. PMID: 41763226.
  • Severe P, Pierre S, Homeus F, et al. Bictegravir, emtricitabine, and tenofovir alafenamide versus ritonavir-boosted protease inhibitor-based antiretroviral therapy in people with HIV and viral suppression on second-line therapy in Haiti: an open-label, randomised, non-inferiority trial. Lancet HIV. 2025 Sep;12(9):e616-e626. Erratum in: Lancet HIV. 2026 Feb;13(2):e84. Erratum in: Lancet HIV. 2026 Feb 24:S2352-3018(26)00037-8. PMID: 40883049.

Resources from Paul E. Sax, MD:

Related NYSDOH AIDS Institute Clinical Guidelines:


Case 17. Trans Lives Matter: Affirmative HIV Care03 Mar 202600:30:02

With guest Dr. Asa Radix, Chris reviews the case of a 32-year-old transgender woman who was diagnosed with HIV testing while receiving gender-affirming care. With a viral load of 82,000 and CD4 count of 365, she had no resistance mutations and no other known major medical conditions. Asa walks Chris through the approach to ART and gender-affirming HIV and primary care for this patient.

References Cited:

  • Braun HM, Candelario J, Hanlon CL, et al. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health. 2017 Oct;4(5):371-375. PMID: 28876170.
  • Blumenthal J, Acevedo-Quinones M, Phanuphak N, et al.  No Clinically Significant Drug–Drug Interactions with Co-administration of Feminizing or Masculinizing Hormone Therapy and Twice-yearly Lenacapavir PrEP in Gender-Diverse Persons, Open Forum Infectious Diseases, Volume 13, Issue Supplement_1, January 2026, ofaf695.525, https://doi.org/10.1093/ofid/ofaf695.525.
  • de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019 May 14;365:l1652. PMID: 31088823.
  • Huang YA, Radix A, Zhu W, et al. HIV Testing and Preexposure Prophylaxis Prescriptions Among U.S. Commercially Insured Transgender Men and Women, 2014 to 2021. Ann Intern Med. 2024 Jan;177(1):12-17. PMID: 38109739.
  • Reisner SL, Pletta DR, Mayer KH, et al. HIV seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study. Lancet HIV. 2025 Apr;12(4):e283-e292. PMID: 40158515.
  • Rodriguez-Hart C, Zhao G, Goldstein Z, Radix A, Torian L. An Exploratory Study to Describe Transgender People with HIV Who Accessed Medicaid and Their Viral Suppression Over Time in New York City, 2013-2017. Transgend Health. 2023 Oct 4;8(5):429-436. PMID: 37810942.


Related Guidelines and Resources:


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