Viremic – Cases in HIV

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 strateg...

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 ...

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, Ko...

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, Cof...

Eileenwelcomes 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. ...

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...

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 ...

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...

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, Ha...

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...

Chris presents the case of a42-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.

Reference...

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 w...

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 i...

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.

Refere...

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, an...

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...

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? ...

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: