HIV in PCP

Screen anyone at risk with new partner/s. Whenever they are getting an STI screening ie syphilis or GCCT, screen for HIVas well. 

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Screening for HIV AB 4th Generation is 99.8 % sensitive and specific. Let them know you are screening. Imagine if you order the test without their knowledge and comes back positive. It will not go well.

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PrEP is a daily duo therapy in one pill. You want to screen people for full HIV and STI panel before with CMP. Monitor Kidney function and Liver function with HIV 4th gen Ab q6 months. 

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Doxy PrEP is preferred combination. Providing PrEP daily regimen with Doxycycline 200 mg once upon unprotected sex.

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HIV positive Ab for HIV 1 or 2 (in africa) would require you to bring the person in to talk in person rather than over the phone.

HIV diagnosis does not require prompt immediate therapy (you can wait at least 2 weeks) however, you want to follow up with HIV viral RNA load and lymphocyte count with CD4 and CD8 to determine and follow the efficacy/degree of AIDS.

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Ideal treatment would be with Briviky. You must test the person for 1. Genotype to understand the mutation status and therapeutic guidance at least once. 2. Order HLA B58 to make sure that the person can tolerate the popular Brikivy. If they are positive, then they will have severe side effect and wont be able to tolerate the antiviral.

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Follow up q6months with HIV RNA load until they are undetectable. CD4/lymphocyte co-testing q6months.

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ID referral is always a good idea.

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Syphilis is a reportable disease that require treatment and titer following q6months. this is most likely done in the state DOH. Recommend looking up the local DOH guideline / protocol / report to tailor your management.

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FYI TITERs can be positive even months out of treatment.

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