Metabolic Complications of HIV Infection
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Lisa M. Chirch, MD
Division of Infectious Diseases, UConn Health, Farmington, CT

Pooja Luthra, MD
Division of Endocrinology and Metabolism, UConn Health, Farmington, CT

Faryal Mirza, MD
Division of Endocrinology and Metabolism, UConn Health, Farmington, CT

Question 1 of 5

A 47-year-old Caucasian man with a history of coronary artery disease who underwent placement of a drug-eluting stent to the left anterior descending artery 3 months ago is referred to you for initial management of newly diagnosed HIV infection. He is not diabetic and does not smoke. His other medications include atorvastatin 40 mg daily, aspirin, clopidogrel, and metoprolol. He also takes pantoprazole 40 mg daily for significant long-standing gastroesophageal reflux disease. His baseline CD4 count is 525 cells/┬ÁL and HIV RNA is 55,000 copies/mL. Baseline liver function testing and blood urea nitrogen/creatinine ratio are within normal ranges.

He is interested in starting antiretroviral therapy as soon as possible, but would like to take as few pills as possible because he already takes several medications for his heart disease. Baseline resistance testing reveals fully sensitive virus without any meaningful resistance mutations.

Which of the following would you recommend as the next step in the management of this patient?

Start bictegravir/emtricitabine/tenofovir alafenamide

Start elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide

Start emtricitabine/rilpivirine/tenofovir alafenamide

Stop his atorvastatin and switch to pravastatin 20 mg daily

Given his current CD4 count and viral load, he does not require immediate therapy; hold off on antiretroviral therapy for now and closely monitor his counts every 3 months

This quiz is not accredited for CME.