|
Topics, Trends & Updates
August 2025
| | | Updated: Use of Injectable CAB/RPV LA as Replacement ART in Virally Suppressed Adults | | |
Updated by lead author Dr. Joseph P. McGowan, with the Medical Care Criteria Committee (MCCC), the Use of Injectable CAB/RPV LA as Replacement ART in Virally Suppressed Adults guideline was developed to provide clinicians with evidence-based recommendations and information on the use of long-acting injectable cabotegravir/rilpivirine (CAB/RPV LA) as replacement antiretroviral therapy (ART) for adults (aged ≥18 years) with HIV who are virally suppressed (HIV RNA level <50 copies/mL).
Updates to this guideline include:
-
Benefits, Potential Risks, and Limitations of CAB/RPV LA section: Recommendation revised: Clinicians should not recommend treatment with CAB/RPV LA for patients who are pregnant or breast/chestfeeding, because of limited safety and efficacy data. (A*)
- New discussion and references added throughout guideline
Contents:
| | Updated: Second-Line ART After Treatment Failure or for Regimen Simplification | | |
Updated by Dr. Joseph P. McGowan, with the MCCC, the Second-Line ART After Treatment Failure or for Regimen Simplification guideline provides clinicians with effective care management strategies for patients with HIV who require changes in their ART regimens. Clinical scenarios may arise in which a patient’s ART is ineffective, leading to virologic failure, adverse effects, or drug-drug interactions with other essential medications; older ART regimens may also be burdensome for patients who may benefit from simplification.
Updates to this guideline include:
-
ART Changes for Regimen Simplification section: Recommendation on genotypic resistance testing revised to include use of proviral DNA genotype testing when no prior resistance testing results are available.
-
Resumption of ART After a Treatment Interruption section: Recommendation on genotypic resistance testing revised to address use of proviral DNA genotype testing when no prior or incomplete resistance testing results are available.
- Global: New references and text added, including discussion of proviral DNA genotype testing.
| | | Updated: Prevention and Treatment of Mpox | | |
Updated by Drs. Jacob R. McLean and Jason E. Zucker, with the MCCC, the Prevention and Treatment of Mpox guideline was developed to inform primary care providers and other clinicians about mpox prevention, presentation, diagnosis, and treatment in adults with and without HIV.
Updates to this guideline include:
-
Mpox Treatment section: The following recommendation was added: Clinicians should not use tecovirimat as monotherapy for the treatment of mpox. (A1)
Contents:
| | |
New Guideline: Interim Guideline on the Use of Twice-Yearly Lenacapavir for HIV Prevention
| | | Viremic—Cases in HIV Podcast: New and Upcoming | |
Join Hosts Eileen Scully and Christopher Hoffmann as they present cases, explore quandaries in adult HIV care, and discuss key evidence and guidelines that inform clinical decision-making.
New Episodes
| | Case 2. How Low Can You Go? A Case of Non‑Suppressible Viremia: Mid-50s-year-old man with HIV since the early 1990s presented for evaluation of persistent low-level viremia (LLV), 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. Listen Now | | Case 3. Preserving the Beans: New Renal Failure and New HIV: After presenting with fatigue, malaise, and muscle cramps, a 28-year-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. Listen Now | | Case 4. Under Pressure: Cryptococcus, ART Initiation, and the Threat of IRIS: 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. Listen August 19 | | |
Case 5. The Heart of the Matter Cardiovascular Disease Risk in HIV: 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. Listen September 2
| | We’re open to suggestions! To submit a clinical topic for a Viremic case discussion, email us at viremicpodcast@jh.edu | | | Conversations With CEI Podcast | |
| |  | Highlights and Perspectives from the 11th Annual NYS Sexual Health Conference: Live from Canandaigua…it’s the 11th Annual NYS Sexual Health Conference! The CEI Sexual Health Center of Excellence hosted the 11th Annual NYS Sexual Health Conference in-person on Friday May 2, 2025, in beautiful Canandaigua, NY. This was the Center’s second in-person conference since the COVID-19 pandemic and was the Center’s largest in-person event held to date, bringing together over 225 clinicians and public health professionals from across NYS (and beyond!). In this episode, host Juhua Wu, Director of the University of Rochester Center for Community Practice and team member of the CEI Sexual Health Center of Excellence, checks in live from the conference with four presenters about their experience at the conference, perspectives on what they learned from other sessions, and “need to know” highlights from their own presentations. Join Juhua, along with Rachel Hart-Malloy, PhD, MPH; Brenda Tesini, MD; Michael Brennan, DNP, FNP; and Jeremy Kidd, MD, MPH, for a real-time review of the conference! Listen Now
| | Upcoming Training, Education, and Events | | |
Are You a Subscriber?
If this newsletter was forwarded to you, please subscribe now to make sure you receive the Clinical Guidelines Program Topics, Trends, and Updates newsletter every month and stay current with new and updated guidelines. We send 1 email per month and do not share our mailing list.
| |  | |
Comments? Questions? Suggestions?
Email us: aiguidelines@jhmi.edu.
We'll get back to you as quickly as possible.
Note that we cannot answer questions about the care or treatment of specific patients and cannot provide clinical advice.
| | | | | |
