World HIV Day

🌍 World HIV Day - Key Updates & Advancements

On this **World HIV Day**, let’s recap the latest **updates** in **HIV treatment and management**.

📊 Shift in HIV-Related Complications

With the advent of **newer antiretroviral (ARV) therapies**, **HIV complications** are shifting from **infectious** to **metabolic** concerns.

**Increasing metabolic issues in HIV patients:**

  • 📈 **Obesity**
  • 🍬 **Diabetes Mellitus (DM)**
  • 🩸 **Dyslipidemia**

These require **continuous monitoring**, just like any other **metabolic disorder**.

⚠️ Undetectable = Untransmissible (U=U)

Though well understood for over a decade, **many still do not accept that** an **undetectable viral load means an untransmissible infection**.

For example, **Post-Exposure Prophylaxis (PEP) is NOT required** if the source patient’s **viral load is undetectable**.

📉 CD4 & Viral Load Monitoring - Changing Guidelines

  • 🔬 **CD4 count** is **no longer required regularly** if **viral load (VL) is undetectable**.
  • 💊 **For compliant patients**, **VL testing** can be done **just once a year** if the viral load remains undetectable.
Friday ID Day

🚀 Immediate ARV Initiation - No Delays Needed

**ARV treatment should be started immediately** after diagnosis, without waiting for VL or CD4 reports.

**Exceptions:** In rare cases like **TB meningitis** or **Cryptococcal meningitis**, ARV initiation must be done under **medical supervision**.

💊 PrEP - Expanding HIV Prevention

**Pre-Exposure Prophylaxis (PrEP)** should be **advocated and encouraged** in:

  • 🛡️ **High-risk groups**.
  • 💑 **HIV discordant couples**.

🩺 HIV Treatment - No More Treatment "Lines"

The concept of **"1st-line, 2nd-line therapies"** is now **obsolete**.

  • ✅ **All patients** are **initially offered the best available three-drug regimen** (**Integrase inhibitor-based**).
  • 🔄 **If the patient maintains an undetectable viral load**, they can be **shifted to a two-drug regimen**.

📢 Key Takeaways

  • ✔️ **HIV complications are shifting toward metabolic issues.**
  • ✔️ **Undetectable viral load = No transmission (U=U).**
  • ✔️ **Regular CD4 tests are no longer necessary if VL is undetectable.**
  • ✔️ **Start ARVs immediately after diagnosis, without delay.**
  • ✔️ **PrEP is crucial for HIV prevention.**

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