Topics, Trends & Updates

September 2024

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Updated Guideline: Second-Line ART After Treatment Failure or for Regimen Simplification

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Updated by lead author Dr. Joseph P. McGowan, with the Medical Care Criteria Committee (MCCC), the August 2024 Second-Line ART After Treatment Failure or for Regimen Simplification guideline provides New York State clinicians with effective care management strategies for patients with HIV who require changes in their antiretroviral therapy (ART) regimens.


Updates to the guideline include:


  • New recommendation in guideline section ART Changes for Regimen Simplification:
  • Regardless of their viral suppression status, if a patient has ongoing adherence challenges with oral ART (even with support) AND a CD4 count <200 cells/mm3 OR is mechanically unable to ingest oral ART, the clinician should engage the patient in shared decision-making and offer CAB/RPV LA, if susceptible, coupled with intensified follow-up support.
  • Discussion of persistence of clonal-derived viremia beyond 48 weeks
  • Additional discussion of adverse effects associated with switching from TDF- to TAF-based regimens
  • Discussion of several abstracts from CROI 2024, including data from the ACTG A5381, CAPELLA, CALIBRATE, VOLVER, LATITUDE, and other studies


Go to the guideline

Updated Resource: ART Drug-Drug Interactions

Lead author Dr. John J. Faragon, with the MCCC, has revised the August 2024 Resource: ART Drug-Drug Interactions for clinicians who manage the care of patients with HIV.


Updates to the resource include:


  • Added information on long-acting injectable ART
  • Added information on ADHD medication interactions
  • Updated information on antidiabetic medication and gender-affirming hormones interactions

Go to the resource

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Conversations With CEI Podcast

An Exciting New Twice-Yearly Option for HIV PrEP: This podcast discusses the recent presentation of data for lenacapavir, a potent capsid inhibitor for HIV that was 100% effective in preventing HIV infection in cisgender women at risk of HIV. If approved, it will offer an exciting new option to prevent HIV, which should dramatically improve our chances of reaching the goal of totally eliminating new HIV infections. The trial compared twice-yearly injections of lenacapavir to both F/TAF and F/TDF in cisgender women and found similar effectiveness for F/TAF compared to F/TDF but there were zero new HIV infections in participants on lenacapavir. Listen Now


When HIV Tests Perplex: Expert Insights on Ambiguous and Discordant Results: "Providers calling into our CEI hotline often ask me what to do when their patient's HIV test results are unclear. These ambiguous or discordant test results can be a source of anxiety and confusion for both patients and healthcare providers alike."


To provide additional insight into this complex issue, Dr. Tony Urbina, Professor of Medicine from Mt. Sinai Health System and Medical Director of the New York State CEI HIV Primary Care and Prevention Center of Excellence, speaks with Dr. Lucia Torian, a distinguished epidemiologist who has dedicated over three decades of her career to the New York City Department of Health. As the Deputy Director of the HIV Epidemiology Program, she brings a wealth of expertise in HIV diagnostic testing and case surveillance.


In our conversation, we dive into real-world scenarios that illustrate the challenges of interpreting HIV test results. We explore real-world cases involving early exposure, false positives, and the added complications of testing migrant populations. The discussion includes practical advice on managing patient anxiety, effective communication strategies, and navigating ambiguous results. Listeners will gain insights into testing acute infections, how to handle PrEP ambiguity, and the role of advanced diagnostic techniques like Western blot tests. Additionally, Dr. Torian shares her thoughts on whether ambiguous results are becoming more prevalent in NYC and provides recommendations for follow-up procedures and timing. Tune in for a comprehensive look at improving HIV testing accuracy and patient care. Listen Now

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