Public Health Service Panel

Public Health Service Panel

Public Health Service Panel

Linda is a 28-year-old female in a discordant relationship with her boyfriend of 1 year. Linda is 12 weeks pregnant based on her last menstrual period. She is engaged in HIV-care and is naïve to antiretroviral therapy (ART) because her CD4 cell count is 538 per mm3 and viral load is 8,300. No tobacco, alcohol, or illegal or illicit drug use.

Physical examination: Normal, healthy 28-year-old gravid female. She is overweight with a body mass index of 28.2.

Laboratory and other tests: Genotype is pan-sensitive without HIV mutations. Ultrasound at her 2-day follow-up estimates she is 15 weeks pregnant.

What are the Public Health Service Panel on Antiretroviral Guidelines for Adults and Adolescents guidelines for HIV-positive pregnant females regarding starting ART? What antiretroviral medications are recommended as first line?  Which drugs should be avoided?  Provide a rationale for all answers.
What education does Linda need regarding her medication?
Are there any risks to the baby during labor?
What should be done for the baby at birth if he/she tests positive for HIV? What will the providers need to do in terms of monitoring the baby?
Prepare and submit a 3-4 page paper [total] in length (not including APA format).
Answer all the questions above.
Support your position with examples.
Please review the rubric to ensure that your assignment meets criteria.
Submit the following documents to the Submit Assignments/Assessments area:Case Study: HIV Patient
There are 16 approved human immunodeficiency virus type 1 (HIV-1) drugs belonging to three mechanistic classes: protease inhibitors, nucleoside and nucleotide reverse transcriptase (RT) inhibitors, and nonnucleoside RT inhibitors. HIV-1 resistance to these drugs is caused by mutations in the protease and RT enzymes, the molecular targets of these drugs. Drug resistance mutations arise most often in treated individuals, resulting from selective drug pressure in the presence of incompletely suppressed virus replication. HIV-1 isolates with drug resistance mutations, however, may also be transmitted to newly infected individuals. Three expert panels have recommended that HIV-1 protease and RT susceptibility testing should be used to help select HIV drug therapy. Although genotypic testing is more complex than typical antimicrobial susceptibility tests, there is a rich literature supporting the prognostic value of HIV-1 protease and RT mutations. This review describes the genetic mechanisms of HIV-1 drug resistance and summarizes published data linking individual RT and protease mutations to in vitro and in vivo resistance to the currently available HIV drugs.
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INTRODUCTION
Sixteen antiretroviral drugs have been approved for the treatment of human immunodeficiency virus type 1 (HIV-1) infection: seven nucleoside/nucleotide reverse transcription (RT) inhibitors (NRTI), six protease inhibitors (PIs), and three nonnucleoside RT inhibitors (NNRTI). In previously untreated individuals with drug-susceptible HIV-1 strains, combinations of three or more drugs from two drug classes can lead to prolonged virus suppression and immunologic reconstitution. However, the margin of success for achieving and maintaining virus suppression is narrow. Extraordinary patient effort is required to adhere to drug regimens that are expensive, inconvenient, and often associated with dose-limiting side effects. In addition to these hurdles, the development of drug resistance looms as both a cause and consequence of incomplete virus suppression that threatens the success of future treatment regimens.
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RATIONALE FOR HIV-1 DRUG RESISTANCE TESTING
An increasing number of studies are showing that the presence of drug resistance before starting a new drug regimen is an independent predictor of virologic response to that regimen (reviewed in references 72, 75, 128, and 138). In addition, several prospective controlled studies have shown that patients whose physicians have access to drug resistance data, particularly genotypic resistance data, respond better to therapy than control patients whose physicians do not have access to these assays (19, 47a, 50a, 92, 139, 380a; Melnick, D., J. Rosenthal, M. Cameron, M. Snyder, S. Griffith-Howard, K. Hertogs, W. Verbiest, N. Graham, and S. Pham, Abstract 786, 7th Conference on Retroviruses and Opportunistic Infections, San Francisco, Calif., 2000; Meynard, J. L., M. Vray, L. Monard-Joubert, S. Matheron, G. Peytavin, F. Clavel, F. Brun-Vezinet, and P. M. Girard, 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, Canada, abstract 698, p. 294, 2000). The accumulation of such retrospective and prospective data has led three expert panels to recommend the use of resistance testing in the treatment of HIV-infected patients (101, 150; U.S. Department of Health and Human Services Panel on Clinical Practices for Treatment of HIV Infection, Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents, 28 January 2000, http://www.hivatis.org/trtgdlns.html) (Tables ​(Tables11 and ​and2)

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