Clinician-to-Clinician Phone Consultation

A family nurse practitioner in a multispecialty clinic in the Midwest called the PEPline regarding her 28-year old female patient who had condomless vaginal intercourse the night before with a non-mutually monogamous man of unknown HIV status. The partner has repeatedly declined HIV testing, and the patient’s last negative HIV test was more than a year ago. The patient takes fluoxetine for depression, and has no other medical conditions. The caller asked whether post-exposure prophylaxis (PEP) is warranted. [Read more…] about Clinician Consultation Center Post-Exposure Prophylaxis Hotline (PEPline) and Pre-Exposure Prophylaxis Hotline (PrEPline)

A physician in the rural Southwest called about a 27-year-old HIV-positive man who has been taking emtricitabine/rilpivirine/tenofovir alafenamide for the past two years. He has had no opportunistic infections or other HIV-related complications, but has developed gastroesophageal reflux disease (GERD) and will require medication to treat it- the caller was considering lansoprazole, which is on the patient’s insurance formulary. His CD4 count is 530 cells/µL and viral load is undetectable. The caller asked for guidance on medication interactions between the patient’s ARVs and lansoprazole. [Read more…] about Clinician Consultation Center HIV Management Warmline

An OB-GYN from Southeast U.S. called regarding an HIV-positive 37-year old pregnant woman in her 34th week of pregnancy. The woman had hepatitis C co-infection but underwent treatment and was considered cured prior to this pregnancy. The patient is also currently enrolled in a methadone maintenance treatment program. She had been started on ARVs before the pregnancy, but has not filled her prescriptions for three months. Her HIV viral load, which was previously undetectable, is now 7000 copies/µL and CD4 count is 363 cells/µL. The physician requested help in considering an ARV change, as well as developing a plan for delivery and postpartum care of the mother and her newborn. [Read more…] about Perinatal HIV Consultation Hotline

A physician called after his first visit with a 48-year old HIV-positive female patient who expressed a desire to stop drinking alcohol. The patient has not consistently been engaged in medical care over the last year, and was hoping to establish care with a new HIV primary care provider. The patient reports drinking a half bottle of vodka daily over the last year since the death of her husband. She reports having tried to stop on her own, but experiences morning tremors and nausea which go away after her first drink. [Read more…] about Clinician Consultation Center Substance Use Warmline

The Substance Use Warmline (SUW) received a call from a physician in a public clinic regarding a 54-year old HIV/HCV coinfected man. The caller had concerns about the patient’s adherence to HIV medications although the patient is currently prescribed a single-pill, once-daily antiretroviral regimen. He has a history of heroin and methamphetamine use and a psychiatric/social history complicated by PTSD and bipolar disorder, for which he takes psychotropic medications and receives intensive case management. [Read more…] about Clinician Consultation Center Substance Use Warmline

A family nurse practitioner in a multispecialty clinic in the Midwest called the PEPline regarding her 28-year old female patient who had condomless vaginal intercourse the night before with a non-mutually monogamous man of unknown HIV status. The partner has repeatedly declined HIV testing, and the patient’s last negative HIV test was more than a year ago. The patient takes fluoxetine for depression, and has no other medical conditions. The caller asked whether post-exposure prophylaxis (PEP) is warranted. [Read more…] about Clinician Consultation Center Post-Exposure Prophylaxis Hotline (PEPline) and Pre-Exposure Prophylaxis Hotline (PrEPline)