As providers start reviewing the update, what are some of the most significant changes or additions that stand out from a clinical perspective?

Yeah, so like usual, that's what I'll kind of cover today.

So when you go to the guideline panel or when you go to the guideline website, the first thing in there is what's new in the guidelines and what's changed.

And that's what I'm going to kind of cover today for everybody.

But there's some new sections that have been added.

And I think the first one is there was a new section that's been entitled The Principles of Antiretroviral Therapy.

And I actually went through this in some detail and really just kind of discusses some of the core issues around what to consider when you're selecting HIV regimens, how to apply those principles as it relates to initial therapy, regimen optimization, and also cases of virologic failure.

What were some of the key updates in the optimization section, particularly for patients who are already virally suppressed?

Can you talk a little bit about the main application that you mentioned, the DHHS Guidelines app?

Yeah, so this is the one I think that most people would probably access if they were going to look, if there was the four apps, this is probably the one most people would probably look at.

Again, right from the drug interaction table, some DHHS.

There's basically four sections to the application.

So those of you who haven't accessed them before, this will kind of be an overview of what's there.

So there's four tabs at the bottom.

that you can use for looking at interactions.

How do the apps address questions about psychiatry?

So what are the most important interaction considerations providers should keep in mind with VicLen?

Yeah, so I think most importantly is there's two main kind of groups or contraindications.

So the first one is dofetilide.

So for those of you who don't know what dofetilide is, this is an antiretroviral drug, which isn't used very common.

It's usually used in refractory atrial fibrillation.

We don't see a lot of patients on it, but if you are a dofetilide hospital, we are actually at Albany Med.

Sometimes this does come up.

As we begin to wrap up, what are your key clinical takeaways for providers considering Biclin?

What were some of the most important PrEP-related updates presented at IAS, and what should HIV care providers take away from those findings?

Yeah.

So thanks, Marianna.

You know, again, you know, this is the IAS meeting, so this is, this was in, in, in Brazil, um, in, in July.

But, uh, you know, hopefully this will be helpful for people.

I, I'm not covering everything.

There was a lot of information that was covered, but I'll, I'll top line some of the major things.

Shifting from prevention to treatment, what were some of the key studies presented on antiretroviral therapy and regimen simplification?

For providers and healthcare organizations dealing with limited supplies, what steps should they be taking right now to manage the shortage and prioritize use of benzathine penicillin?

Yeah.

So I think the, the most important thing is really monitoring your local supplies of, of benzathine p- uh, penicillin, um, a- a- and determining what the local pattern of use is and kinda to for- forecast your needs.

So many places have been doing this ongoing.

Uh, but again, continue to contract distri- the, the contact distributors to provide, uh, the, the BPG as, which is the, the benzathine penicillin G, as appropriate.

Um, you can also contact the company and, and request product for individual pregnant patients or neonates with syphilis.

Um, they have a medical request process, uh, if the distributor has no supply.

When benzathine penicillin isn't available, what alternative treatment approaches should providers be considering, and what do they need to know about using lenticillin as a substitute?

What changed in the recommendations for infants with HIV or those at high risk of acquisition?

Yeah.

So out of all the stuff that I wanna cover today, I think this is probably the most important piece 'cause it does, it does have some implications.

But, um, it's 'cause it, it fairly affects what providers do, especially those that are in the hospital setting, uh, when you're required to start triple therapy or full treatment, uh, to a newborn who's being delivered.

Um, so, so, you know, these situations do occur occasionally, especially if the mom is viremic or, uh, if there's a concern for, for, for transmission, you know, uh, the, you know, in the, in the patient and the pa-- the mom has not been suppressed, um, you know, that newborn really should be put on triple therapy.

And so, and so triple therapy or full treatment, um, so what does that look like now? So i-in, in the what to start section, um, they, they, they have listed out treatment regimens that are recommended for initial therapy in infants and children with HIV.

Um, the preferred regimen for initial ART now in full-term infants, if they're less than thirty, thirty days old and weighing at least two kilograms, is now the second-generation integrase inhibitor dolutegravir.

Can you talk a little bit about some of the recent changes to the opportunistic infection guidelines as well?

Can you talk about the key clinical trials that support these regimens and what those studies tell us about their effectiveness?

Yeah, so I'd be happy to do this too.

So most of these trials, again, they're all very similar designs, right? And these were trials that basically where people are switched to these two drug maintenance therapy, and they have very strict inclusion criteria.

And they usually are designed for patients who have a history of excellent adherence and are doing well on therapy.

They're undetectable.

and few, if any, virologic failures.

And some of the specifics of some of the indications, you can't have any virologic failures, in fact, if you're going to do this on label.

Based on the data and guidelines, how should providers be thinking about when it's appropriate to use a two-drug regimen in practice?

What stands out in terms of disparities across age, race, and geography, and what should providers take away from that?

Yeah, so I think the most important thing that we still talk about, the biggest risk factor for HIV for people who are acquiring HIV is men having a pretended sex with men.

So MUSM or MMSC, men with a male-to-male sexual contact.

There's different ways of different terminology, but the CDC right now is using MMSC, so male-to-male sexual contact.

and that's been about two-thirds of the new infections for many years so obviously that's our big our big push for obviously we should think about everybody for prep certainly people who are uh who have male to male sexual contact as a risk really we should be focusing on them for hiv prevention uh and also obviously for treatment if they've been they've been diagnosed um So who is most infected, I think, is important.

And if you look at among males 13 to 24 years old, these younger patients, Black African-American males accounted for the highest percentage of diagnoses contributing to that male-to-male sexual contact.

So if you look at Black African males age 13 to 24, that was over just under 50%, so 47% of diagnoses attributed to the male-to-male sexual contact were Black men 13 to 24 years old.

Turning to clinical implications, can you highlight the recent updates to the DHHS recommendations on statin use for people with HIV? Sure.