217.3 🩺 內科專科考前版

217.3.0.1 1⃣ DTG in Pregnancy

  • Tsepamo 2018 signal: 0.94% NTD in DTG conception vs 0.12% other ART
  • Subsequent analyses lower risk (~ 0.3% vs 0.1%)
  • WHO + DHHS: DTG OK for all pregnant women, including conception
  • Folic acid supplementation standard
  • 2024: DTG remains preferred

217.3.0.2 2⃣ Cabenuva Implementation

  • Lead-in oral cabotegravir + rilpivirine 1 month before switch
  • Verify virologic suppression
  • IM injection monthly or every 2 months
  • 2 separate injections (ventrogluteal or gluteal)
  • ATLAS-2M every-2-month dosing non-inferior
  • Useful for adherence challenges, patient preference

217.3.0.3 3⃣ Lenacapavir Salvage + PrEP

  • Sunlenca (lenacapavir) — capsid inhibitor
  • SC every 6 months
  • Approved 2022 for highly treatment-experienced
  • PURPOSE-1 (2024): 100% prevention in cisgender African women
  • PURPOSE-2 (2024): 100% prevention in MSM/transgender
  • FDA PrEP approval expected 2025-2026
  • Once-yearly dosing in development

217.3.0.4 4⃣ Long-Term ART Side Effects

  • TAF + InSTI weight gain (mechanisms under study)
  • Cardiometabolic monitoring
  • Lifestyle counseling
  • Statin if indicated (drug interactions)

217.3.0.5 5⃣ ART in Renal Failure

  • Avoid TDF
  • TAF preferred
  • Some agents (ABC, raltegravir) no adjustment
  • Hemodialysis considerations
  • Renal transplant + HIV: possible with careful management

217.3.0.6 6⃣ HIV-Associated Neurocognitive Disorders (HAND)

  • 30-50% prevalence
  • ART helps but residual deficit
  • ICAP, COGSTATE testing
  • Risk: low CD4 nadir, viremia, age, comorbidities
  • Treatment: optimize ART, manage comorbidities

217.3.0.7 7⃣ Statins + HIV

  • REPRIEVE 2024: pitavastatin reduced MACE 35% in HIV+ adults
  • Recommendation evolving toward broader statin use
  • Drug interactions: pitavastatin or rosuvastatin preferred (less PI interaction)
  • Avoid simvastatin + lovastatin with PIs

217.3.0.8 8⃣ HIV Cure Research

  • Berlin/London/DÃŒsseldorf patients — proof of concept
  • Latency reversing agents (HDAC inhibitors, PKC agonists)
  • Broadly neutralizing antibodies (bNAbs) — trials
  • Gene therapy / CRISPR
  • Therapeutic vaccines
  • Block-and-lock vs shock-and-kill
  • ATI (analytical treatment interruption) trials with novel agents

217.3.0.9 9⃣ 健保 / Taiwan

  • 公費 ART universally available HIV+ Taiwan
  • 公費 PrEP (high-risk groups since 2018 expansion)
  • 公費 HIV testing free
  • Cabenuva, lenacapavir — limited 健保 / 自費
  • ART adherence support programs

217.3.0.10 10. Future ART Directions

  • Once-weekly to once-yearly dosing
  • Implantable devices (in development)
  • mRNA-encoded bNAbs
  • Combination + simplification regimens
  • Pediatric formulations
  • Pre/post-exposure prophylaxis innovations