Viremic – Cases in HIV

A 43-year-old man with HIV is virally suppressed on Odefsey. He started Biktarvy 5 years ago but was switched because of headaches. He recently developed worsening kidney function. Listen as Chris Hoffmann of Johns Hopkins and guest Tony Urbina , from the Icahn School of Medicine at Mount Sinai, discuss switching this patient to a newly or soon-to-be approved antiretroviral medication. References:...

A 48-year-old man with HIV that is well-controlled on dolutegravir/lamivudine has met someone and they are starting to date. His partner is HIV-seronegative, and they have not yet been sexually active. Listen as Eileen Scully and Chris Hoffmann of Johns Hopkins discuss the importance of normalizing sexuality in patients with HIV and strategies for counseling patients that “undetectable=untransmitt...

A 53-yr-old woman has a long history of HIV and a fully suppressed viral load. She feels irritable, does not feel rested in the mornings, and wakes up with sweats at night. Listen as Eileen Scully of Johns Hopkins and guest Sara Looby , from Massachusetts General Hospital, assess her symptoms and history, diagnose her stage of menopause, and evaluate the risks and benefits of menopausal hormonal t...

Dr. Joel Gallant joins host Chris Hoffmann of Johns Hopkins to review new data and developments from the 26th International AIDS Conference (AIDS 2026) , which was held in Brazil in July. They focus on abstracts that have implications for HIV care. Reference:   Perez Navarro A, Nutt CT, Siedner MJ, McCluskey SM, Hill A. Virologic Failure and Emergent Integrase Strand Transfer Inhibitor Drug Resist...

A 41-yr-old man with HIV for 15 years, suppressed on ART, has had elevated liver enzymes for several years. Listen as Chris Hoffmann and Juhi Moon from Hopkins review the differential diagnosis and diagnostic and management approaches with a focus on metabolic dysfunction associated steatotic liver disease. References: Bril F. Metabolic liver disease: A summary of major guidelines and identifying...

Hello Viremic listeners. We are taking a break for the month of July. Please check out our past episodes and catch up on any cases you may have missed . We love hearing from our listeners, so please send us comments or potential case topics to viremicpodcast@jh.edu . Don’t forget to give us a like and follow us wherever you access podcasts. We’ll be back on Tuesday, August 4 with a new case to dis...

A new-to-you patient—51-yr-old man with HIV since the early 2000s—has spotty vaccine records. How to educate, make recommendations, and avoid too many vaccinations at once? Listen as Chris and Eileen from Johns Hopkins make the case argue for their favorite vaccines among the many recommended for adults with HIV and describe their approaches to patient education, prioritizing based on specific pat...

A 42-yr-old man with AIDS presents feeling unwell, with white spots in his mouth, and scattered violaceous macules on his upper extremities; he has never taken ART. Listen as hosts Eileen Scully and Chris Hoffmann from Hopkins describe their initial work-up for a patient with a CD4 count of 10; discuss symptoms, diagnosis, and treatment of Kaposi sarcoma and other HHV8-related diseases; and rememb...

Chris presents a 62-yr-old man with HIV for >30 yrs, with viral suppression and many drug resistance mutations, whose ART must be changed due to a drug-drug interaction, but also for simplification. As part of their discussion, Chris and Eileen review reasons to change ART regimens, and work through the evidence-based options for this patient based on his history and resistance mutations profil...

With guest Dr. Jeremy Kidd , Chris reviews the case of a 27-yr-old man with HIV who reports using methamphetamine to enhance sex and has unsuppressed HIV. Is this chemsex? Is the unsuppressed viral load related? How should Chris discuss this with his patient, and what should he recommend? How should he approach the topic of harm reduction if the patient is not going to stop using chemsex? Referenc...

Eileen welcomes Dr. Joel Blankson to review the case of 28-year-old man who is an elite controller. They discuss elite control characteristics, monitoring, and treatment, while also touching upon patient education and shared ART decision-making. References Cited: Hatano H, Yukl SA, Ferre AL, et al. Prospective antiretroviral treatment of asymptomatic, HIV-1 infected controllers. PLoS Pathog . 2013...

How to treat pharyngeal gonorrhea in a 32-year-old gay man with HIV who has a documented cephalosporin allergy? Chris presents this case to guest Dr. Marguerite (Margie) Urban , director of the NYSDOH CEI Sexual Health Center of Excellence and longtime member of the Adult HIV Guidelines Committee of Clinical Guidelines Program. They explore options for treatment and consider the role of gepotidaci...

Eileen presents the case of a 32-yr-old woman newly diagnosed with HIV-2 and invites guest Dr. Sanjiv Shah to discuss HIV-2 epidemiology, diagnosis, treatment, and monitoring. Listen as they explore the difficulties in diagnosing HIV-2, the complexity of treatment, including in pregnant women, and resources available to clinicians. Reference Cited:  Peruski AH, Wesolowski LG, Delaney KP, et al. Tr...

Dr. Paul Sax , author of an annual “ Really Rapid Review of the Conference on Retroviruses and Opportunistic Infections (CROI) ,” joins host Eileen Scully to review CROI 2026 abstracts of particular interest to clinicians taking care of patients with HIV. CROI 2026 abstracts: Abstracts are cited within the transcript text and those cited are listed below in numerical order, with the abstract numbe...

With guest Dr. Asa Radix , Chris reviews the case of a 32-year-old transgender woman who was diagnosed with HIV testing while receiving gender-affirming care. With a viral load of 82,000 and CD4 count of 365, she had no resistance mutations and no other known major medical conditions. Asa walks Chris through the approach to ART and gender-affirming HIV and primary care for this patient. References...

A 33-year-old man with HIV presents with a flu-like syndrome and a disseminated vesicular rash after sexual contact with a new partner. Differential diagnosis includes mpox, syphilis, other STIs, HSV and disseminated VZV. Listen as Eileen and her guest, Dr. Shauna Gunaratne work through the mpox diagnosis, and discuss the 2022 mpox outbreak, along with evidence-based recommendations for testing, t...

Chris presents the case of a 42-yr-old gay man at high risk of anal cancer to guest Dr. Bruce Hirsch, and they work through the best course for screening and prevention of a disease with high rates of morbidity and mortality that disproportionately affects people with HIV. Listen as Chris and Bruce talk about who to vaccinate and when, who and when to screen, and what screening entails, while ackn...

The case of a 28-year-old diagnosed with HIV when she became pregnant prompts Eileen and guest Dr. Jean Anderson to explore many of the challenges of HIV care in pregnancy: managing a new diagnosis, disclosure, stigma, partner involvement, antiretroviral therapy, perinatal transmission prevention, breastfeeding, harm reduction, and postpartum care. Their wide-ranging discussion opens with Jean’s p...

Like many in HIV, Chris is also a PrEP provider. In this episode, he presents a case to Dr. Rona Vail to work through the best approach to PrEP for a young, gay Black man. They work through the issues of oral vs injectable PrEP, dosing schedules for oral PrEP, the studies that support each approach, and this patient’s eligibility for each to determine the best recommendations. They end by discussi...

Hello Viremic listeners. We are taking a break this week and encourage you to take a look back at our past episodes and catch up on any cases you may have missed . We'll be back on January 6, 2026 with a new case to discuss! From all of us at Viremic we hope you have a peaceful, healthy and joyous holiday season! 

After 3 years on injectable CAB/RPV, a patient develops viremia, with a viral load of ~1,300 copies/mL. Failure of injectable CAB/RPV occurs in 1% to 2%, despite adherence. What factors have been associated with CAB/RPV failure? Can regimen failure be predicted or prevented? Listen as Chris and Eileen discuss the data, their advice to patients considering a switch to injectable CAB/RPV, and their...

A 32-year-old man with well-controlled HIV, seen after a recent relationship split and sexual activity with new partners, is screened and diagnosed with syphilis. Eileen discusses this case with guest Dr. Matthew Hamill , who reviews his approach to STI screening and risk reduction, emphasizing an approach that normalizes screening. Matthew then reviews syphilis testing, diagnosis, and staging, in...

A 54-year-old woman with longstanding HIV and obesity is stable on ART, but concerned that it is causing weight gain. How best to address this growing concern? Listen as Chris and Eileen decipher the evidence related to weight gain and ART and weigh the best strategies for addressing this increasingly common and social media inflected concern for patients with HIV and their care providers? Referen...

A 62-year-old patient with HIV for ~40 yrs presents on the life-saving TRIO regimen after a beloved care provider retires. Will a switch improve his quality of life? Eileen and Chris suspect that a change to a once-a-day regimen with fewer pills will maintain his viral suppression and make life easier, but the TRIO regimen inspires dedication in many long-term patients. Would he be open to a switc...

Subspecialists request simplified ART for a 56-year-old woman with a long ART history, who is taking a DOAC, has evolving renal function, and some drug resistance. Which factors to prioritize? Eileen and Chris have some, but not a complete medical history. Listen as they work through the information they do have, consider 7 questions key in making an ART switch, and evaluate the available options....