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Applying HIV ASSIST

CME

Applying an HIV Care Decision-making Tool in Asia: HIV-ASSIST 

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 26, 2025

Expiration: June 25, 2026

Manish Bamrotiya
Manish Bamrotiya, MBBS, FHM
Tanyaporn Wansom
Tanyaporn Wansom, MD, PhD
CME/CE Information

Activity

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Patient Case 1: Initial ART Choice in a Person With TB Coinfection

Our first case scenario involves a 34-year-old man who was diagnosed with HIV just 2 days ago. The patient was also previously diagnosed with a case of sputum-positive pulmonary tuberculosis (TB) a week ago via a chest X-ray that showed infiltrates in the right upper lobe and sputum smear microscopy that was positive for acid-fast bacilli.

He currently exhibits a persistent cough, night sweats, weight loss, and fatigue, although he does not present with any neurologic symptoms or signs of extrapulmonary TB.

The patient was accordingly initiated on anti-TB drugs 5 days ago with a regimen containing isoniazid, rifampicin, pyrazinamide, and ethambutol.

This patient does not report any major comorbidities except some alcohol use and a history of smoking (approximately 10 pack-years).

In this case scenario, the baseline HIV-1 RNA and genotyping are not available. This patient’s HLA-B*5701 status is also unknown, but we know his CD4+ cell count is 156 cells/mm³. We also know that this patient was sensitive to all first-line anti-TB drugs (rifampicin-sensitive TB confirmed by GeneXpert MTB/RIF). In addition, the patient’s blood indices are all normal:

  • Hemoglobin: 11.5 g/dL (mild anemia)
  • Liver function tests: Mildly elevated alanine aminotransferase (55 U/L, normal range: 10-40 U/L) because of anti-TB therapy
  • Serum creatinine (SCr): 1.0 mg/dL (normal)
  • Fasting blood glucose: 95 mg/dL (normal)

Which ART regimen would you recommend for this patient?

Video 1: Demonstration

 

Patient Case 1: Discussion

In all, this case scenario illustrates how healthcare professionals (HCPs) can use HIV-ASSIST to individualize ART for people with coinfections. Since many patients are diagnosed with HIV and TB coinfection, this tool is helpful for discerning drug–drug interactions between HIV ART and anti-TB drugs, such as DTG and rifampin.

In this case, the regimens recommended by HIV-ASSIST as having strong evidence are EFV/TDF/FTC and DTG/TDF/3TC. By contrast, BIC/TAF/FTC and DRV/COBIFTC/TAF are not recommended by HIV-ASSIST owing to interactions with rifampicin. 

Delving deeper into the tool’s resources, you can see that the dosing recommendations given are consistent with WHO guidelines and other countries’ guidelines. 

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