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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

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Patient Case 2: ART for a Patient With Worsening Renal Function

For the next case, we discuss a patient who has worsening renal function. I am sure many of us who treat people living with HIV will inevitably encounter situations like this, as more people are receiving ART for longer and experiencing aging with HIV and possibly other comorbidities.

Our patient in this case is a 54-year-old man with hyperlipidemia. He is receiving atorvastatin for his hyperlipidemia and tested positive for HIV 2 years ago. His HIV-1 RNA is suppressed on his current ART regimen, consisting of DTG and FTC/TDF.

Unfortunately, he is now presenting to the clinic with worsening renal function.

His laboratory parameters are as follows:

  • CD4+ cell count: 630 cells/mm3, so quite high
  • Undetectable HIV-1 RNA
  • No resistance associated mutations (RAMs)
  • BMI: 25 kg/m2
  • Complete blood count (CBC): normal
  • SCr: 3.5 mg/dL
  • Creatinine clearance: 26 mL/min
  • No hepatitis B and hepatitis C confection
  • HLA-B*5701 status: negative 

To which ART regimen would you recommend switching this patient?

Video 2: Demonstration

Patient Case 2: Discussion

Once again, HIV-ASSIST is an invaluable resource for HCPs who provide care for people living with HIV and other comorbidities. This tool provides clear dosing recommendations with evidence-based insights and detailed rationale for each suggested regimen.

This comprehensive tool not only helps enhance HCP understanding of what makes an ART regimen suitable or not, but it also supports informed decision-making. It ensures that HCPs can optimize treatment plans and address patient-specific factors like renal function and hyperlipidemia.

For example, in this case HIV-ASSIST ranks a switch to the well-studied tenofovir-sparing regimen of DTG/RPV as more favorable than remaining on the current regimen, in part because of the patient’s renal function.

Similar to the first case scenario, HIV-ASSIST can also help assess drug–drug interactions and tolerability for patients living with HIV. I find it particularly helpful for navigating complex cases and aligning my care with best practices in accordance with international and regional guidelines.

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