Viremic – Cases in HIV

Dr. Eileen Scully & Dr. Christopher Hoffmann
  • 5.0 (10)
  • MEDICINE
  • UPDATED BIWEEKLY

Hosted by Eileen Scully, MD, PhD, and Christopher Hoffmann, MD, MSC, MPH, both HIV specialists at Johns Hopkins, Viremic explores quandaries in adult HIV care. Each case discussion includes medical history and diagnoses, challenges in care and treatment, and key evidence and guidelines that informed clinical decision making. Cases are presented as a composite from the hosts’ clinical practice, with all identifying details removed to protect the privacy of patients. Case discussions are for informational purposes only and not offered as medical or clinical practice advice for patients or clinicians. Any mention of specific medications or commercially available products is a description of use only, not an endorsement. Viremic is produced by the Clinical Guidelines Program, a collaborative effort of the New York State Department of Health AIDS Institute and the Johns Hopkins University Division of Infectious Diseases. Do you have comments or suggestions for future case topics? Email us at viremicpodcast@jh.edu. Please note that we cannot reply to questions about specific cases or medical conditions.

  1. 1D AGO

    Case 16. Mpox After the Outbreak

    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, treatment, and prevention. References Cited: Akter F, Hasan TB, Alam F, et al. Effect of prior immunisation with smallpox vaccine for protection against human Mpox: A systematic review. Rev Med Virol. 2023 Jul;33(4):e2444. Epub 2023 Mar 30. PMID: 36999223.CDC. Monkeypox. Tecovirimat (TPOXX) for Treatment of Monkeypox. Available at https://www.cdc.gov/monkeypox/hcp/clinical-care/tecovirimat.htmlDalton AF, Diallo AO, Chard AN, et al. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023. MMWR Morb Mortal Wkly Rep. 2023 May 19;72(20):553-558. PMID: 37200229.Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023 Mar 18;401(10380):939-949. Epub 2023 Feb 21. Erratum in: Lancet. 2023 Apr 8;401(10383):1158. doi: 10.1016/S0140-6736(23)00584-6. PMID: 36828001.PALM007 Writing Group; Ali R, Alonga J, Biampata JL, et al. Tecovirimat for Clade I MPXV Infection in the Democratic Republic of Congo. N Engl J Med. 2025 Apr 17;392(15):1484-1496. PMID: 40239067.Titanji BK, Eick-Cost A, Partan ES, et al. Effectiveness of Smallpox Vaccination to Prevent Mpox in Military Personnel. N Engl J Med. 2023 Sep 21;389(12):1147-1148. PMID: 37733313.Related Guidelines and Guidance: New York State Department of Health AIDS Institute Clinical Guidelines Program:- Prevention and Treatment of Mpox- Immunizations for Adults With HIV > Mpox- Management of IRIS- Doxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted Infections- Guidance: Adopting a Patient-Centered Approach to Sexual Health- GOALS Framework for Sexual History Taking in Primary CareResources: CDC Guidelines for Collecting and Handling Specimens for Mpox Testing NYSDOH Guidance on Testing at Commercial and Public Health Laboratories

    32 min

  2. FEB 3

    Case 15. A Pain in the Butt: Anal Cancer Screening and Prevention

    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 acknowledging the difficulties. References Cited: Palefsky JM, Lee JY, Jay N, et al. Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer. N Engl J Med. 2022 Jun 16;386(24):2273-2282. PMID: 35704479.Barnell GM, Merchant M, Lam JO, Silverberg MJ. Early Outcomes of a High-Resolution Anoscopy-Based Anal Cancer Screening Program Among People With HIV Enrolled in an Integrated Health Care System. J Acquir Immune Defic Syndr. 2019 Jul 1;81(3):292-299. PMID: 30964759.Deshmukh AA, Lin YY, Damgacioglu H, et al. Recent and projected incidence trends and risk of anal cancer among people with HIV in North America. J Natl Cancer Inst. 2024 Sep 1;116(9):1450-1458. PMID: 38713084.Related NYSDOH AI Guidelines and Guidance: Screening for Anal Dysplasia and Cancer in Adults With HIVPrevention and Management of Human Papillomavirus Infection in Adults With HIVPrimary Care for Adults With HIVImmunizations for Adults With HIV > Human Papillomavirus (HPV)Guidance: Adopting a Patient-Centered Approach to Sexual Health

    36 min

  3. JAN 20

    Case 14. “AIDS Is Not My Worst Problem”: Caring for Women with HIV

    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 perspective on care of women with HIV, which is informed by 40 years of ground-breaking work in the field. References Cited: Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994 Nov 3;331(18):1173-80. PMID: 7935654.Sibiude J, Le Chenadec J, Mandelbrot L, et al. Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery. Clin Infect Dis. 2023 Feb 8;76(3):e590-e598. PMID: 36037040Related Guidelines and Guidance: American College of Obstetricians & Gynecologists (ACOG): Optimizing Postpartum Care. Committee Opinion Number 736. May 2018.U.S. Department of Health and Human Services (DHHS): Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States(June 2025)New York State Department of Health AIDS Institute Clinical Guidelines Program: - HIV Testing During Pregnancy, at Delivery, and Postpartum- NYS Good Practices to Prevent Perinatal HIV Transmission- Guidance: Questions, Answers, and Best Practices for Medical Management of Perinatal HIV Exposure in New York State- U=U Guidance for Implementation in Clinical Settings- PrEP to Prevent HIV and Promote Sexual HealthResources: Antiretroviral Pregnancy RegistryCDC HIV Hotlines and Warmlines > Perinatal HIV Hotline: Provides clinicians with around-the-clock advice on indications and interpretations of HIV testing in pregnancy, and consultation on antiretroviral use during pregnancy, labor and delivery, and the postpartum period. 1-888-448-8765 (24 hours, seven days a week)Edinburgh Postnatal Depression Scale

    39 min

  4. JAN 6

    Case 13. Got PrEP? HIV Adjacent Care

    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 discussing barriers to PrEP and the importance of choices now that there are so many PrEP options. References Cited:  Bekker LG, Das M, Abdool Karim Q, et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024 Oct 3;391(13):1179-1192. PMID: 39046157.Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30;363(27):2587-99. PMID: 21091279. Kiweewa FM, Ahmed K, Nair G., et al. Adherence to F/TAF in cisgender women prevents HIV with low risk of resistance or diagnostic delay. Abstract 194. CROI; 2025 Mar 9-12; San Francisco, CA. https://www.croiconference.org/abstract/1937-2025/. Koss CA, Ayieko J, Kabami J, et al. Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda. AIDS. 2024 Mar 1;38(3):339-349. PMID: 37861683. Marrazzo J, Tao L, Becker M, et al. HIV Preexposure Prophylaxis With Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women. JAMA. 2024 Mar 19;331(11):930-937. PMID: 38427359. Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020 Jul 25;396(10246):239-254. PMID: 32711800.Molina JM, Ghosn J, Assoumou L, et al. Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study. Lancet HIV. 2022 Aug;9(8):e554-e562. PMID: 35772417.Molina JM, Capitant C, Spire B, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med. 2015 Dec 3;373(23):2237-46. PMID: 26624850.Related NYSDOH AIDS Institute Clinical Guidelines and Guidance: PrEP to Prevent HIV and Promote Sexual HealthPEP to Prevent HIV InfectionGuidance: Adopting a Patient-Centered Approach to Sexual HealthGOALS Framework for Sexual History Taking in Primary CarePrevention and Management of Hepatitis B Virus Infection in Adults With HIV

    32 min

  5. 12/23/2025 · BONUS

    Holiday Greetings

    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!

    1 min

  6. 12/09/2025

    Case 12. Injectable ART Failure: Minor Risk of a Major Event

    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 response when failure occurs. References Cited: Orkin C., Arasteh K., Gorgolas Hernandez-Mora M., et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. N Engl J Med 2020;382(12):1124-35. PMID: 32130806.Overton E. T., Richmond G., Rizzardini G., et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with human immunodeficiency virus 1 type 1 infection: 152-week results from ATLAS-2M, a randomized, open-label, phase 3b, noninferiority study. Clin Infect Dis 2023;76(9):1646-54. PMID: 36660819.Swindells S., Andrade-Villanueva J. F., Richmond G. J., et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med 2020;382(12):1112-23. PMID: 32130809.van Welzen BJ, Van Lelyveld SFL, Ter Beest G, et al. Virological Failure After Switch to Long-Acting Cabotegravir and Rilpivirine Injectable Therapy: An In-depth Analysis. Clin Infect Dis. 2024 Jul 19;79(1):189-195. PMID: 38207125.Related Guideline: NYSDOH AI: Use of Injectable CAB/RPV LA as Replacement ART in Virally Suppressed Adults

    29 min

  7. 11/25/2025

    Case 11. Unfolding Stories to Untangle Syphilis Testing

    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, including neurosyphilis assessment, and treatment.Related Guidelines and Guidance Centers for Disease Control and Prevention: Sexually Transmitted Infections Treatment Guidelines, 2021. Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources.NYSDOH AI Clinical Guidelines Program:  Guidance: Adopting a Patient-Centered Approach to Sexual HealthGOALS Framework for Sexual History Taking in Primary CareClinical Resources National STD Curriculum: A free educational website from the University of Washington STD Prevention Training Center.STD Clinical Consultation Network: From the National Network of STD Clinical Prevention Training Centers For New York State Clinicians: CEI Clinician Consultation Phone Line: 866-637-2342: A toll-free service for New York State clinicians offering real-time clinical consultations with specialists on HIV, sexual health, hepatitis C, and drug user health.CEI Sexual Health Resources web page: https://ceitraining.org/resources/sexual-health

    37 min

  8. 11/11/2025

    Case 10. A Growing Problem: ART-Associated Weight Gain

    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?References Cited: Abelman RA, Ma Y, Mehta CC, et al. Switch to Integrase Strand Transfer Inhibitors During the Menopausal Transition Is Associated With Accelerated Body Composition Change in Women With HIV. Clin Infect Dis. 2025 Jun 4;80(5):1125-1132. PMID: 39495675.Caniglia EC, Shapiro R, Diseko M, et al. Weight gain during pregnancy among women initiating dolutegravir in Botswana. EClinicalMedicine. 2020 Nov 5;29-30:100615. PMID: 33437946.Elion J, Gruber J, Radtchenko M, et al. Predictors of weight gain among people with HIV (PWH) over 3-year period. Abstract Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 - 17 July, Kigali, Rwanda & Virtual. J Int AIDS Soc. 2025 Jul;28 Suppl 4(Suppl 4):e26518. PMID: 40657994. Glidden DV, Mulligan K, McMahan V, et al. Metabolic Effects of Preexposure Prophylaxis With Coformulated Tenofovir Disoproxil Fumarate and Emtricitabine. Clin Infect Dis. 2018 Jul 18;67(3):411-419. PMID: 29415175.Griesel R, Maartens G, Chirehwa M, et al. CYP2B6 Genotype and Weight Gain Differences Between Dolutegravir and Efavirenz. Clin Infect Dis. 2021 Dec 6;73(11):e3902-e3909. Erratum in: Clin Infect Dis. 2022 Mar 1;74(4):755. PMID: 32960272.Koethe J. ACTG A5391: A Randomized Multicenter 3-arm Controlled Trial for People with Obesity on Integrase Inhibitors and Tenofovir Alafenamide switching to Doravirine, with or without Tenofovir Disoproxil Fumarate (The DO-IT Trial). Abstract. Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 - 17 July, Kigali, Rwanda & Virtual. J Int AIDS Soc. 2025 Jul;28 Suppl 4(Suppl 4):e26518. PMID: 40657994.Lake JE, Wu K, Bares SH, et al. Risk Factors for Weight Gain Following Switch to Integrase Inhibitor-Based Antiretroviral Therapy. Clin Infect Dis. 2020 Dec 3;71(9):e471-e477. PMID: 32099991.Landovitz RJ, Zangeneh SZ, Chau G, et al. Cabotegravir Is Not Associated With Weight Gain in Human Immunodeficiency Virus-uninfected Individuals in HPTN 077. Clin Infect Dis. 2020 Jan 2;70(2):319-322. PMID: 31125395.Norwood J, Turner M, Bofill C, et al. Brief Report: Weight Gain in Persons With HIV Switched From Efavirenz-Based to Integrase Strand Transfer Inhibitor-Based Regimens. J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):527-531. PMID: 28825943. Ogbuagu O, Ruane PJ, Podzamczer D, et al. Long-term safety and efficacy of emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV-1 pre-exposure prophylaxis: week 96 results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet HIV. 2021 Jul;8(7):e397-e407. Erratum in: Lancet HIV. 2021 Dec;8(12):e734. PMID: 34197772.Sax PE, Erlandson KM, Lake JE, et al. Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials. Clin Infect Dis. 2020 Sep 12;71(6):1379-1389. PMID: 31606734.Venter WDF, Moorhouse M, Sokhela S, et al. Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV. N Engl J Med. 2019 Aug 29;381(9):803-815. Epub 2019 Jul 24. PMID: 31339677. [ADVANCE Trial]Short WR, Ramgopal M, Hagins DP, Lee J, Simonson J, Hsu T-H, Xu P, Anderson D. DEFINE Study A prospective, randomized trial to assess a protease inhibitor–based regimen switch strategy to manage integrase inhibitor–related weight gain 12th IAS Conference on HIV Science, 23 - 26 July,  Brisbane, Australia & Virtual Abstract 5962 Related Guideline: Clinical Info HIV.gov: Weight Gain in People With Treated HIV. Cardiovascular and Metabolic Complications in People With HIV. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV, September 2025.

    30 min
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About

Hosted by Eileen Scully, MD, PhD, and Christopher Hoffmann, MD, MSC, MPH, both HIV specialists at Johns Hopkins, Viremic explores quandaries in adult HIV care. Each case discussion includes medical history and diagnoses, challenges in care and treatment, and key evidence and guidelines that informed clinical decision making. Cases are presented as a composite from the hosts’ clinical practice, with all identifying details removed to protect the privacy of patients. Case discussions are for informational purposes only and not offered as medical or clinical practice advice for patients or clinicians. Any mention of specific medications or commercially available products is a description of use only, not an endorsement. Viremic is produced by the Clinical Guidelines Program, a collaborative effort of the New York State Department of Health AIDS Institute and the Johns Hopkins University Division of Infectious Diseases. Do you have comments or suggestions for future case topics? Email us at viremicpodcast@jh.edu. Please note that we cannot reply to questions about specific cases or medical conditions.

Information

  • Creator
    Dr. Eileen Scully & Dr. Christopher Hoffmann
  • Years Active
    2025 - 2026
  • Episodes
    17
  • Rating
    Explicit
  • Copyright
    Copyright © Johns Hopkins University Clinical Guidelines Program 2025-2026
  • Show Website
    Viremic – Cases in HIV