Viremic – Cases in HIV

Dr. Eileen Scully & Dr. Christopher Hoffmann

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. 6D AGO

    Case 20. New Options for Treating Pharyngeal Gonorrhea

    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 gepotidacin and zoliflodacin, two new first-in-class drugs approved by the FDA in December 2025 for treatment of uncomplicated gonorrhea. References Cited:  Barbee LA, Soge OO, Khosropour CM, et al. The Duration of Pharyngeal Gonorrhea: A Natural History Study. Clin Infect Dis. 2021 Aug 16;73(4):575-582. PMID: 33513222.Hutt DM, Judson FN. Epidemiology and treatment of oropharyngeal gonorrhea. Ann Intern Med. 1986 May;104(5):655-8. PMID: 2938529.Kirkcaldy RD, Workowski KA. Gentamicin as an alternative treatment for gonorrhoea. Lancet. 2019 Jun 22;393(10190):2474-2475. Epub 2019 May 2. Erratum in: Lancet. 2019 Jun 29;393(10191):2590. PMID: 31056292.Luckey A, Balasegaram M, Barbee LA, et al. Zoliflodacin versus ceftriaxone plus azithromycin for treatment of uncomplicated urogenital gonorrhoea: an international, randomised, controlled, open-label, phase 3, non-inferiority clinical trial. Lancet. 2026 Jan 10;407(10524):147-160. Epub 2025 Dec 11. PMID: 41391465.Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections. N Engl J Med. 2023 Apr 6;388(14):1296-1306. PMID: 37018493. Ross JDC, Wilson J, Workowski KA, et al. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1): a phase 3 randomised, open-label, non-inferiority, multicentre study. Lancet. 2025 May 3;405(10489):1608-1620. Epub 2025 Apr 14. PMID: 40245902.St Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020 Dec 18;69(50):1911-1916. PMID: 33332296.Related Guidelines and Guidance: Centers for Disease Control and Prevention (CDC): CDC Sexually Transmitted Infections Treatment Guidelines, 2021NYSDOH AI:Questions, Answers, and Best Practices for Expedited Partner Treatment (EPT)Doxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted InfectionsGuidance: Adopting a Patient-Centered Approach to Sexual HealthGOALS Framework for Sexual History Taking in Primary CareResources for New York State Clinicians:  Conversations With CEI Podcast: Two New Treatments for Gonorrhea; one is available now! CEI Sexual Health Center of Excellence: The Sexual Health Center of Excellence provides sexual health clinical education, trainings, preceptorships, and additional clinical tools for community providers in NYS. The Center educates clinicians on the latest NYS guidelines on the management of patients with STIs. Phone number: 585-274-3045.CEI Clinical Consultation Line: 866-637-2342. This is a toll-free service for NYS clinicians offering real-time clinical consultations with specialists on HIV, sexual health, hepatitis C, and drug user health.

    36 min
  2. MAR 17

    Case 18. What’s New from CROI 2026 with Dr. Paul Sax

    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 number, authors, and title for each. If you attended CROI 2026, you have access to the abstracts online now through the CROI website; if you were not an attendee, check the CROI website late April/early May for access to the abstracts through the CROI searchable abstract database. Abstract 126. Kapoor, Y. MK-8527 Phase III Dose Selection for Monthly Oral HIV-1 Preexposure Prophylaxis. Abstract 128. Ndlovu, N et al, Twice-Yearly Subcutaneous Lenacapavir for PrEP: Updated HIV-1 Incidence and Safety Data in PURPOSE 1.Abstract 129. Cantos Lucio, VD. Lenacapavir for PrEP: HIV-1 Incidence and Safety From PURPOSE 2 at End of Randomized Blinded Phase.Abstract 134. Edgar, J. Altered Viral Kinetics at ATI After Dual LS-bNAbs Plus ART: A Preliminary Analysis of RIO Arm B.Abstract 140. Pires Dos Santos, AG., Immune-Mediated Viral Control With Budigalimab ± Trosunilimab: First Results of Phase II Global RCT.Abstract 142. Haser, G et al., Hepatitis B Reactivation/Infection in People With HIV on Tenofovir-Sparing Antiretroviral Therapy.Abstract 177. Rockstroh, JK et al., DOR/ISL (100/0.25 mg) vs BIC/FTC/TAF for Initial HIV-1 Therapy: Week 48 Results of a Phase III Study.Abstract 181. Cantos Lucio, VD. Lenacapavir for PrEP: HIV-1 Incidence and Safety From PURPOSE 2 at End of Randomized Blinded Phase.Abstract 529. Spinelli, M. et al, Virologic Outcomes After LA ART Initiation With and Without Viremia in 2 Large US Clinic Cohorts.Abstract 530. Chan, NY, et al. Week-24 Outcomes of Long-Acting Injectable ART in People With HIV and Suboptimal Viral Suppression.Abstract 593. Dieterich, DT et al., HIV-HBV Coinfection and Long-Acting Cabotegravir + Rilpivirine in the US: HBV and HIV Outcomes.513: Meissner, E. et al. Phase III Efficacy and Safety of Switch From B/F/TAF to Single-Tablet BIC/LEN in ARTISTRY-2.197: Seib, KL, Meningococcal B (4CMenB) Vaccination for the Prevention of Gonorrhea in Men Who Have Sex With Men.References Cited: Bekker LG, Das M, Abdool Karim Q, et al; PURPOSE 1 Study Team. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024 Oct 3;391(13):1179-1192. Epub 2024 Jul 24. PMID: 39046157.Kelley CF, Acevedo-Quiñones M, Agwu AL, et al; PURPOSE 2 Study Team. Twice-Yearly Lenacapavir for HIV Prevention in Men and Gender-Diverse Persons. N Engl J Med. 2025 Apr 3;392(13):1261-1276. Epub 2024 Nov 27. PMID: 39602624.Ombajo LA, Penner J, Nkuranga J, et al. Second-Line Switch to Dolutegravir for Treatment of HIV Infection. N Engl J Med. 2023 Jun 22;388(25):2349-2359. PMID: 37342923.Paton NI, Musaazi J, Kityo C, et al; NADIA Trial Team. Dolutegravir or Darunavir in Combination with Zidovudine or Tenofovir to Treat HIV. N Engl J Med. 2021 Jul 22;385(4):330-341. PMID: 34289276.Rockstroh JK, Kassim S, Paredes Ret al. Fixed-dose daily doravirine (100 mg) with islatravir (0·25 mg) versus bictegravir, emtricitabine, and tenofovir alafenamide for initial HIV-1 therapy: 48-week results of a phase 3, randomised, controlled, double-blind, non-inferiority trial. Lancet HIV. 2026 Feb 25:S2352-3018(26)00033-0. Epub ahead of print. PMID: 41763226.Severe P, Pierre S, Homeus F, et al. Bictegravir, emtricitabine, and tenofovir alafenamide versus ritonavir-boosted protease inhibitor-based antiretroviral therapy in people with HIV and viral suppression on second-line therapy in Haiti: an open-label, randomised, non-inferiority trial. Lancet HIV. 2025 Sep;12(9):e616-e626. Erratum in: Lancet HIV. 2026 Feb;13(2):e84. Erratum in: Lancet HIV. 2026 Feb 24:S2352-3018(26)00037-8. PMID: 40883049.Resources from Paul E. Sax, MD: NEJM Voices: Really Rapid Review: Conference on Retroviruses and Opportunistic Infections 2026PaulSaxMD SubstackRelated NYSDOH AIDS Institute Clinical Guidelines: Use of Injectable CAB/RPV LA as Replacement ARTPrEP to Prevent HIV and Promote Sexual HealthPrevention and Management of Hepatitis B Virus Infection in Adults With HIVImmunizations for Adults With HIV

    43 min
  3. MAR 3

    Case 17. Trans Lives Matter: Affirmative HIV Care

    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 Cited: Braun HM, Candelario J, Hanlon CL, et al. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health. 2017 Oct;4(5):371-375. PMID: 28876170.Blumenthal J, Acevedo-Quinones M, Phanuphak N, et al.  No Clinically Significant Drug–Drug Interactions with Co-administration of Feminizing or Masculinizing Hormone Therapy and Twice-yearly Lenacapavir PrEP in Gender-Diverse Persons, Open Forum Infectious Diseases, Volume 13, Issue Supplement_1, January 2026, ofaf695.525, https://doi.org/10.1093/ofid/ofaf695.525.de Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019 May 14;365:l1652. PMID: 31088823.Huang YA, Radix A, Zhu W, et al. HIV Testing and Preexposure Prophylaxis Prescriptions Among U.S. Commercially Insured Transgender Men and Women, 2014 to 2021. Ann Intern Med. 2024 Jan;177(1):12-17. PMID: 38109739.Reisner SL, Pletta DR, Mayer KH, et al. HIV seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study. Lancet HIV. 2025 Apr;12(4):e283-e292. PMID: 40158515.Rodriguez-Hart C, Zhao G, Goldstein Z, Radix A, Torian L. An Exploratory Study to Describe Transgender People with HIV Who Accessed Medicaid and Their Viral Suppression Over Time in New York City, 2013-2017. Transgend Health. 2023 Oct 4;8(5):429-436. PMID: 37810942.Related Guidelines and Resources: NYSDOH AIDS Institute Clinical Guidelines: - Primary Care for Adults With HIV- Selecting an Initial ART Regimen- Drug-Drug Interaction Guide: From HIV Prevention to TreatmentAustralasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) Adult Antiretroviral Guidelines: US DHHS Guidelines with Australian Commentary > Transgender People With HIVFenway Health: Medical Care of Trans and Gender Diverse AdultsUniversity of California San Francisco (UCSF): Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People > Initiating Hormone TherapyWorld Professional Association for Transgender Health (WPATH): Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

    30 min
  4. FEB 17

    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
  5. 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
  6. 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
  7. 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
out of 5
10 Ratings

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.

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