HIV

Transmission: via body fluids
AIDS= CD4<200 or AIDS defining illness (opportunistic infxn)
Markers: CD4 & viral load (goal <50)
When to start tx: EVERYONE
1st line thearpies: 2NRTI+NNRTI or INSTI or boosted PI
Triumeq: HLA-B*5701 (-) ONLY
Stribild: CrCL >/= 70 ml/min ONLY
Genvoya: CrCl >/= 30 ml/min ONLY
Truvada + Tivicay
NRTI
BBW: lactic acidosis, hepatic steatosis, lipodistrophy
Peripheral neuropathy & pancreatitis
Nephrotoxicity, BMD, BMS, HSR
NNRTI: hepatic issues, efavirenz in combo w Truvada is now an
alternative
Protease inhibitors: metabolic complications; need to be boosted
w ritonavir
Integrase inhibitors: well tolerated
Choosing regimen
Comorbidities, adherence, access
AE, food requirement, pill burden
Want to prevent resistance as much as possible 
adherence is very important
All pregnant pt should receive ART
Post exposure px (PEP): should be w/in 72 hrs for 28 days
Truvada + Isentress or Tivicay
Pre-exposure px (PrEP): high risk pts

Fungal infxn
Azole antifungals: reduction in ergosterol synthesis
Fluconazole --_> itraconazole  voriconazole posaconazole (most to least coverage)
Fluconazole needs to be renally adj
Itraconazole

Opportunistic infxn

CAP

TB

Nosocomial PNA/Aspiration PNA

IAI

Anemia

Sepsis
PK Mega Case

Bloodstream infxn

Endocarditis

Anemia