Division of Infectious Diseases

Publication Alert: Antiretroviral Refill Histories as a Predictor of Future Human Immunodeficiency Virus Viremia

The content below was provided by Darryl Sokpa, ’22 PharmD/MBA candidate at UNMC College of Pharmacy. He led a recently published study, collaborating with UNMC ID faculty Drs. Sara Bares and Nada Fadul, and mentored by UNMC ID pharmacist faculty Dr. Joshua Havens.

What prompted this study?

Adherence to antiretroviral therapy (ART) remains the cornerstone of treatment for HIV infection. Many adherence metrics including subjective reporting, assessment of drug concentrations in dried blood spots (DBS)/hair/urine, novel technologies such as medication event monitoring systems, and the quantification of prescription refill histories as a percentage of days covered (PDC), have been evaluated in other studies. While each of these adherence metrics has its own set of positive and negative attributes, PDC is arguable the easiest to collect, encompassing of all antiretrovirals, and can be used in real-time clinical decision-making.

Our colleagues, Byrd et al, have explored using PDCs to evaluate association with viral suppression and to identify minimum PDC thresholds for current viral suppression both in aggregate and by ART regimen type. We wanted to evaluate the use of PDC as a measure to assess future viral failure and to identify an associated PDC threshold level. Additionally, we aimed to find predictive factors for low adherence levels under the identified PDC threshold level.

What are the key findings?

Our analysis found PDC was associated future viral failure in our cohort of 867 participants contributing to 1923 matched pairs (annual PDC matched to first reported HIV RNA in subsequent year). PDC ≤52% was identified as a threshold level predictive of future HIV viremia in our analysis. Sub-groups with higher odds of a PDC ≤52% were Black race, people experiencing homelessness, those with government-based insurance or uninsured, and those not in a committed relationship.

What is the clinical take home message?

Our findings suggest PDC may be a useful clinical tool to identify patients at risk of future viral failure. Additionally, our results may help clinicians better understand adherence trends to make better real-time clinical decisions and identify patients that may benefit from adherence support interventions and/or resistance testing. Further, in conjunction with the findings of Byrd et al, we now have a key adherence zone bordered by the identified PDC thresholds (52-82%) to be further evaluated for long-term HIV outcomes.

Lastly, while the current literature using PDC as an adherence marker is encouraging, it is important to recognize the limitations of PDC values. Most notably, PDC is still an imperfect adherence metric because it only represents pharmacy ART dispensations and not actual ingestion.

Darryl Sokpa, pictured left, led this project. He is a ’22 PharmD/MBA candidate at UNMC College of Pharmacy.

Read the full article here.

Citation: Sokpa D, Lyden E, Fadul N, Bares SH, Havens JP. Antiretroviral Refill Histories as a Predictor of Future Human Immunodeficiency Virus Viremia. Open Forum Infect Dis. 2022 Jan 28;9(3):ofac024. doi: 10.1093/ofid/ofac024. PMID: 35187193; PMCID: PMC8849282.

#PharmToExamTable: Are we correctly dosing β-lactam antibiotics?

A #PharmToExamTable question about antibiotic treatment, answered by Jeremy Tigh, PharmD, an ID pharmacy resident at UNMC

(Reviewed by Andrew Watkins, PharmD)

In a recent popular publication, Crass et al. ask the question: are we jumping the gun on renal dosing of antibiotics? In this review I expand upon Crass’s question, with a focus on β-lactams.

β-lactams, Dosing Strategies, and Clinical Trials

β-lactams are one of the most commonly prescribed antibiotic drug classes with numerous clinical indications for gram-positive and gram-negative infections. Penicillins, cephalosporins, and carbapenems all share common s structural aspects that bind to penicillin binding proteins, inhibiting the cross linking of peptides in the bacterial cell wall, resulting in bactericidal action. Efficacy parameters are described as the percentage of time of the dosing interval in which the free serum antibiotic concentration remains above the minimum inhibitory concentration (MIC). The value needed for bactericidal activity varies, but generally the goal is 40-70%; however, clinical data suggests that optimal rates of clinical cure and bacteriological eradication (protects against regrowth and subsequent development of resistance) are achieved with time above MIC of 100% (1).

Early Antibiotic Therapy and Acute Kidney Injury

Acute kidney injury (AKI) is common in patients presenting with infectious diseases resulting in dosage adjustment per drug labeling for many first line antibiotics. Crass et al. hypothesized that this dosage reduction is likely unnecessary in many patients as AKI can be transient and that by dose-adjusting so early in therapy, important patient outcomes may be impacted due to decreased drug exposure (3). In their retrospective study looking at more than 18,500 patient encounters they were able to provide evidence to support their hypothesis. AKI was common with an overall rate of approximately 1 in 5 of their population. When they restricted their analysis to patients with clinically meaningful renal dysfunction (likely warranting dose adjustment) up to 38% of those cases may have qualified. Additionally, they showed that 57% of those patients had resolution of their kidney injury by 48 hours and that there was a higher probability that patients with AKI on admission would have recovery rather than persistence of the AKI (3). One possible explanation for this dynamic renal function may be due to inaccuracies in the way that we measure and estimate a patient’s clearance, as serum creatinine is dynamic and variable. The authors suggest that delaying dose adjustment on initiation of therapy for β-lactam antibiotics may enhance meeting pharmacodynamic targets during crucial early therapy, but this must be balanced with the risk of toxicity. Limitations of their study include that antibiotic dosing and patient outcomes were not evaluated, making it difficult to know whether or not this actually affects patient outcomes.

Critically Ill Patients

Intensive care unit (ICU) patients are usually excluded from dose finding studies as pharmacokinetics and drug exposure are often significantly altered in this population (4). Because of this, utilizing standard dosing regimens for β-lactams may make it difficult to achieve optimal exposure. A recently published study by Abdulla et al. looked at patients treated with a variety of β-lactams and subsequent drug levels and attainment of pharmacodynamics goals (.4) The study included 147 patients, of which 63.3% met a goal of time above MIC at 100%. When analyzing time above 4 times the MIC (a suggested optimal concentration), only 36.7% met the goal. They identified male gender, a high BMI, and an eGFR >90 ml/min as risk factors for not obtaining goal PD parameters. Another study performed by Wong et al. support these findings (5) In a similar population they analyzed the same PD goals, but also analyzed time that drug concentration was 10 times above MIC, a subjective surrogate for toxicity. Out of 330 patients analyzed, a similar number of patients met PD goals as compared to Abdulla et al., but 17.3% of patients were indicated to have dosage reductions with measured high levels, emphasizing the risk of excessive drug exposure. Failure to obtain target values was not independently associated with negative clinical outcomes, making it difficult to support the hypothesis that non-target obtainment would lead to worse clinical outcomes. The complexity and dynamic nature of ICU patients makes associating clinical variables and risk of not obtaining target PK/PD goals difficult to apply without therapeutic drug monitoring. Currently, therapeutic drug monitoring for β-lactams is not widely used in clinical practice. Lack of guidelines, long turnaround times, and limited laboratory access are barriers to its implementation (4,5).

Conclusions

It is important to consider the limitations of estimating renal function and applying renal dosage adjustment to dynamic patients. Prospective studies are needed to establish causal links between antibiotic doses, renal dysfunction and enhancement (ARC), and patient outcomes in both acute and critically ill patients before therapeutic drug monitoring of β-lactams will be accepted as a useful tool in optimizing therapy.

References

Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998;26(1):1-10; quiz 11-12.
Zhang L, Xu N, Xiao S, et al. Regulatory perspectives on designing pharmacokinetic studies and optimizing labeling recommendations for patients with chronic kidney disease. Journal of clinical pharmacology. 2012;52(1 Suppl):79s-90s.
Crass RL, Rodvold KA, Mueller BA, Pai MP. Renal Dosing of Antibiotics: Are We Jumping the Gun? Clin Infect Dis. 2019;68(9):1596-1602.
Abdulla A, Dijkstra A, Hunfeld NGM, et al. Failure of target attainment of beta-lactam antibiotics in critically ill patients and associated risk factors: a two-center prospective study (EXPAT). Critical care (London, England). 2020;24(1):558.
Wong G, Briscoe S, McWhinney B, et al. Therapeutic drug monitoring of β-lactam antibiotics in the critically ill: direct measurement of unbound drug concentrations to achieve appropriate drug exposures. Journal of Antimicrobial Chemotherapy. 2018;73(11):3087-3094.
Boschung-Pasquier L, Atkinson A, Kastner LK, et al. Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2020;26(3):333-339.

A Message of Thanks to our current and former UNMC trainees from Dean Britigan.

Content provided by UNMC COM Dean, Dr. Bradley Britigan, previously published at https://www.unmc.edu/newsroom/2022/02/02/a-message-from-the-dean-a-note-of-thanks-from-the-front-line/

I write this having just completed 14 days of seeing inpatients at Nebraska Medicine as the attending physician on the general infectious diseases consult service, a care team that includes students, residents, a fellow, and infectious disease specialized pharmacists.

The service provides consultative care to patients located across most of Nebraska’s Medicine’s inpatient units on the 42nd Street campus. This activity provides me with the opportunity to return to clinical medicine and clinical teaching, something that I still enjoy immensely. It also pretty much assures that I get in my 10,000 steps each day.

But most importantly, it provides me with the opportunity to witness the exceptional dedication that the faculty, staff, resident, fellows and students who make up UNMC and our health system partners (Nebraska Medicine, Children’s Hospital & Medical Center, the VA and Madonna) demonstrate each day in our missions of patient care, education, research and service.

This year, as was the case this time last year, finds us in the middle of a COVID-19 surge. But this year is different. The health system, and those providing care, are more stressed, as they deal with chronic staffing shortages due to the departure of health care professionals from the workforce over the past year. This has been made acutely worse by a significant portion of current care providers themselves being out with COVID or needing to be home to care for infected family members due to the high infectivity rate of the omicron variant.

This staffing shortage has required limiting available services, which negatively impacts the care of patients with medical issues other than COVID, frustrating both patients and caregivers. Everyone — health care providers, patients and families — are tired and burned out from this pandemic that is fueled in part by an ongoing and unending barrage of medical disinformation. Despite all the challenges, the collegiality, teamwork and respect for one another that I saw in action repeatedly over the past two weeks was inspiring.

I am so proud to be part of this organization. Although everyone deserves recognition for their efforts, at this time I want to call out a group of individuals who too often do not receive the thanks and recognition that they deserve — our residents and fellows. This group of young physicians have been on the front lines of the pandemic over the past two years, providing much of the patient care 24/7, all while learning and developing their own skills and playing a critical role in the education of our medical students. On behalf of the faculty of the College of Medicine and its leadership, thank you to each of our current and former residents and fellows for all that you have done and continue to do for UNMC.

Seeking a Full-time Physician to Join UNMC’s HIV Program

The Division of Infectious Diseases at the University of Nebraska Medical Center in Omaha, NE is looking to add an ID physician to join our well-established HIV team recognized for providing expert care locally, regionally, and nationally.

As the largest provider of care to patients living with HIV in the Omaha area, the HIV clinic provides quality health care in a truly integrated system wherein medical care, pharmaceutical expertise, case management and advocacy are provided via a multidisciplinary approach. Alongside the clinical care, the UNMC HIV program actively participates in both clinical and translation research and has a team of research nurses and support staff and a culture that is fully supportive of research. Finally, the HIV team is involved in education both in the community and in UNMC’s colleges of medicine, nursing, and pharmacy.

We are looking for an Infectious Diseases physician with a passion for HIV care to join our group and look forward to hearing from anyone who is interested in the position.

Opportunity Highlights:
• Largest provider of HIV care in Nebraska
• Ryan White HIV/AIDS Program Grantee
• Robust clinical HIV research program with multiple investigator-initiated, NIH and industry funded clinical trials

If you are interested, please submit your application here.

Nebraska Tropical Medicine Course

Has the impending New Year and the specter of license renewal left you clamoring to meet continuing education requirements? Does your clinical practice serve people traveling to or arriving from the tropics, or are you planning to do so? Are you booked to do work in the tropics, or exploring the idea of doing so? Then, the Nebraska Tropical Medicine Course may be for you!

This familiarization and refresher course has an expanding list of activities for physicians, nurses, and other allied health professionals seeking to better expand or renew their awareness of tropical medicine issues. With accreditation through the University of Nebraska Medical Center, there are currently over 6 hours of continuing education credits and Maintenance of Certification credit (ABIM, ABPath and ABPeds) available, and the content is growing. Orient to the context, learn about malaria and enteric disease, review cases, and join the group.

Learn more about the course

Dr. Jana Broadhurst (left) and Dr. David Brett-Major (right) are the course directors

Course Learning Objectives

Upon completion of this course, the participant should be better able to:

Identify pervasive, episodic, and emerging threats to patients and communities
Develop strategies for case management based upon patients’ and healthcare professionals’ context in tropical medicine and emerging infectious diseases
Integrate tropical medicine approaches to the delivery of care and how a team functions to make informed decisions while respecting the patient and community values

This tropical medicine course is also offering scholarships for eligible international applicants to cover the registration fees of the modules.

Submit Your Application Now »

Content courtesy Bailey Wrenn, MA

Learn more about our open Community ID physician position!

Content provided by Dr. Starlin

Our community infectious diseases team aims to provide service to patients outside of main University of Nebraska Medial Center (UNMC) campus. It is one of the few fully dedicated Academic Community Infectious Disease services in the country and we are proud to embrace Nebraska Medicine’s (NMC) and UNMC’s vision and mission to offer services to all Nebraskans- because in Nebraska, we take care of each other.

We provide unparalleled experience in clinical care which plays a vital role in our Infectious Disease program. Our community infectious disease team members are also fully involved in division’s multiple academic, clinical and research activities. The core physicians are Dr. Richard Starlin, Dr. Richard Hankins and Dr. Daniel Brailita.

*Dr. Rick Starlin, service line director (Center); Dr. Richard Hankins (left), Dr. Dan Brailita (right)*

The service started in 2018 with Dr. Starlin as service line director. Dr. Starlin has many years of experience practicing infectious disease at UNMC as well as community based infectious diseases in several hospitals throughout Nebraska. He brings significant expertise in the field of employee health, occupational health, atypical mycobacterial infections, and orthopedic infection.

The service expanded adding Dr. Hankins, who joined from inside the ranks of our own UNMC infectious disease fellowship program, bringing further expertise and interest in infection prevention, antimicrobial stewardship, community-based infections, medical education and public health.

In early 2021, Dr. Brailita joined the division further adding significant community infectious disease, DHHS medical consultative services for tuberculosis, and infection prevention expertise. Dr. Brailita has helped build a large hospital and clinic based infectious diseases practice in areas of Nebraska previously void of ID. In addition to our core physicians, several other academic ranked physicians with interest in community ID participate in our community service. Likewise, the core physicians participate in ID rotations on the UNMC Main campus. We have excellent support from outstanding advanced practice providers who are valued team members and have established a relationship of trust and respect with many community physicians.

While providing on-site services to facilities in Omaha area, our community infectious disease service recently expanded to strategically support several major facilities in Nebraska, using the newest technology and telemedicine services. Currently we provide on-site ID coverage and consultative services at Bellevue Medical Center (BMC) and Madonna Rehabilitation Hospital (MRH) in Omaha. Coverage at BMC allows ID to work collaboratively with primary care and other specialists in a community hospital setting. Many of the complex patients discharged from NMC continue their medical care at MRH. The Community ID service is thus able to follow and provide continuity of care for these patients.

We are providing Telemedicine ID Consultative Services at Madonna Rehabilitation Hospital in Lincoln, as well as inpatient and outpatient ID Telehealth services to Mary Lanning Healthcare, a community hub in Central Nebraska. There are plans for expansion of Telehealth services to several other facilities. We have the capability to interconnect with our partners from Antimicrobial Stewardship Program (ASAP), Nebraska Infection Prevention and Control Program (ICAP) and others. Our physicians serve as associate medical directors for these important projects that address ID/IP needs in the state.

Our UNMC ID Fellows have participated and appreciate the opportunity to spend time on Community ID and Telehealth with our core team/ faculty. Community ID is now included in the formal training of our fellows.

We are open to further expansion of our services. For a Community ID attending there are endless opportunities to shape one’s career. While our service has clinical focus, the career pathways of our team are very diverse and open, with every individual taking a different approach to clinical and non-clinical research, public health training and directorship, academic career and teaching, advocacy, and involvement in community projects. The position is perfect for a physician who is looking for a clinically-oriented career path. The community ID faculty position can also be adapted for those who are interested in research or teaching. Opportunities to immediately engage in FTE-funded academic work in infection control and prevention are available through Nebraska ICAP/ASAP.

Learn more and apply: https://unmc.peopleadmin.com/postings/59954

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Antibiotic Awareness Week Publication Alert: Confronting antimicrobial resistance beyond the COVID-19 pandemic

Antibiotic Awareness Week 2021,”an annual observance that raises awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use” runs this year from November 18-24 2021. This is a global campaign with messaging from the CDC and the WHO calling on all of us to not only Be Antibiotics Aware, but to actively engage in activities to reduce the spread of antimicrobial resistance.

To kick off #USAAW21 and #WAAW21, we share this #ThrowbackThursday publication from September 2020: Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election. I coauthored this perspective in the Lancet with Drs. Steffanie Strathdee and Sally Davies.

In this article, we highlighted ongoing challenges due to antimicrobial resistance worldwide: 700K deaths per year, costing US100 trillion globally, and more than 2.8 million infections/35K deaths/$20billion in healthcare expenditures in the US.

We also described how the current COVID-19 pandemic is likely exacerbating antimicrobial resistance, with excessive antibiotic use when not clinically indicated, and redirection of resources globally away from antimicrobial stewardship to COVID-19 activities.

We end with a call to action that “the path forward is not only one that builds back from the COVID-19 pandemic, but also addresses AMR in the context of pandemic preparedness” and “collaboration is the most effective way to tackle global health threats“.

*Click on the figure to enlarge. COVID-19 Related Antimicrobial Resistance Challenges and Potential Solutions*

Read more of the perspective piece here: https://www.thelancet.com/article/S0140-6736(20)32063-8/fulltext/#bib2

UNMC ID Antimicrobial Stewardship Pharmacists celebrated with Acute Care Pharmacist of the Year and Rising Star Pharmacist Awards

Content provided courtesy Colleen Malashock, PharmD, BCPS

Thirty-three acute care pharmacists received heartfelt nominations from sixty-five peers and colleagues for Pharmacist of the Year 2021. The criteria for this honor included embodiment of our ITEACH values, demonstrating professionalism and leadership, serving as a role model for other colleagues with regard to advancing the profession of pharmacy and having a positive impact based on service to the community. This year, two awards were given – the Acute Care Pharmacist of the Year Award, and the Rising Star Pharmacist Award: both awardees came from the UNMC ID division.

Bryan Alexander, PharmD, BCIDP, AAHIVP was selected as the winner of the Acute Care Pharmacist of the Year award. Dr. Alexander has been with Nebraska Medicine for three years. In addition to his role leading the Outpatient Antimicrobial Therapy (OPAT) team, he has been instrumental in the distribution of COVID-19 monoclonal antibody therapeutic agents throughout the state of Nebraska. He was asked to work with the State Health Department to develop a system to equitably distribute these agents and ensure areas with COVID-19 hot spots had the products and knowledge to administer them.

Dr. Alexander was nominated by six colleagues. Jasmine Marcelin, MD, stated in her nomination, “He consistently embodies ITEACH values. His attention to detail is impeccable, and I trust him completely to advise me on antimicrobial decisions in difficult patient scenarios.”

He was also nominated by James Lawler, MD, who highlighted, “Bryan has been front and center in Nebraska Medicine’s fight to limit the impact of COVID-19 in the Omaha community and across the state. Through his leadership, the state was able to administer thousands of courses to the most vulnerable, preventing hundreds of hospitalizations and deaths.”

*Bryan Alexander, PharmD, was recognized with this year’s Acute Care Pharmacist of the Year award*

In addition to the Acute Care Pharmacist of the Year, a Rising Star Pharmacist was also honored.

This year’s recipient of the Rising Star award is Andrew Watkins, PharmD. Dr. Watkins joined the staff of Nebraska Medicine last July after completing our PGY2 Infectious Diseases Residency program in June 2020. He serves as the pharmacy coordinator for the Nebraska Antimicrobial Stewardship Assessment Program (ASAP) program.

One of his three nominations came from Muhammed Salman Ashraf, MD, who states, “He has been a great team player and worked with ICAP and Global Center for Health Security colleagues, long-term care pharmacies, hospitals, long-term care facilities and many other partners across the state to set up a long-term care monoclonal antibody program which is a unique model across the country.”

*Andrew Watkins, PharmD, was named the Rising Star Pharmacist*

We are thrilled to acknowledge the accomplishments and express our gratitude for the work done by these two pharmacists for Nebraska Medicine and the state of Nebraska this past year. What a great way to launch into the upcoming Antibiotic Awareness Week, than to start off celebrating two of our Antimicrobial Stewardship pharmacists!

Round 2: IDWeek 2021 “Ryder’s Review”

Content provided by Dr. Jonathan Ryder, second year UNMC ID fellow

Now as a second-year fellow (and second year attendee), IDWeek 2021 had a different feel. The virtual conference was no longer a new experience, having done this at IDWeek 2020 and SHEA 2021. While we hope for in-person meetings in the near future, I settled in for this conference a bit easier than last year. Once again this year, I felt quite fortunate to attend this conference as part of my fellowship training, as the emphasis on fellow education at UNMC is clear.

The first day of IDWeek 2021 as a second-year fellow is the Vincent T. Andriole Board Review Course. We covered high-yield material across several sessions, including UNMC’s Dr. Andrea Zimmer presenting on infections in transplant recipients. Next, we had the Fellows’ Day Workshop immediately preceding the meeting. This workshop kicked off with several challenging ID cases. We then had sessions to prepare for job interviews and contracts that provided perspective on our futures. Additionally, we had breakout sessions in areas of career interest, so I attended the session on antimicrobial stewardship.

Officially IDWeek started with 24 hours of COVID-19, the second consecutive Chasing the Sun day. This year focused more on COVID-19 vaccine development. I particularly enjoyed the perspectives on the development of mRNA technology born out of research on RSV vaccines. I also enjoyed learning about research on post-acute sequelae of COVID-19.

The next four days of IDWeek were my favorite: various sessions on innumerable infectious disease topics. With great anticipation prior to IDWeek, I always map out which sessions to attend. However, it is tough sledding given the abundance of high-quality sessions. I try to focus on my areas of interest (antimicrobial stewardship, endocarditis, antibiotic resistance) while balancing this with sessions that I need to learn more about (HIV, outpatient ID). I was fortunate to share my favorite IDWeek sessions with Dr. Sara Dong on the Febrile podcast this year, so check it out to hear a bunch of clinical pearls.

In conclusion, I had a highly educational experience at IDWeek 2021 once again with a wide swathe of expert speakers covering high yield infectious disease topics. However, I truly hope we can have an in-person conference this upcoming year. With two straight years of virtual conference, I have not been able to meet the infectious diseases community in-person, including several fellows that I have interacted with virtually. Here is to hoping to seeing everyone in Washington D.C. in 2022!

COVID-19 vaccines at the Specialty Care Center

(Pictured: Adele Haas, CMA, prepares and administers COVID-19 vaccines to patients at the SCC)

Since mid-August 2021, the Nebraska Medicine Specialty Care Center (SCC) has been busy administering Pfizer BioNTech COVID-19 vaccine to patients at the clinic. Many of these patients were previously hesitant about receiving COVID-19 vaccines elsewhere in the community, but had expressed willingness to complete it at the SCC.

At that time (8/13/21), Just over 70% of the approximately 1200 patients at the SCC had already completed the initial COVID-19 vaccine series. Nichole Regan, APRN at the clinic, stated, “We were really excited about these numbers, but wanted to continue to educate the 30% of our patients that weren’t yet vaccinated, and connect them to vaccination resources. Knowing we could offer the vaccine right here in clinic, we had a hunch that would help patients feel more willing and comfortable to get vaccinated.”

Two months later, the clinic COVID-19 vaccine completion rate has steadily risen to 75%, and the SCC is also now offering Pfizer third doses and booster doses to those eligible.

A small group of patients have received their THIRD dose of a COVID-19 mRNA vaccine, based on guidance released by the CDC in August 2021, directed at immunocompromised patients. In terms of persons with HIV, immunocompromised patients are considered to be those not on antiretroviral therapy (ART), and/or with CD4 counts less than 200 cells/mcL. These guidelines actually impact a very small percentage of patients at the SCC, as over 91% of the patients are on ART with undetectable HIV RNA viral loads.

The SCC has also now ramped up vaccine clinic operations to offer Pfizer COVID-19 vaccine BOOSTERS daily, as all patients with HIV are eligible for a mRNA booster 6 months after receiving the 2^nd dose of either Pfizer or Moderna vaccines (based on HIV as a qualifying medical condition, regardless of viremic control and immune function). They are also providing Pfizer boosters to patients who initially received a Janssen COVID-19 vaccine at least 2 months ago.

Content provided by Nikki Regan, MSN, APRN, NP-C