Rapid ART
(HIV antiretroviral therapy)
Streamlined for non-HIV providers
Updated 3.19.2021
HIV diagnosis:
- confirmed positive,
- or rapid test positive with high probability of confirmed positive based on clinical impression and/or S/CO ratios.
Disclose and evaluate for Rapid ART
- Disclose:
- “Your test shows that you (have/probably have) HIV.” (pause)
- “We’d like to offer you safe and effective treatment today. How do you feel about taking medications?” (pause and listen)
- Labs- add on, draw or order these labs if not already done:
- HIV-1 RNA Quantitative with Reflex to Genotype with RT/PI (Quest 34471 or LabCorp 550432)
- Or Genotype RT/PI alone if RNA quant already done (Quest 34949 or LabCorp 551697)
- CD4 absolute count and % (Quest 7924 or LabCorp 505271)
- CMP
- CBC
- upreg if pregnancy potential.
- Ask 3 screening questions to rule-out previous ART, crypto, TB and PCP if patient wants ART:
- “Have you ever taken HIV medications other than Truvada before?”
- If yes, be sure to get a genotype and consult or do a warm hand-off to an HIV provider who will determine the treatment regimen.
- “Are you having any headaches that are out of the ordinary?”
- If yes, refer for or get a CT to rule out lesion, blood for cryptococcal antigen, LP and admit if abnormal. Start cryptococcal meningitis treatment 2-10 weeks before ART.
- “Have you had a cough for more than 2 weeks, fevers, night sweats or weight loss in past month or so?”
- If yes, refer for or get a chest x-ray and sputa to rule out TB. Start TB treatment 2-8 weeks before ART. For PCP, initiate ART once stable on PCP treatment.
- “Have you ever taken HIV medications other than Truvada before?”
- Prescribe rapid ART and link to care if patient does not report the contraindications above.
- Prescribe Biktarvy 1 tab PO daily, 30-day supply, no refills.
- If pregnant or high potential: prescribe Tivicay 50 mg 1 tab PO + Truvada 1 tab PO daily.
- If has Medi-Cal, write on script: “HIV med, bill to Medi-Cal carve-out” for coverage.
- If no prescriber is onsite, contact your team’s provider via telemedicine if available.
- Provide a warm hand-off: personal call or message to HIV team/provider with patient.
- Highland ED: call HIV team at 510-437-8368 (M-F, 7:30-5:00) or EPIC route to: HIV and HCV (Hep C) Linkage. (e.g. “Started ART, please follow.”)
- Aim for intake visit and med check with HIV team within 1-2 days.
References
- Guidelines followed: DHHS adult HIV ART guidelines 9/2019, IAS HIV ART guidelines 10/2020, SF Rapid ART guide 6/2021.
- The full set of recommended baseline labs include: HIV RNA PCR viral load, CD4, CMP, lipids, pregnancy test, hep A/B/C, TB screen, STIs, HIV RT/PR genotype, cryptococcal antigen if CD4<100.