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PODCAST

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. All clinical discussions presented on Viremic are for informational purposes only and are not offered as medical or clinical practice advice for patients or clinicians. Viremic

health & fitness medicine

All Episodes

29:13

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

Viremic – Cases in HIV ·

2025/12/09

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.,

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37:13

Case 11. Unfolding Stories to Untangle Syphilis Testing

Viremic – Cases in HIV ·

2025/11/25

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 GuidanceCenters for

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30:11

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

Viremic – Cases in HIV ·

2025/11/11

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

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26:12

Case 9. A New TRIO to Reduce ART Complexity

Viremic – Cases in HIV ·

2025/10/28

A 62-year-old patient with HIV for ~40 yrs presents on the life-saving TRIO regimen after a beloved care provider retires. Will a switch improve his quality of life? Eileen and Chris suspect that a change to a once-a-day regimen with fewer pills will maintain his viral suppression and make life easier, but the TRIO regimen inspires dedication in many long-term patients. Would he be open to a switch? Would it confer other benefits? Listen as Eileen and Chris consider the necessity of switch

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29:41

Case 8. Charting a Path Forward

Viremic – Cases in HIV ·

2025/10/14

Subspecialists request simplified ART for a 56-year-old woman with a long ART history, who is taking a DOAC, has evolving renal function, and some drug resistance. Which factors to prioritize? Eileen and Chris have some, but not a complete medical history. Listen as they work through the information they do have, consider 7 questions key in making an ART switch, and evaluate the available options. References and Resources Cited:Paton NI, Musaazi J, Kityo C, et al. Efficacy and safety of

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31:43

Case 7. Newer Kids on the Block: Novel ARVs for...

Viremic – Cases in HIV ·

2025/09/30

How to formulate an effective ART regimen acceptable to 56-year-old man, with unsuppressed HIV, 20+ yr. ART history, extensive drug resistance, and adherence challenges? Listen as Eileen and Chris interpret resistance testing results, discuss barriers to treatment and adherence for this patient, and evaluate the possibility of using one of the novel agents—fostemsavir, ibalizumab, and lenacapavir. What would you do?References and Resources Cited:Emu B, Fessel J, Schrader S, et al. Phase 3

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34:54

Case 6. Is More Really More? Optimizing Options for a...

Viremic – Cases in HIV ·

2025/09/16

Healthy 48-yr old man with HIV for 15 years, stable viral suppression, looking to optimize health—diet, exercise, immune-boosting supplements, safest HIV and HTN meds. Listen as Chris and Eileen discuss their approach to giving patients the good news about their health, health maintenance, supplement use, and whether to stay the course or switch ART regimens in patients who are doing well.Resources:NIH Office of Dietary Supplements: Dietary Supplement Fact Sheets FDA: Information for

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33:12

Case 5. The Heart of the Matter: Cardiovascular...

Viremic – Cases in HIV ·

2025/09/02

New COVID-19 vaccine policy, proviral DNA testing, then the case of a woman with 10+ years viral suppression, CKD, and CVD, identified as a statin candidate after a significant cardiac event. With no family history of CVD, her risks included exposure to older ARVs and smoking 1 to 3 cigarettes/day. Listen as Drs. Scully and Hoffmann delve into non-infectious comorbidities associated with HIV, risk factors, and adjusted CVD risk calculation for women and African Americans.References

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40:55

Case 4. Under Pressure: Cryptococcus, ART Initiation,...

Viremic – Cases in HIV ·

2025/08/19

After brief mention of an HIV vaccine, the hosts turn to the challenges of treating cryptococcal meningitis in a 46-year-old woman with profound immune suppression after being off ART for 6-12 months. Emphasizing the high potential for morbidity and mortality, Chris and Eileen focus on the complexities of cryptococcal meningitis medical management, including the role of immune constitution, timing of ART initiation, and the risk of IRIS. Listen as they work through the treatment

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30:24

Case 3. Preserving the Beans: New Renal Failure and...

Viremic – Cases in HIV ·

2025/08/05

After presenting with fatigue, malaise, and muscle cramps, a 28-yr-old man with history of STIs is diagnosed with new renal failure (Cr >9 mg/dL) and HIV (VL ~3 mil. copies/mL). Drs. Scully and Hoffmann note the missed opportunities for HIV prevention, then review HIV-associated kidney disease and evaluate regimens safe for rapid ART initiation.References CitedBahr NC, Yarlagadda SG. Fanconi Syndrome and Tenofovir Alafenamide: A Case Report. Ann Intern Med. 2019;170(11):814-815. PMID:

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32:02

Case 2. How Low Can You Go? A Case of...

Viremic – Cases in HIV ·

2025/07/22

Mid-50s-yr-old man with HIV since the early 1990s presented for evaluation of persistent low-level viremia, despite consistent engagement in care and ART. Genotypic testing found only a variety of minor mutations. The patient and his care provider were concerned about the health consequences, including the risk of inflammatory diseases in the future, and about implications for U=U. After a brief discussion of the good news on lenacapavir for HIV prevention and a reminder about mpox

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