[Crew member audio] Alright Charles. And go, and here we go, camera set, pictures up, and everyone ready, and, action!

[On-screen] This video contains the personal views, opinions, and experiences of the featured healthcare providers (HCPs). The HCPs have been compensated by Gilead for participating in this video.

[On-screen] HIV LEADERS UP CLOSE

[On-screen] “Living with HIV Today”
Lisa Spacek: I'm so excited to be here. I really think that the changes that have happened in HIV care and therapy are something that we need to sit down and think about, and remember from where we've come.

[On-screen] Lisa Spacek, MD
Philadelphia, PA
Theo Hodge, MD
Washington, DC

Looking Back on HIV [0:26]

June Gipson: So Lisa, over the past 40 years, how has it changed for you?

[On-screen] June Gipson, PhD, EdS
Jackson, MS

Lisa Spacek: It's changed quite a bit, but in some ways it's stayed exactly the same.

[On-screen] 1981: HIV is first reported in the US by the CDC.¹

1987: The first antiretroviral therapy is FDA approved to treat HIV.¹

2006: The first single-tablet regimen ART is FDA approved to treat HIV.²

ART, antiretroviral therapy; CDC, US Centers for Disease Control and Prevention; FDA, US Food and Drug Administration.

Lisa Spacek: And I think that the important work that brought me to the space of HIV is something that's been consistent, because of the way that HIV profoundly changes people's lives. And the idea that 40 years ago we managed so many toxicities, side effects of medication, trying to take medicines around different mealtimes, and how we do it today is a phenomenal difference.

Theo Hodge: As our treatments have evolved, we actually can tailor therapy to the patient, because they have options. Now remember, in 1996, there was no options. No, you took what you had and you had to do with what you had that we did the best we had with what we had.

June Gipson: And I would say with the evolution of the medication, it feels as if it's almost addressing the social determinants of health. Because I remember when you had to eat, you had to have food. And there were times when people, they didn't have food. And so you're pretty much balancing out your life on how you're going to feel that day with medication.

And so when you create medications that can make it easy for a person in their life, because mind you, the people that I deal with, they're already encountering poverty, their homelessness, there's so many other factors that's impacting their lives. But once you have these choices where you can actually get medication the way that you want to get the medication, and it's not creating side effects that prevent you from working, going to school, you can live a long, healthy life.

[On-screen] When taken as prescribed, HIV medications can help people with HIV to live longer, healthier lives.³

Lisa Spacek: I really want to pick up on that, June, because I remember when it was said, “We're not going to die with this. We're going to live with this.”

The Importance of Education [2:29]

June Gipson: Education is so important. I like to liken that to when you get on the airplane, and if you've flown before you know the message, put your seatbelt on. If we lose oxygen, this is going to drop down. It's the same message. And if you've flown for a long time, it's like you know the message. But you also have to keep in mind, it's always someone's first time.

Theo Hodge: Who doesn't know the message.

June Gipson: Who doesn't know. And so because we're going to always have someone who doesn't know about HIV, doesn't understand HIV, that doesn't understand implications of HIV. We have to keep the education going.

Theo Hodge: And you're right, education, education, education. That's the only way to get through the stigma. I mean, that is how you disperse stigma is with education.

Lisa Spacek: We go for it.

Theo Hodge: Yes, we do that! We do it!

Lisa Spacek: We go for it in HIV, because we can. And that makes it all work out so much better. So what we've seen is medications that are good long-term solutions. We've seen that medication regimens are simplified. So we've really moved from a time when we've had to bring so many resources to bear and now we still do, but in a different way, with medications that aren't as toxic, aren't as complicated, fewer pills, all that has made it a different practice.

Theo Hodge: So let's talk about U=U.

Undetectable=Untransmittable (U=U) [3:52]

Theo Hodge: Lisa, could you explain that for our audience and give us some context of how that has impacted your patient practice?

Lisa Spacek: So U=U means undetectable is untransmittable. And what that means is that if a patient or a person achieves viral suppression for 6 months, they're no longer able to transmit HIV to another person. That means that the person who's living with HIV doesn't feel infectious and they don't feel like they could be harmful to another person. I was so happy to be able to tell that to people, because once I started to explain it, I almost felt like some people looked lighter.

[On-screen] According to the DHHS guidelines, getting to and staying undetectable (viral load <200 copies/mL) for at least 6 months prevents sexual transmission of HIV.⁴

DHHS, US Department of Health and Human Services.

Theo Hodge: It really did.

Lisa Spacek: The burden and the weight of feeling like you could hurt somebody was so hard. And the idea that infectious diseases are infectious diseases, it's the nature of the work of infectious disease practitioners and the truth of transmission of viruses. U=U changes that. It changes that completely. The idea of not being transmittable brings us to the idea that we really can end the HIV epidemic.

[On-screen] The Ending the HIV Epidemic in the US (EHE) initiative focuses on 4 key strategies that, implemented together, aim to reduce new HIV infections by 90% by 2030⁵:

DIAGNOSE all people with HIV as early as possible.

TREAT people with HIV rapidly and effectively to reach sustained viral suppression.

PREVENT new HIV transmissions by using proven interventions, including PrEP and syringe services programs.

RESPOND quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.

PrEP, pre-exposure prophylaxis.

[On-screen] References: 1. National Institutes of Health. Progress against HIV/AIDS timeline. Reviewed August 23, 2024. Accessed November 11, 2024. https://www.oar.nih.gov/about/progress-against-hivaids-timeline 2. US Food and Drug Administration. The history of FDA's role in preventing the spread of HIV/AIDS. Reviewed March 14, 2019. Accessed October 9, 2024. https://www.fda.gov/about-fda/fda-history-exhibits/history-fdas-role-preventing-spread-hivaids 3. MedlineLine Plus. Living with HIV. Updated July 16, 2024. Accessed December 31, 2024. https://medlineplus.gov/livingwithhiv.html 4. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Department of Health and Human Services. Updated September 12, 2024. Accessed October 9, 2024. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf 5. Centers for Disease Control and Prevention. Ending the HIV Epidemic in the US Goals. Published March 20, 2024. Accessed November 11, 2024. https://www.cdc.gov/ehe/php/about/goals.html

GILEAD and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners.
© 2025 Gilead Sciences, Inc. All rights reserved. US-UNBP-2923 03/25

Introduction [0:00]

[On-screen] This video contains the personal views, opinions, and experiences of the featured healthcare providers (HCPs). The HCPs have been compensated by Gilead for participating in this video.

[On-screen] HIV LEADERS UP CLOSE

[Crew member audio] And action.

[On-screen] “Initiating Antiretroviral Therapy: Guidelines-Based Considerations”

Ann Khalsa: I think it's important for providers to be aware of the guidelines, particularly for initiation.

Ann Khalsa, MD, MSEd
Phoenix, AZ

DHHS Guidelines: Baseline Testing for Entry into HIV Care [0:13]

[On-screen] DHHS, US Department of Health and Human Services.

[On-screen]
Lisa Spacek, MD
Philadelphia, PA

Lisa Spacek: So, if you would join me in talking

[On-screen]
Theo Hodge, MD
Washington, DC

Lisa Spacek (cont’d): about the testing that we do for initiation.

The 2 tests that I would start off with include the viral load and the T-cell CD4 count. So the viral load importantly is an RNA test.

[On-screen]
TESTS FOR MONITORING HIV PROGRESSION*

• Viral load
• CD4 count

*Please see the full US Department of Health and Human Services guidelines comprehensive list of laboratory tests for entry into HIV care.

It's not the diagnosis that's the antibody; it's the viral load that is the copies per mL of virus that can be detected in the blood. And so that to me is a very objective marker of so many things.

Then there's the CD4 T-cell count.

So this T cell or lymphocyte is something that measures the robust nature of the immune system.

And then we can get a sense for whether or not a patient is at risk for other kinds of infections like tuberculosis or cytomegalovirus, or these other opportunistic infections that can happen at different degrees of immunosuppression.

Ann Khalsa: Those are the tests that are unique to HIV.

So they always have to come in for labs, because we measure our treatment success by that viral suppression of the viral load.

Lisa Spacek: That's great.

Ann Khalsa: And the most important one timewise is that viral load because as soon as the patient starts taking the medicines, that viral load is going to suppress.

[On-screen] According to the DHHS, after initiation of ART, viral load reduction to below limits of assay detection usually occurs within the first 12 to 24 weeks, when taking their treatment as prescribed.

ART, antiretroviral therapy; DHHS, US Department of Health and Human Services.

Theo Hodge: Exactly.

Additional Laboratory Testing [1:47]

Theo Hodge: The additional labs you have to use, I mean you have to get the basic, okay, we want to know what your kidney function's going to be, what's your liver function going to be? So, you want to get those basic labs. And then we know that from some of our drugs that are guideline recommended, we want to know their hepatitis B status because if they're chronically hepatitis B positive, then you're going to want to know and inform the patient and teach that patient.

[On-screen]
ADDITIONAL LABORATORY TESTING*

• Basic metabolic panel
• Urinalysis
• ALT, AST, total bilirubin
• Hepatitis B

*Please see the full US Department of Health and Human Services guidelines comprehensive list of laboratory tests for entry into HIV care.

Lisa Spacek: So important.

Theo Hodge: Exactly. And you want to know, you know, there are other hepatitis serologies, the A and C, and then of course you want to know all of their STIs. Our patients are coming in. That's when you do your sexual history and you swab everything that you can, because with one sexually transmitted infection comes other sexually transmitted infections.

[On-screen]
ADDITIONAL LABORATORY TESTING*

• Hepatitis A & C

*Please see the full US Department of Health and Human Services guidelines comprehensive list of laboratory tests for entry into HIV care.

Ann Khalsa: Absolutely.

Theo Hodge: So those are some of the basics that we always check when we're looking at the basic initiation labs.

Lisa Spacek: I would add pregnancy.

Theo Hodge: Of course.

[On-screen]
ADDITIONAL LABORATORY TESTING*

• Pregnancy test

*Please see the full US Department of Health and Human Services guidelines comprehensive list of laboratory tests for entry into HIV care.

Lisa Spacek: So pregnancy test, and I would also add the complete blood count.

[On-screen]
ADDITIONAL LABORATORY TESTING*

• Pregnancy test
• CBC with differential

*Please see the full US Department of Health and Human Services guidelines comprehensive list of laboratory tests for entry into HIV care.

Lisa Spacek: I think that that is a part of the information gathering that helps direct the care.

Ann Khalsa: So one of the things that I have loved the most about being an HIV provider all these decades is I was trained actually in family medicine, so I was trained to be comprehensive and focus on health maintenance. And so I like looking for all these other health maintainable items, cholesterol, tuberculosis, vitamin D, osteoporosis, all this other stuff that we do as part of our...

[On-screen]
ADDITIONAL LABORATORY TESTING*

• Lipid profile
• Random or fasting glucose

*Please see the full US Department of Health and Human Services guidelines comprehensive list of laboratory tests for entry into HIV care.

Ann Khalsa (cont’d): ...comprehensive service, because our folks do unfortunately age a little faster because the immune system is always revved up. And so they've got chronic inflammation, and so they're getting more heart disease and more cancers, et cetera. So, we also check all those other things at baseline when they come in and then annually just to maintain their health.

[On-screen]
DHHS GUIDELINES LIST OF LABORATORY TESTS FOR ENTRY INTO HIV CARE*

✓ HIV antigen/antibody testing
✓ CD4 count
✓ HIV viral load
✓ Genotypic resistance testing
✓ Hepatitis A, B, C
✓ Basic metabolic panel
✓ ALT, AST, total bilirubin
✓ CBC with differential
✓ Lipid profile
✓ Random or fasting glucose
✓ Urinalysis
✓ Pregnancy test

[QR Code] View the DHHS guidelines

*This list is not exhaustive. Please see full DHHS guidelines list of laboratory tests for entry into HIV care.

ALT, alanine aminotransferase; AST, aspartate aminotransferase; CBC, complete blood count; CD4, cluster of differentiation 4; DHHS, US Department of Health and Human Services.

Selecting an ARV Regimen: Considerations for Initial Therapy [3:47]

[On-screen] ARV, antiretroviral.

Ann Khalsa: I think the guidelines need to be looked at in their entirety and then you can get down to details. The most important thing is to pick a regimen that they will take, that is tolerable, that's not going to have a bunch of side effects, too many pills, too complicated, they can't remember it. But of course, it has to be powerful enough that we can do rapid start, that we can start immediately.

[On-screen]
Some factors to consider when selecting an initial ARV regimen:

• Potential adverse events and drug-drug interactions
• Pill burden
• Dosing frequency
• Virologic efficacy
• Genetic barrier to resistance
• Potential of transmitted resistance to components
• HLA-B*5701 testing requirement

Theo Hodge: Exactly. And I think a term that we use often when we're talking about HIV management is genetic barrier. So when we're talking about a new patient, the guidelines would suggest that we use a very high genetic barrier so that the likelihood, because most often we're doing rapid start, at least we do in my clinic, you're playing guess your best.

[On-screen]
DHHS-recommended regimens are those with demonstrated durable virologic efficacy, favorable tolerability and toxicity profiles, and ease of use.

DHHS, US Department of Health and Human Services.

Theo Hodge: So, because you're going to get a resistance test, but that resistance test is going to be pending at the time that you start your medications. So, you want to choose a high barrier to resistance.

[On-screen]
The DHHS also recommends that providers consider selecting a regimen with a high barrier to resistance.

DHHS, US Department of Health and Human Services.

Ann Khalsa: It's always a boost for me personally to get together with colleagues who are equally dedicated and have committed themselves to this. And again, as you said, to share this with the next generation because our patients now, they're surviving HIV and they need continued care. So thank you for what you do.

Theo Hodge: And, you know, one day we will retire. So y'all need to learn this.

[Laughter]

[On-screen] Reference: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Department of Health and Human Services.
Updated September 12, 2024. Accessed February 27, 2025. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

GILEAD and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners.
© 2025 Gilead Sciences, Inc. All rights reserved. US-UNBP-3311 05/25

Introduction [0:00]

[Crew member audio] Alright Charles. And go, and here we go, camera set, pictures up, and everyone ready, and action!

[On-screen] This video contains the personal views, opinions, and experiences of the featured healthcare providers (HCPs). The HCPs have been compensated by Gilead for participating in this video.

[On-screen] HIV LEADERS UP CLOSE

[On-screen] “Introduction to HIV Resistance”

Drug Resistance Can Cause HIV Treatment to Fail [0:13]

Jay Gladstein: It's interesting that HIV has the highest—biological mutation rate known to science. It mutates quickly.

[On-screen] Jay Gladstein, MD
Los Angeles, CA

Linda Wesp: Yeah, yes, yes.

[On-screen] Linda Wesp, PhD, MSN, RN, FNP-C
Milwaukee, WI

Krisczar Bungay: Viruses are smart, might be smarter than human beings.

Linda Wesp: That's what I always say.

Krisczar Bungay: They can change, and once they adapt,

[On-screen] Krisczar Bungay, MD
New York, NY

Krisczar Bungay (cont’d): And the medicines that you're giving them are no longer effective.

[On-screen] Will Giordano-Perez, MD,
MBA
Silver Spring, MD

Krisczar Bungay: Then they develop this resistance to that drug that perhaps you can't use anymore. And even worse, you can't use the whole class of drug anymore.

[On-screen] HIV drug resistance HIV drug resistance occurs when the virus mutates and affects the ability of ART to block its replication.¹
ART, antiretroviral therapy.

Not All HIV Regimens Have the Same Barrier to Resistance [0:44]

Jay Gladstein: The guidelines recommend that we start with a regimen that has what we call a high genetic barrier to resistance. And the same holds true with switchs. If we're choosing to switch a regimen for whatever reason, maybe it's for convenience or side effects or decreased number of tablets, the guideline recommendation is to switch to a regimen with also that high genetic barrier to resistance. And it's really so amazing now that we have that available to us.

[On-screen] an ARV’s genetic barrier to resistance can be defined as the number of mutations needed to cause resistance. ARVs with a high barrier to resistance require more mutations before resistance develops.²

DHHS guidelines recommend choosing a regimen with a high barrier to resistance when selecting an initial ARV regimen or optimizing treatment.³

ARV, antiretroviral; DHHS, US Department of Health and Human Services. .

Resistance Can Potentially Limit Future Treatment Options [1:31]

Will Giordano-Perez: What can we do to set our patients up for success, while at the same time addressing what is often leading our patients to develop resistance, or mutation, versions of their HIV? And so ultimately, I think what worries me the most is when I must de-simplify, or a make more complex, a treatment regimen because someone has not been adherent to a single-pill regimen, for instance.

[On-screen] Counsel patients to take their HIV medication as prescribed.³

Will Giordano-Perez: so, I now have to make their regimen more complicated. And so whatever barriers were already in place in their life to make the one pill a day hard, we've now multiplied those barriers, and we've made it twice or 3 times as hard.

Linda Wesp: Sometimes we have our pill charts sometimes and so I'll, as I'm teaching NP students, I'll be like, this is what I use to sit down with my patients and be like, listen, if this whole group, this whole line of pills, we're not going to be able to use if we develop resistance to this class.

Jay Gladstein: So, Will, we're talking about this general concept of resistance and so far, we've been talking about resistance in an individual, but how does that affect the community that that person is a part of?

The Impact of Resistance on a Community [2:39]

Will Giordano-Perez: Coming back out from a bird's-eye view and looking at how that affects our patients and their entire communities, I think is a powerful way to look at it. And so generally, I think the ways in which we have these conversations are around the fact that we are not sexual beings living on islands. We live within networks and sexual networks. And so, if I have a patient who's developing a resistant strain of HIV and is sexually active within their sexual network, well now the HIV that any of those individuals meet is a resistant variant of HIV. And so that resistance spreads within the community. It can be obtained and acquired within a community.
And it's also going to lead to more complicated medication regimens for those individuals at the time of diagnosis.

[On-screen] Drug resistance, once acquired, is permanent and may require more complicated treatment regimens.³

Jay Gladstein: From the get-go. They've done nothing, they've never been on medication, but the virus they acquired already has its signature of resistance mutations.

Will Giordano-Perez: Yeah. I mean, this is probably where most of my conversations around resistance come up, because in my kind of generation of HIV care, it's about destigmatizing HIV and having HIV. And that includes resistance.

Jay Gladstein: Yeah, to your point, we've got some really powerful tools for suppressing the virus, suppressing the community's viral load.

Linda Wesp: Yeah, there's a lot of reason for hope. And I think again, making sure to somehow destigmatize and encourage to take this team approach, not just for that individual person but for the community.

[On-screen] References: 1. Drug Resistance. HIV.gov. Reviewed August 4, 2021. Accessed October 9, 2024. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/drug-resistance 2. Gardner EM, Burman WJ, Steiner JF, et al. Antiretroviral medications adherence and the development of class-specific antiretroviral resistance. AIDS. 2009;23(9):1035-1046. 3. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Department of Health and Human Services. Updated September 12, 2024. Accessed October 9, 2024. https://clinicalinfo. hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

GILEAD and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners. © 2025 Gilead Sciences, Inc. All rights reserved. US-UNBP-2924 03/25

Introduction [0:00]

[Crew member audio] Alright Charles. And go, and here we go, camera set, pictures up, and everyone ready, and, action!

[On-screen] This video contains the personal views, opinions, and experiences of the featured healthcare providers (HCPs). The HCPs have been compensated by Gilead for participating in this video.

[On-screen] HIV LEADERS UP CLOSE

[On-screen] "A Closer Look at HIV Resistance: Important Terms and Tests”

Jay Gladstein: So the wild-type virus is essentially the virus that exists in the wild,

Wild-Type HIV [0:18]

[On-screen] Jay Gladstein, MD, Los Angeles, CA

Jay Gladstein: Before that evolutionary pressure that medication poses to the virus before it's had a chance to—

[On-screen] Linda Wesp, PhD, MSN, RN, FNP-C, Milwaukee, WI

Jay Gladstein (cont’d): —have an impact and select out—

[On-screen] Krisczar Bungay, MD, New York, NY

Jay Gladstein (cont’d): —certain resistance mutations.

[On-screen] Will Giordano-Perez, MD, MBA, Silver Spring, MD
Jay Gladstein: So the wild type is what that population of virus looks like before there's that artificial introduction of medication.

Will Giordano-Perez: So something that comes up sometimes is the difference between transmitted resistance versus acquired resistance. How do you go about explaining that?

Transmitted Resistance vs Acquired Resistance [0:53]

Jay Gladstein: So that's an important difference. We often associate acquired resistance with something the patient did, meaning that they didn't take the medication on time and resistance acquired, was acquired while they were taking medication. But people can also have transmitted resistance, meaning that the virus that was transmitted to them that they got at the time that they were infected with HIV, that transmits with it all of the resistance that it already had. So people can have resistance when they first show up as HIV positive.

Will Giordano-Perez: Hence our guidelines to do resistance testing at the time of diagnosis.

Jay Gladstein: Exactly.

[On-screen] DHHS guidelines recommend that providers conduct genotypic drug-resistance testing at baseline during initial visits.¹

DHHS, US Department of Health and Human Services.

[On-screen] Acquired resistance: When a drug-resistant strain of HIV emerges while a person is on ART for HIV treatment.²

Transmitted resistance: When a person acquires a strain of HIV that is already resistant to certain ARV drugs.³

The likelihood of developing drug resistance is dependent on the level of ART in the plasma while the HIV virus is replicating. Several factors may contribute to suboptimal drug levels, including adherence challenges, drug absorption, and drug-drug interactions.¹

ART, antiretroviral therapy; ARV, antiretroviral.

Using Resistance Tests to Detect HIV Viral Strains [1:58]

Will Giordano-Perez: What are the different types of resistance testing that we do?

Krisczar Bungay: We have 3 different types of resistance testing. There's the genotype testing.

I do that on all my new patients. There's a phenotype testing that takes a lot longer to get, but I think it's more important if you're concerned about protease inhibitors. I think that's really the big goal of that test. And genotype, you can get it much faster these days, you can get it in 2 weeks.

[On-screen] Phenotypic resistance assays can be used to assess RT, PR, and IN resistance.¹

IN, integrase; PR, protease; RT, reverse transcriptase.

Krisczar Bungay: And then you have those patients who you might want to simplify their regimen and you don't have any testing, and that's the proviral DNA testing. So that does not require a viral load. It can be undetectable. Sometimes you may not get results, even if they're undetectable. That does happen. If it doesn't show up, it doesn't mean you don't have it. It's not very specific, unfortunately. But it might help you, let's say, oh, you have this, therefore you can't do this, but it may not help you so much when it's not there.

[On-screen] TYPES OF RESISTANCE TESTS
Genotypic assays detect drug-resistant mutations in HIV genes.¹

Phenotypic assays measure the extent to which a person’s strain of HIV will multiply in different concentrations of ARV drugs. The addition of phenotypic to genotypic resistance testing is recommended for people with known or suspected complex drug-resistance mutation patterns.¹

Proviral DNA analysis is a next-generation sequencing genotypic resistance assay designed to detect hidden or archived resistance mutations and does not require a viral load.^1,4 It is used to guide regimen optimization while a patient is virologically suppressed.¹

ARV, antiretroviral; DNA, deoxyribonucleic acid.

Linda Wesp: Jay, what are like if you could just list some resistance mutations, what are the ones that come to mind that you might see commonly on resistance panel?

Jay Gladstein: So some of the common ones would be M184V, K103N, E138, and there's a variety of E138s: E138K, for example. Those are some of the common ones that we watch out for that may guide our treatment decisions.

[On-screen] Some common resistance mutations today^5,6:

• M184V (NRTI RAM)
• K103N (NNRTI RAM)
• E138K (NNRTI RAM)

This list is not inclusive of all common resistance mutations.

NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; RAM, resistance-associated mutation.

Krisczar Bungay: I actually write down in their history, when you can write their HIV status, what resistance they have. In case you're no longer the provider for that patient.

Jay Gladstein: Resistance is a permanent comorbidity. It's like having an additional medical condition that we need to think about and treat a little differently.

“We're Part of a Community of Other Treaters” [4:00]

Linda Wesp: Sometimes I dial up phone a friend, “Hey, what would you do?” I still will do that if I have a complicated panel of resistance.

Jay Gladstein: That’s a great point.

Linda Wesp: Sometimes I'm not thinking of something or whatever it might be. So I'll use my resources.

Jay Gladstein: That's a great point. We're not, even if we're practicing by ourselves in our own office, we're not practicing alone. There's always other people. We're part of a community of other treaters and generally people are going to be very happy to reach out and help.

[On-screen]

[Gilead Logo]

References: 1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. US Department of Health and Human Services. Updated September 12, 2024. Accessed October 9, 2024. https://clinicalinfo. hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf 2. HIV.gov. HIV/AIDS Glossary Acquired Resistance. Accessed December 31, 2024. https://clinicalinfo.hiv.gov/en/glossary/acquired-resistance 3. Drug Resistance. HIV.gov. Reviewed August 4, 2021. Accessed October 9, 2024. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/drug-resistance 4.Monogram Biosciences. GenoSure Archive^®. Accessed October 9, 2024. https://monogrambio.labcorp.com/resources/suppression-management/genosure-archive 5. Stanford University HIV Drug Resistance Database. NRTI Resistance Notes. Updated March 9, 2024. Accessed October 9, 2024. https://hivdb.stanford.edu/dr-summary/resistance-notes/NRTI/ 6. Stanford University HIV Drug Resistance Database. NNRTI Resistance Notes. Updated March 9, 2024. Accessed October 9, 2024. https://hivdb.stanford.edu/dr-summary/resistance-notes/NNRTI/

GILEAD and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks are the property of their respective owners. © 2025 Gilead Sciences, Inc. All rights reserved. US-UNBP-2943 03/25

Introduction [0:00]

[Crew member audio] Alright Charles. And go, and here we go, camera set, pictures up, and everyone ready, and, action!

[On-screen] This video contains the personal views, opinions, and experiences of the featured healthcare providers (HCPs). The HCPs have been compensated by Gilead for participating in this video.

[On-screen] HIV LEADERS UP CLOSE

[On-screen] "Getting Ahead of Resistance: 3 Clinical Considerations”

1 The Importance of a High Barrier to Resistance During ART Selection [0:14]

ART, antiretroviral therapy.

Jay Gladstein: We have really come an enormous way when it comes to HIV therapy, and we do have regimens that have a very high genetic barrier to resistance. But not all barriers are the same.

[On-screen] Jay Gladstein, MD, Los Angeles, CA

Jay Gladstein: I had a patient that was on the regimen—

[On-screen] Will Giordano-Perez, MD,
MBA, Silver Spring, MD

Jay Gladstein (cont’d): And it happened to have a lower genetic barrier. And despite what we know was perfect adherence,

[On-screen] Krisczar Bungay, MD, New York, NY

Jay Gladstein (cont’d): it failed and that patient developed resistance. So we had to switch to another regimen.

[On-screen] Linda Wesp, PhD, MSN, RN, FNP-C, Milwaukee, WI

Jay Gladstein: Thankfully it's working, but it's important even in this era where we don't do these long, complicated studies and discussions about all of these different resistance mutations, resistance is still a thing. It is just part and parcel of what this virus is. So we have to keep it in mind. Regimens can fail.

2 Counsel Individuals on How Resistance Can Impact Them [1:07]

Will Giordano-Perez: So we talked about the importance of actually educating our patients on the risk for resistance. What do you say when they ask, “Well, if I were to develop resistance, is it possible that resistance might go away or could it fix itself?”

Krisczar Bungay: I get that question quite a lot actually. Yeah, I tell my patients, once you have the resistance, it's permanent, it's never going to go away. And you have to keep that in mind in future regimens for that patient. And so yeah, it's forever.

Linda Wesp: I don't want to scare people around the resistance conversation, so I feel like I try to navigate this very fine line of figuring out where are they at and what do they know. But I think for me, the conversation of resistance comes up with a way I try to be motivating around adherence.

3 Discuss Adherence and Understand Potential Obstacles [1:54]

Jay Gladstein: In general, how do we counsel patients even with the possibility of failure being there? We always want to give a patient hope, because if they don't have that hope and that trust, we're not going to be able to give them the basic counseling we need to give them.

[On-screen] The DHHS recommends that providers should inform individuals starting ART of the importance of adherence in achieving and maintaining viral suppression.

ART, antiretroviral therapy; DHHS, US Department of Health and Human Services.

Linda Wesp: I try to, all the way from the start is just be like, “Hey, just let's just keep it real. You don't have to lie to me about or make up a story.” I know most of the reason people don't take meds is usually not because they’re not wanting to, it's usually a systemic thing like a pharmacy issue or something else going on.

Will Giordano-Perez: Sometimes those little bits, it's the little things that can absolutely be game-changing. When we talk about adherence, knowing whether or not my patient has to hide their medications from their partner, are they in an abusive relationship? Were they recently incarcerated and started on a more complicated regimen, because that’s what was covered in the prison system and then hated it, had terrible side effects, stopped taking it, and now here they are without meds. Initially on the surface we can see them as being nonadherent, or worse, noncompliant, and recognize that there's a lot more to that story. But if I didn't create that space for them to share that story with me, I wouldn't know that information.

Will Giordano-Perez (cont’d): My role is to take what I know, what I've learned both scientifically, but also what I know and learned about my patient. Put those things together, and provide them with some amount of advice that's going to actually set them up for success.

[On-screen] Supporting individuals and understanding potential barriers to adherence are fundamental to achieving treatment success.

[On-screen] Reference: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Department of Health and Human Services. Updated September 12, 2024. Accessed October 9, 2024. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf

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