Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Thera VIII > 14c HIV Regimen Choices Mak > Flashcards

14c HIV Regimen Choices Mak Flashcards

1
Q

For Initial ART Regimens, what does it mean to be in the Preferred DHHS Category?

A

Randomized controlled trials show optimal efficacy and durability. Favorable tolerability and toxicity profiles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For Initial ART Regimens, what does it mean to be in the Alternative DHHS Category?

A

Effective but have potential disadvantages. May be the preferred regimen for individual patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For Initial ART Regimens, what does it mean to be in the Acceptable DHHS Category?

A

Less virologic efficacy, lack of efficacy data, or greater toxicities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 main categories (drug combinations) when choosing the initial treatment?

A

1 NNRTI + 2 NRTIs. OR. 1 PI + 2 NRTIs. OR. 1 II + 2 NRTIs. Fusion inhibitor not recommended in initial ART

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the preferred dual-NRTI pair?

A

TDF/FTC (Truvada). Once-daily dosing. High virologic efficacy. Active against HBV. Potential for renal and bone toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the next alternative if TDF/FTC isn’t used?

A

ABC/3TC (Epzicom). Once-daily dosing. Risk of hypersensitivity reaction if positive for HLA-B*5701. Possible risk of cardiovascular event; caution in patients with CV risk factors. Possible inferior efficacy if baseline HIV RNA > 100,000 copies/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an acceptable dual-NRTI pair if the first two choices are not used?

A

ZDV/3TC (Combivir). BID dosing. Preferred dual NRTI for pregnant women. More toxicities than TDF/FTC or ABC/3TC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the preferred dual-NRTI for pregnant women?

A

ZDV/3TC (Combivir)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the preferred triple therapy that is NNRTI based?

A

EFV + TDF/FTC (Atripla)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the preferred triple therapy that is PI based?

A

ATV/r + TDF/FTC. OR. DRV/r (QD) + TDF/FTC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the preferred triple therapy that is II based?

A

RAL + TDF/FTC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the preferred triple therapy for Pregnant Women?

A

LPV/r (BID) + ZDV/3TC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When doing a treatment/regimen evaluation, what should be done when the status of HIV control is Controlled (VL down and CD4 up)?

A

HIV RNA < 20 = virologic suppression = goal. Continue, change, add agents to be in recommended category

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When doing a treatment/regimen evaluation, what should be done when the status of HIV control is Controlled but intolerant to regimen/toxicity?

A

Substitute from same class, different ADR profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When doing a treatment/regimen evaluation, what should be done when the status of HIV control is Virologic failure?

A

Resistance testing, and offer new regimen: Treatment interruptions if no rational options, Avoid changing to cross-resistant agents, Avoid changing among 1st generation NNRTIs. Empirically replace > 2-3 new agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Virologic Failure?

A

HIV RNA > 400 copies/mL after 24 weeks, > 50 copies/mL after 48 weeks, or > 400 copies/mL after viral suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Incomplete Virologic Response?

A

In patient on initial ART, HIV RNA > 400 copies/mL after 24 weeks on therapy or > 50 copies/mL by 48 weeks (confirm with second test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Virologic Rebound?

A

Repeated detection of HIV RNA after virologic suppression (> 50 copies/mL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Immunologic failure?

A

Failure to achieve and maintain adequate CD4 increase despite virologic suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Lactic Acidosis/Hepatic Steatosis?

A

Rare, but high mortality. Evidently owing to mitochondrial toxicity. Associated with NRTIs (especially d4T, ddl, ZDV). More common in women, pregnancy, obesity, underweight. Clinical presentation variable: have high index of suspicion. Lactate > 2-5 mmol/dL plus symptoms. Treatment: discontinue ARVs, supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Hepatotoxicity like with ARV treatment?

A

Severity variable: usually asymptomatic, may resolve without treatment interruption. May occur with any NNRTI, PI, most NRTIs, or MVC. PIs: Especially TPV, RTV; increased risk in Hepatitis B or C, EtOH, other hepatotoxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Insulin Resistance like with ARV treatment?

A

Insulin resistance, hyperglycemia, and diabetes associated with ZDV, d4T, ddl, some PIs (IDV, LPV/r), especially with chronic use. Mechanism not well understood. Screen regularly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Fat Maldistribution (Lipoatrophy) like with ARV treatment?

A

Peripheral fat wasting more associated with NRTIs, especially thymidine analogues (d4T > ZDV, ddl > TDF, ABC, 3TC, FTC). May be more likely when combined with EFV (boosted PIs). Associated with dyslipidemia, insulin resistance, lactic acidosis. Monitor closely; intervene early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is Fat Maldistribution (Lipohypertrophy) like with ARV treatment?

A

Central fat accumulation more associated with regimens containing PIs and NNRTIs (EFV, RAL). Associated with dyslipidemia, insulin resistance, lactic acidosis. Monitor closely; intervene early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Hyperlipidemia like with ARV treatment?

A

Increased total cholesterol, LDL, and TG (associated w/ all RTV-boosted PIs, EFV, NVP, d4T, ZDV, ABC). Increased HDL seen with EFV, RTV-boosted PIs. Concern for cardiovascular events, pancreatitis. Monitor regularly. Treatment: consider ARV switch; lipid-lowering agents (caution with PI + certain statins)

26
Q

What are Cardiovascular and Cerebrovascular events like with ARV treatment?

A

MI and CVA: risk associated with PIs. Risk of MI with recent ABC and ddl use in some studies. Seen especially in patients w/ traditional CV risk factors. Assess and manage risk factors. Consider ARVs with less risk of cardiovascular events, especially in patients at high risk of CVD. Cardiac conduction abnormalities: PR prolongation with ATV/r, LPV/r. PR and QT prolongation with SQV/r. Avoid if risk factors; baseline and monitoring ECG recommended

27
Q

What is Osteonecrosis (AVN) like with ARV treatment?

A

Associated with PIs

28
Q

What is Osteopenia/osteoporosis like with ARV treatment?

A

Assocaited with various ARVs, particularly NRTIs in combination with PIs or NNRTIs. TDF: greater bone mineral density loss than ZDV, d4T, or ABC

29
Q

What is Rash like with ARV treatment?

A

Most common with NNRTIs, especially NVP (no benefit of prophylactic steroids or antihistamines). PIs especially FPV, DRV, TPV, ATV. NRTIs: especially ABC (consider hypersensitivity syndrome). II: RAL (uncommon). CCR5 antagonist: MVC

30
Q

What is Nephrotoxicity like with ARV treatment?

A

Renal insufficiency associated with TDF, IDV. Nephrolithiasis: IDV, ATV

31
Q

Which ARV is associated with Bone Marrow Suppression?

A

ZDV. Worse when taken with: Dapsone, Hydroxyurea, Ribavirin, Bactrim

32
Q

What are the ADRs like in HIV-Infected Women?

A

Increased risk of certain ARV related ADRs: NVP hepatotoxicity with CD4 > 250, Lactic acidosis, metabolic complications. Avoid EFV with child-bearing potential

33
Q

Which statins are preferred when on ARV therapy?

A

Pravistatin preferred. Can also use Rosuvastatin. Atorvastatin has some DDIs, but can be used if patient has really high LDL

34
Q

In general, how do PIs cause DDIs?

A

3A4 inducers

35
Q

In general, how do NNRTIs cause DDIs?

A

3A4 inducers

36
Q

In general, how does ETR (NNRTI) cause DDIs?

A

2C9 and 2C19 inhibitor

37
Q

In general, how does MVR cause DDIs?

A

3A4 substrate

38
Q

In general, how do RTV and ETR cause DDIs?

A

p-gp inhibitor

39
Q

What is HIV treatment like in Pregnant Women?

A

For women not already on ARVs, consider delaying treatment until 10-12 weeks gestation. In women already on ART, consider continuing therapy, though effects of ARVs on fetus in 1st trimester are uncertain. Perform resistance testing before starting ART or prophylaxis, and for women on ART w/ detectable HIV RNA

40
Q

What are the regimen considerations for pregnant women?

A

Potential PK changes. Potential ADRs. Impact on perinatal HIV transmission risk. Potential short- and long-term ARV effects on the fetus and newborn

41
Q

What treatment options are usually not used in pregnant women?

A

EFV (avoid in first trimester). PIs (optimal levels of some PIs may not be reached, especially in 3rd trimester; once-daily LPV/r not recommended)

42
Q

What is postpartum management like?

A

Continuation of ART for maternal health should be determined on same basis as for pregnant persons. Breast-feeding is not recommended. Avoid premastication of food for the infant. If ARVs are discontinued postpartum, stop all ARVs simultaneously unless the regimen includes an NNRTI

43
Q

When treating a patient with opioid addiction, what is usually ok to use with Methadone?

A

NRTIs (no significant effects on methadone levels; ZDV levels increased)

44
Q

How does HIV-2 compare to HIV-1?

A

Usually longer asymptomatic stage, lower plasma HIV-2 RNA levels, lower mortality rates. Coninfection with both is possible. NNRTIs and Enfuvirtide: HIV-2 is intrinsically resistant

45
Q

What are the treatment options for HIV w/ Hep B co-infection?

A

3TC, FTC, TDF. Peg-interferon alfa, Entecavir, Adefovir. HBV treatment for all with + HBsAg

46
Q

What are the recommendations for HIV w/ HCV co-infection?

A

Defer HIV treatment if CD4 > 500. Treat HCV when CD4 > 200. Treat HIV only when CD4 < 200, hold HCV Rx

47
Q

Which medications should be avoided when treating HIV (CD4 < 200) with HCV co-infection?

A

Avoid d4T, AZT, NVP, TPV if possible

48
Q

What medications are used in HCV/HIV co-infection?

A

Pegylated IFN + Ribavirin x48 weeks. Genotype 1: add NS3/4A PI (Boceprevir, Telaprevir)

49
Q

Which medication combinations should be avoided with HCV/HIV co-infection?

A

Avoid Ribavirin w/ ddI (increased pancreatitis and lactic acidosis). Avoid AZT with Ribavirin (increased anemia)

50
Q

What should be done for patients no on ART that have TB?

A

Need to initiate TB treatment promptly. CD4 < 50, start ART within 2 weeks of starting TB treatment. CD4 > 50, start ART within 2-4 weeks of starting TB treatment, if severe sx (delay ART if clinically stable; but still necessary within 8-12 weeks)

51
Q

What do you need to use prophylaxis for when CD4 > 200?

A

S. pneumoniae, VZV

52
Q

What do you need to use prophylaxis for when CD4 < 200?

A

Pneumocystis pneumoniae

53
Q

What do you need to use prophylaxis for when CD4 < 150?

A

Histoplasma capsulatum

54
Q

What do you need to use prophylaxis for when CD4 < 100?

A

Toxoplasma gondii

55
Q

What do you need to use prophylaxis for when CD4 < 50

A

MAC

56
Q

What treatment options are used for prophylaxis when CD4 > 200?

A

Revaccinate if no PPV within last 5 years. Vaccinate against VZV (Varivax, 3 months apart)

57
Q

What is often used for prophylaxis for Pneumocystis pneumonia (CD4 < 200)?

A

TMP/SMX 1 DS daily

58
Q

What is often used for prophylaxis for Histoplasma capsulatum (CD4 < 150)?

A

Itraconazole 200mg QD

59
Q

What is often used for prophylaxis for Toxoplasma gondii (CD4 < 100)?

A

TMP/SMX 1 DS tab daily

60
Q

What is often used for prophylaxis for Mycobactrium avium complex (MAC) (CD4 < 50)?

A

Azithromycin 1,200mg once weekly. Clarithromycin 500mg BID. Azithromycin 600mg twice weekly

61
Q

What is the basic regimen for PEP (Occupational PEP)?

A

Basic Regimen (FTC + TDF. OR. AZT + 3TC/FTC) + Kaletra (preferred). 4 week regimen recommended

62
Q

What is the basic regimen for Non-occupational PEP?

A

3 ARVs started w/in 72 hours of exposure x28 days. Preferred: EFV or Kaletra + Preferred basic regimen

Thera VIII (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions