Anti-HIV therapy

Question 1

what is considered a low risk of progression viral load?

Answer 1

<5000 copies/mL

Question 2

what is considered high risk of progression viral load?

Answer 2

> 30K-40K copies/mL

-likely to have drug resistant species

Question 3

What are baseline labs to order when presented with HIV pt?

Answer 3

HIV test (western blot)
HIV antibody test (ELISA)
CD4 count
CBC, LFT
SCr, BUN, electrolytes
lipids and blood glucose (if suspect DM)
STD and Hep panals

Plasma HIV RNA if VL > 1000 to determine genotype of HIV

Question 4

what is category A HIV?

Answer 4

asymptomatic dz
persistent generalized lymphadenopathy
acute/primary HIV illness

Question 5

what is category B HIV?

Answer 5

symptomatic

• persistent candidiasis
• fever, diarrhea
• going below 200 CD4 count

Question 6

what is category C? full blown AIDS

Answer 6

CD4s well below 200
symptoms caused by opportunistic infections
-KS, CMV, HSV, PCP, MAC
-usually have a few months to live

Question 7

when does CDC recommend using HAART>

Answer 7

all AIDS pts regardless of CD4 count

asymptomatic pts with CD4 counts below 350

Question 8

what should an HIV pt get with CD4 counts between 350 and 500?

Answer 8

A2 recommended HAART therapy (moderate strength)

-good evidence suggests that you should start

Question 9

what should an HIV pt get with CD4 counts above 500?

Answer 9

B3 recommended HAART therapy (weak)

-no good evidence suggests that this therapy will help

Question 10

what are the NRTIs that are used most?

Answer 10

abacavir
emtricitabine
tenofovir

Question 11

what combo NRTIs are most used?

Answer 11

Truvada
Atripla
-reduces the pill burden

Question 12

which NNRTIs are most used?

Answer 12

nevirapine
efavirenz,
etravirine
rilpivirine

Question 13

which protease inhibitors are used most?

Answer 13

kaletra,

reyataz, atazanavir

Question 14

what is the integrase inhibitors?

Answer 14

raltegravir (isentress)

Question 15

what is the main fusion inhibitor?

Answer 15

enfuvirtide (injectable)

Question 16

what is the number one preferred NNRTI regimen combination drug?

Answer 16

atripla

Question 17

what is preferred PI based regimen combination for pregnant women?

Answer 17

lopinavir/ritonavir (BID) + zidovudine + lamivudine

Question 18

what is a ritonavir boosted regimen?

Answer 18

ritonavir blocks liver metabolism of other drug so the other drug can stay around longer

Question 19

what does the INSTI based regimen include?

Answer 19

raltegravir + TDF/FTC

Question 20

which class of HIV drugs require renal adjustments?

Answer 20

NRTI except for abacavir

Question 21

what side effects do NRTIs have?

Answer 21

lactic acidosis
hepatomegaly
steatosis

Question 22

what side effects does zidovudine have?

Answer 22

anemia
nausea
HA

Question 23

what side effects does tenofovir have?

Answer 23

renal issues

Question 24

what side effects do didanosine and stavudine have?

Answer 24

mitochondrial toxicity

Question 25

which nuc drug combinations are not given?

Answer 25

AZT, D4T
DDI/D4T
AZT/DDI
TDF/DDI
don't use didanosine

Question 26

what side effects does efavirenz have?

Answer 26

category X, CNS problems, rash, must take on empty stomach

Question 27

what side effects does have nevirapine?

Answer 27

hepatotoxicity

f must have CD4 <400

Question 28

what are major toxicities of PI class of drugs?

Answer 28

metabolic toxicities (ie hyperlipidemia, osteoporosis)
all are CYP450 substrates and have many drug interactions

Question 29

when should PIs be taken?

Answer 29

with food

Question 30

when should NNRTIs and nucs be taken>

Answer 30

on an empty stomach