ART ADE

Question 1

Enfurvitide

Answer 1

BID SQ injections, local reaction, sclerotic lesion

Question 2

Fostemsavir

Answer 2

Nausea, diarrhea

Question 3

Ibalizumab

Answer 3

IV only

Dizziness, diarrhea, nausea, rash

Question 4

Maraviroc

Answer 4

Rash

Hepatotoxicity

Question 5

INSTIs

Answer 5

Weight gain

esp Dolutegravir + TAF, Biktarvy

Question 6

DTG

BIC

Answer 6

Increase in CrCl by inhibition of OCT2 transporter

Question 7

EVG

Answer 7

Combined with cobi so GI sx, DDI, increase Cr

Question 8

RAL

Answer 8

Fewest drug interactions among INSTI
Elevated CK
Proximal myopathy (with normal CK)
SJS/TEN

Question 9

ddI

D4T

Answer 9

Mitachondrial and metabolic effects:
Lactic acidosis
Hepatic steatosis
Myopathy
Cardiomyopathy
Peripheral Neuropathy
Pancreatitis
Lipodystrophy

Neuropathy and lipodystrophy irreversible (or partially)

Question 10

ddI
D4T
ZDV

Answer 10

Hyperlipidemia

Question 11

ABC

Answer 11

Hypersensitivity Reaction (+HLAB*5701)

Cardiovascular risk?

Question 12

FTC

Answer 12

Discoloratoin of skin, nails, tongue

Question 13

TAF

Answer 13

Weight gain
Renal (CI if CrCl <30)
BMD
(less than TDF)

Monitoring same as TDF:

• Cr - baseline, 2-8 weeks, Q3-6mo
• UA - baseline, Q6mo
• Serum phos if CKD

Question 14

TDF

Answer 14

Bone demineralization

Screening:
-DXA postmenopausal women and men >50

Nephrotoxicity:
-Decreased GFR, Phosphate wasting, Fanconi Syndrome

Question 15

ZDV

Answer 15

Bone marrow suppression
Myopathy (up to 17%)
Fatigue
Lipoatrophy

Question 16

EFV

Answer 16

QTc prolongation
Dyslipidemia
Hepatotoxicity
Neuropsychiatric
Rash

Question 17

ETR

Answer 17

Rash (mild-moderate)

Question 18

NVP

Answer 18

Hypersensitivity reaction with life-threatening rash and/or hepatotoxicity
-Can be accompanied by fever, fatigue, myalgias/arthralgias, blisters, oral lesions, conjunctivitis, facial edema, eosinophila,

Question 19

RPV

Answer 19

QTc prolongation (avoid if other QTc prolonging med)
Elevated Cr (inhibition of tubular secretion)
Neuropsychiatric (but <<< than efavirenz)

Question 20

Ritonavir

Answer 20

Inhibits CYP450 3A enzyme

GI side effects

Question 21

Cobicistat

Answer 21

Inhibits CYP3A enzyme
Reduces tubular secretion of creatinine via competitive inhibition of MATE1 secretion - Benign increase in Cr and (not true) decrease in GFR
-Typically Cr rises 0.1-0.15 in first 8 weeks then stabilizes
—-> Change in Cr >0.4 suggests other cause

GI symptoms

Question 22

PIs

Answer 22

More GI side effects than other classes
—Older PIs worse than newer PIs

Cardiovascular risk

• –HLD, insulin resistance, premature atherosclerosis, MI
• —–Only indinavir and lopinavir-ritonavir w clear MI association

Prolonged PR, AV block (avoid r-boosted PIs if conduction defects or other PR prolonging meds)

Bleeding risk in hemophilia

Question 23

Indinavir

Lopinavir-ritonavir

Answer 23

MI risk association

Question 24

Atazanavir-ritonavir
Lopinavir-ritonavir
Saquinavir-ritonavir

Answer 24

Prolonged PR and AV block

Question 25

Saquinavir-ritonavir

Answer 25

Prolonged QTc

Question 26

Indinavir | Saquinavir

Answer 26

Lipaccumulation, especially with thymadine-analog NRTIs (d4T and ZDV)

Question 27

Atazanavir

Answer 27

Lower potency Hyperbilirubinemia (indirect from inhibition of conjucation) Nephrolithiasis (occurs average 2 years after starting) with rod-shape crystals, stones Ca phosphate or atazanavir - often radiolucent) --Can have crystal nephropathy without stones (rising Cr or sterile pyuria) Cholelithiasis (rare)

Question 28

Darunavir

Answer 28

Abdominal pain/diarrhea - up to 14% Rash 10%, usually mild within first mo then resolves - --Severe rash with fever +/- tranaminitis 1% - -----Increased risk with sulfa allergy (not contraindication)

Question 29

Indinavir

Answer 29

Nephrotoxicity Twice daily Urologic and renal abnormalities: Dysuria, flank pain, renal colic, hematuria, crystalluria, nephrolithiasis, AKI, CKD, papillary necrosis) ---Nephrolithiasis in 1/5

Question 30

Lopinavir-ritonavir

Answer 30

Hyperlipidemia (esp total cholesterol and TG) Diarrhea Alcohol in liquid formulation (do not give to pregnant women or with disulfiram or metronidazole) High pill burden

Question 31

Ritonavir liquid formulation

Answer 31

Alcohol in liquid formulation (do not give to pregnant women or with disulfiram or metronidazole)

Question 32

Saquinavir

Answer 32

High pill burden Prolongd QTc and PR, increases risk of AVB and TdP ---Should not be taken with other QT prolonging meds or if hx prolonged QT

Question 33

Tipranavir

Answer 33

High pill burden Intracranial hemorrhage Hepatotoxicity ---Contraindicated w class B or C hepatic insufficiency

Question 34

Bictegravir Dolutegravir Rilpivirine Cobicistat

Answer 34

Increase Cr by inhibition of tubular Cr secretion but don't impact true GFR

Question 35

DTG

Answer 35

Headache Insomnia Greater weight gain than other ART