Block 4 - HIV/OI Flashcards
What is AIDS?
Caused by HIV
CD4 count <200
What kind of virus is HIV and what receptors do they have?
Enveloped single-stranded RNA retrovirus that has its own reverse transcriptase and integrase
gp41 glycoprotein with a gp120 docking glycoprotein
CD4 count and viral load + HIV
Within 2-8 wks, viral load spikes up and CD4 goes down.
Then in 1-3 months, CD4 goes back up, but not to normal limit and viral load dramatically goes down
Then after 2 years, viral load steadily goes up and CD4 goes down
When diagnosing for HIV, what kind of test should you get?
4th gen
Tests for IgG, IgM, and p24 antigen
**takes 2-3wks
What is considered the “backbone regimen” of HIV Tx?
Always 3 drugs
2 of them are NRTI
Third drug is an INSTI or NNRTI, sometimes PI
Start ASAP and use a back up for first 6 months and until viral load is under 200
What are the NRTIs?
Lamivudine
Emtricitabine
Abacavir
Tenofovir disoproxil or ala.
What are the NNRTIs?
Ends with “virine” or is efavirenz
What are the integrase inhibitors?
Ends with “gravir”
What are the protease inhibitors?
Ends with “navir”
NRTI MOA?
DNA analogue that prohibits reverse transcriptase of viral RNA to viral DNA
When prescribing your two NRTIs, how should you do it?
Either Tenofovir or Abacavir
with either emtricitabine or lamivudine
Abacavir info?
Avoid w/ heart issues
Must have HLA 5701*B testing prior to initiation
Metabolized by liver only (no kidney adjustments)
Tenofovir DF info?
Renal impairment
Bone demineralization
Decreases in lipids
Has generic drug
Tenofovir alafenamide info?
Wt gain with INSTI
Does NOT decrease lipids
Brand only
INSTI AE?
Wt gain
DDI w/ polyvalent cations (2hrs before or 6 hours after)
Dolutegravir and Bictegravir has neural tube defects
DDI of Dolutegravir?
RIF
Which INSTI is an injectable?
Cabotegravir awaiting FDA approval
Efavirenz counseling?
Bedtime on empty stomach
Has CNS effects (nightmares, psychosis, depression, etc)
Dont use if HIV load >100k
Rilpivirine counseling?
Take w/ water AND high calorie meal to increase absorption
Dont take w/ PPIs, caution with H2RAs or antacids, DDI with warfarin or decadron
QTc prolongation
Dont use if viral load >100k or CD4 <200
Protease Inhibitors class AE?
Hyperlipidemia, lipodystrophy/fat redistribution, insulin resistance
Darunavir counseling?
Take w/ food
Must be boosted w/ PK enhancer
What are the PK enhancers that are used?
Ritonavir and Cobicistat
What drug regimen must be used in PrEP?
Tenofovir DF + emtricitabine
Must have a negative HIV test too
What drug regimen must be used in PEP?
Tenofovir DF + Emtricitabine + dolutegravir or raltegravir for 28 days within 72 hrs of exposure
What additional immunizations are needed for peeps with HIV?
Pneumococcal, meningitis, HPV, HAV, HBV
Pros and Cons of PrEP?
Pro: Prevents HIV
Cons: Takes 21 days to be effective, doesnt protect from other STDs, and labs q3months
What is used prophylactically and used as Tx for PJP Pneumonia?
CD4 <200
Bactrim
**requires G6PD testing prior to initiation
What is used prophylactically and used as Tx for Toxoplasmosis?
Undercooked meat, cat feces, raw shellfish
CD4 <100 if IgG+
Bactrim for prophylaxis
Pyrimethamine (available thru special pharmacy programs), Sulfadiazine, Leucovorin for Tx
What is used prophylactically and used as Tx for Mycobacterium avium Complex (MAC)?
Acid fast bacilli + Greatest risk if CD4<50 and not suppressed on ART
Azithromycin 1200mg weekly for prophylaxis
Clarithromycin 500mg BID + ethambutol daily for treatment for 12 months
Info of immune reconstitution inflammatory syndrome?
Risk factors = TB and cryptococcal meningitis
Prevent = delay ART until OI induction completion
