Chapter 26: HIV Flashcards
1
Q
HIV treatment is called
A
Antiretroviral therapy (ART)
2
Q
When HIV continues to replicate, the viral load (increases or decreases) and the CD4+ count (increases or decreases)
A
increases
decreases
3
Q
AIDS is diagnosed when the CD4+ count falls below ___ cells/mm3
A
200
4
Q
What is it called when a woman with HIV spreads it to her child through pregnancy, childbirth or breastfeeding
A
mother-to-child or vertical transmission
5
Q
What are the high-risk indicators for becoming infected with HIV
A
- Sharing drug-injection equipment
- High-risk sexual behaviors
- History of STI, hepatitis or TB infection
6
Q
In about ___ weeks post-infection, the viral load is high enough for HIV RNA and HIV p24 antigens to be detected, with an initial HIV-1/HIV-2 Antigen/Antibody screening test
A
2 weeks
7
Q
Positive HIV results should be confirmed with
A
Antibody Differentiation Immunoassay
8
Q
What does the Antibody Differentiation Immunoassay differentiate between
A
differentiates if the antibodies are HIV-1 or HIV-2
9
Q
Nearly all HIV infection in the US is from which HIV subtype
A
HIV-1
10
Q
Antibodies can be detected from most people by - weeks
A
4-6
11
Q
What is the OTC HIV test kit called
A
OraQuick
12
Q
OraQuick detects the presence of
A
HIV Ab
13
Q
Individuals with a positive HIV result from the OraQuick test must
A
follow up with a confirmatory HIV lab test
14
Q
The OraQuick test should be use >/= __ months from the exposure due to the lag in Ab production; testing sooner can cause a false negative result
A
3
15
Q
What is stage 1 of the HIV life cycle & which drugs work here
A
Binding/attachment
- Maraviroc
- Trogarzo
16
Q
What is stage 2 of the HIV life cycle & which drugs work here
A
Fusion
-Fuzeon
17
Q
What is stage 3 of the HIV life cycle & which drugs work here
A
Reverse transcription
-NNRTIs, NRTIs
18
Q
What is stage 4 of the HIV life cycle & which drugs work here
A
Integration
-INSTIs
(both start with I)
19
Q
What is stage 5 of the HIV life cycle
A
Transcription & Translation
20
Q
What is stage 6 of the HIV life cycle
A
Assembly
21
Q
What is stage 7 of the HIV life cycle & which drugs work here
A
Budding
Protease inhibitors
22
Q
What is the major lab indicator for immune function
A
CD4+ count
23
Q
What is the most important indicator of response to ART
A
HIV viral load
24
Q
A high viral load can be due to
A
medication non-adherence or drug resistance
25
What is the treatment goal in HIV
undetectable HIV viral load
26
What drug-specific testing should be performed if considering using abacavir
HLA-B*5701 allele
27
What drug-specific testing should be performed if considering using maraviroc
Tropism assay
28
ART is recommended in all HIV-infected individuals to:
reduce progression and prevent transmission to partners
29
Adherence must be >/= __% to prevent resistance
95% (i.e., missing no more than 1 dose/month with a once-daily regimen)
30
What are the names of the HIV combo tablets that contain 2 NRTIs
Truvada and Descovy
31
The 2 tablet regimens contain which two drug classes
An INSTI by itself + 2 NRTIs in a combo tablet
32
When should Tenofovir DF (or TDF) be avoided
Renal impairment or high fracture risk
| -If using, consider a DEXA and calcium & vitamin D supplementation
33
Which 1 tablet once a day regimen contains abacavir
Triumeq
34
The presence of the HLA-B*5701 allele with abacavir indicates a higher risk of
hypersensitivity reaction
35
Dovato should not be started if the HIV RNA is > ____ copies/mL or if there is a _____ co-infection
500,000
| hepatitis B virus
36
What are the first line ART regimens if treatment-naïve
1 INSTI + 1 or 2 NRTIs (tenofovir/emtricitabine or abacavir/lamivudine)
37
Why are NRTIs the backbone of HIV therapy
- Good tolerability
- Few drug interactions
- Lack of resistance in ART-naïve patients
38
older NRTIs have a higher risk of ____ and ____ with ____
lactic acidosis & hepatomegaly with steatosis
39
Tenofovir disoproxil fumarate brand name
Viread
40
Lamivudine brand name
Epivir
41
Zidovudine brand name
Retrovir
42
NRTI MOA
competitively inhibit reverse transcriptase enzyme (works at stage 3)
43
All NRTIs except ___ must be dose adjusted in renal impairment
abacavir
44
Which NRTI is still given IV during labor and delivery to protect the baby
Zidovudine
45
NRTI boxed warnings
- Lactic acidosis (mainly with older NRTIs)
- Hepatomegaly with steatosis (mainly with older NRTIs)
- NRTIs treat HIV and some treat HBV. Do not d/c NRTIs if HBV-positive without adequate HBV treatment; discontinuation can cause acute HBV exacerbation
- Do not use abacavir if treating both HIV/HBV
46
Abacavir is CI with
HLA-B*5701 allele or with a history of HSR
47
Which NRTI requires the patient to carry a medical card
abacavir
48
Stavudine and didanosine have a BW for
pancreatitis and severe hepatomegaly with steatosis
49
Zidovudine has a BW for
anemia (treat with EPO), must have ferritin & TSAT above certain levels for EPO to be effective
50
Tenofovir DF has a warning for renal toxicity, including
Fanconi syndrome
51
Which NRTIs can cause lipodystrophy (body fat redistribution)
Stavudine, didanosine, zidovudine
52
Which NRTIs can cause peripheral neuropathy
Stavudine, diadinosine
53
Which NRTI can cause hyperbilirubinemia
Stavudine
54
SE of ALL NRTIs
Nausea, diarrhea
55
Lamivudine & emcitritabine SE
HA
56
In preferred treatment regimens, which two NRTIs can be replaced with each other, but should not be used together
emcitritabine can be replaced with Lamivudine
57
Do not use any tenofovir formulation with which HBV drug
adefovir
58
Which formulation of tenofovir has less bone and renal effects
Tenofovir AF (TAF)
59
INSTIs end in
-tegravir
60
MOA of INSTIs
block the integrase enzyme, preventing viral DNA from integrating into the host cell DNA (stage 4)
61
INSTIs should be separated from which other meds and by how long
Take INSTIs 2 hours before or 6 hours after aluminum & Mg-containing products
62
Bictegravir in combo is called
Biktarvy
63
Elvitegravir in combos is called (2 names)
Genvoya, Stribild
64
Dolutegravir brand name
Tivicay
65
Raltegravir brand names
Isentress, Isentress HD
66
Dolutegravir (Tivicay) has a small risk of
neural tube defects in pregnancy, HSR with severe rash, and hepatotoxicity
67
Raltegravir has a warning for
myopathy/↑ CPK
68
INSTI side effects
HA, insomnia, diarrhea, weight gain
WIDe?
69
Bictegravir and dolutegravir can ↑ which lab value, but has no effect on ___
SCr
| no effect on GFR
70
NNRTI MOA
Inhibit the reverse transcriptase enzyme (same as NRTIs), but NNRTIs bind to the enzyme non-competitively while NRTIs compete for the binding site (stage 3)
71
Which drugs are NNRTIs
Efavirenz, Rilpivirine
72
How should Rilpivirine be taken
with water and a MEAL (do not substitute with protein drink)
Rilp (rope) in a good meal
73
Rilpivirine should not be used with which drug classes
Do not use with PPIs and separate from H2RAs and antacids. Rilpivirine requires acidic environment for absorption
Has pi in name, not ppi bc can't use together
74
How should efavirenz be taken
Empty stomach QHS (to decrease CNS effects)
75
NNRTI BW
hepatotoxicity, severe rash (Nevirapine is worse for hepatotoxicity and rash)
76
Rilpivirine should not be used with strong CYP ____
inducers
77
Efavirenz SE
Psych symptoms (suicidality), CNS effects, generally resolve in 2-4 weeks, ↑ TC, TGs
78
Rilpivirine SE
depression
79
Rilpivirine should not be used if viral load > ____ copies/mL and or CD4+ counts < ___ cells/mm3 due to higher failure rate
>100,000
| < 200
80
Protease inhibitors end in
-navir
81
Ataznavir brand name
Reyataz
82
Darunavir brand name
Prezista
You dare run from the prez-ident
Run from the prezz (press)
83
Protease inhibitor MOA
Inhibits protease enzyme, which prevents protein strands from being cut into the smaller pieces needed for assembly of new virions. (stage 7)
84
PIs are no longer used first line due to
More metabolic problems (hyperglycemia/insulin resistance, dyslipidemia with ↑ LDL and TG), lipodystrophy
85
Atazanavir should not be used with which types of meds
acid-lowering
| Take 2 hours before or 1 hour after antacids
86
Tipranavir BW
hepatitis, intracranial hemorrhage
87
Ataznavir & Darunavir must be given with
a booster (like ritonavir or cobicistat)
88
PIs should be taken with
food
89
Which PI solutions have high alcohol content and should be avoided with metronidazole, tinidazole and disulfuram
Kaletra and ritonavir
90
All PIs have a warning for
hepatic effects and hypersensitivity reaction
91
Atazanavir has warnings for
hyperbilirubinemia, PR interval prolongation, severe skin reactions
92
Darunavir, fosamprenavir, and tipranavir should be used with caution in
sulfa allergy
93
Indinavir warning
nephrolithiasis
94
PIs should be used with caution in 3A4 ___
inducers (will ↓ PI)
95
Which drugs should not be used with PIs
alfuzosin, colchicine, apixaban, edoxaban, rivaroxaban, dronedarone, amiodarone, direct-acting antivirals, hormonal contraceptives, lovastatin, simvastatin (use atorva or rosuvastatin instead)
96
Which drugs are used as boosters in HIV
ritonavir and cobicistat
97
Ritonavir brand name
Norvir
98
Cobicistat brand name
Tybost
99
How should ritonavir be taken
with food
100
How should cobicistat be taken
With the boosted drug (e.g., darunavir, atazanavir & elvitegravir) & with food
101
T/F: ritonavir and cobicistat can be interchanged
false
102
ritonavir and cobicistat drug interactions
Do not use with dronedarone, lovastatin, simvastatin, phenobarbital, phenytoin, rifampin, and St. John's wort
103
ritonavir and cobicistat inhibit
3A4, 2D6 and P-gp
104
Which drugs should not be used with cobicistat
colchicine & voriconazole
105
Which drugs should not be used with ritonavir
Alprazolam, amiodarone, dronedarone, itraconazole
106
Boosters are used to
increase the level of an ART (they are inhibitors, so they also increase the level of many other drugs)
107
Stribild should not be used in CrCl < __
50
108
Genvoya should not be used in CrCl < __
30
109
CCR5 antagonists work at which stage
Stage 1
110
Fusion inhibitors work at which stage
2
111
CD4+ Directed Post-attachment HIV-1 inhibitors work at which stage
Stage 1
112
Maraviroc (CCR5 antagonist) must have ___ assay prior to use
Tropism
| -It is not useful if CXCR4 or mixed (CXCR4/CCR5)
113
Enfuvirtide SE
injection site reaction (given SC)
114
What are AIDS-defining conditions
-Opportunistic infections
-Kaposi's sarcoma
HIV Wasting Syndrome
115
What drugs can be used to increase appetite in patients with HIV Wasting Syndrome
Dronabinol and nabilone and megestrol (Megace ES) a progestin that stimulates appetite
116
A paradoxical worsening of either a new or known condition that has been suppressed, but becomes unmasked after ART is started or treatment is changed to a more effective regimen is known as
Immune Reconstitution Inflammatory Syndrome (IRIS)
117
What should be done if IRIS occurs
ART should be continued and the unmasked condition should be treated
118
If a pregnant patient is not already on ART, which regimens could be started
- Abacavir/lamivudine + atazanavir or daranuvir with ritonavir OR raltegravir or dolutegravir
- TDF/emtricitabine (or lamivudine) + atazanavir or daranuvir with ritonavir OR raltegravir or dolutegravir
119
What is PrEP
Taking a 2-drug combination to prevent infection from a high-risk behavior
Taken daily before high-risk activity
120
What must be done prior to starting PrEP
Confirm that the patient is HIV-negative with Ab test
121
Which drugs are used in PrEP
Truvada or Descovy
122
Treatment with PrEP must include follow-up every __ months
3
123
When is PEP used
After HIV-exposure, within 72 hours & taken for 28 days
124
Which drugs are used in PEP
Truvada (if CrCl >/= 60) + Dolutegravir (Tivicay) OR Raltegravir (Isentress)
125
When can nonoccupational PEP be used
after sex without a condom or after injection drug use
126
When can occupational PEP be used
After needlestick
127
Which 3 drugs are 1 tablet daily for HIV
Remember TBD
| Triumeq, Biktarvy, Dovato
128
Dovto contains which 2 drugs
Dolutegravir/Lamivudine
| think of Demi Lovato
129
Which two HIV drugs contain cobicistat
Genvoya and Stribild
130
Atripla contains which drugs
Efavirenz/TDF/Emtricitabine
ATdEE - a triple attack on nucleo transcriptase
131
Biktarvy contains which drugs
Bictegravir/Emtricitabine/TAF
132
Complera contains which drugs
Rilpivirine/TDF/Emtricitabine
CERTifieD in nucleo transcriptase inhibition
133
Genvoya contains which drugs
Elvitegravir/Cobicistat/TAF/Emtricitabine
GEETAC
134
Odefsey contains which drugs
Rilpivirine/Emtricitabine/TAF
ORETA
135
Stribild contains which drugs
Elvitegravir/Cobicistat/TDF/Emtricitabine
SCEnTED
136
Triumeq contains which drugs
Dolutegravir/Abacavir/Lamivudine
TALD
137
Emtricitabine can cause ____ on palms of hands and on soles of feet
darkening of skin color
