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NAPLEX 2024 > Chapter 26: HIV > Flashcards

Chapter 26: HIV Flashcards

1
Q

HIV infection leads to T-cell death!!!: General backgroung, what is HIV, how does it attack T-Cells?, complications?

A
  • HIV is a single-stranded RNA retrovirus that replicates in CD4+ T-helper cells, destroying them in the process. Untreated HIV infection results in the destruction of billions of T cells daily.
  • Continued HIV replication increases viral load and decreases CD4+ count.
  • Treatment for HIV is called antiretroviral therapy (ART).
  • AIDS is diagnosed when the CD4+ count falls below 200 cells/mm3 or with the presence of AIDS-defining conditions (discussed later)… At this stage, the weakened immune system cannot fight off opportunistic infections (OIs) or specific malignancies indicative of AIDS.
  • With adherence to treatment, current regimens yield remarkable results, allowing people with HIV to live long and healthy lives.
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2
Q

How is HIV Transmitted?

A

Infection spreads through direct contact with bodily fluids such as blood, semen, vaginal fluid, rectal fluids, and breast milk. Transmission commonly occurs through vaginal and rectal sex, as well as sharing needles. Additionally, HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth, or breastfeeding, known as mother-to-child or vertical transmission.

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3
Q

CDC recommends routine HIV Screening at least once for all patient 13-64 y/o. If patient is high risk? testing should be done annually! High risk patients include:

A
  • Sharing drug -injection equipment: needles, syringes and cookers (used to mix up or “cook” drugs).
  • High-risk sexual behaviors: homosexual male sex, multiple partners, prostitution, sex with a person known to be infected.
  • History of a sexually transmitted infection (e.g., syphilis, chlamydia, gonorrhea)
  • Hx of hepatitis or tuberculosis (TB) infection.
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4
Q

HIV

STAGES OF INFECTION AND DIAGNOSTIC TESTING:

A
  1. Acute HIV infection: presents as non-specific flu like symptoms (ie. fever, fatigue, HA, lymphadenopathy) can last a few days to several weeks. Patient will become asymptomatic after inital phase but the virus is still replicating/ capable of being transmitted… over time CD4 count decreases but can take several years to progress to AIDs
    .
    - 2 weeks post infection, the viral load is high enough for HIV RNA and HIV p24 antigens to be detected with an inital HIV-1/HIV2 antigen/antibody screening test. .. Positve result should be confirmed with antibody differentiation immunoassay which differentiates Hiv1 (the more common one in USA) from HIV2 antibodies…Antibodies can be detected in most people 4-12 weeks after getting the disease.
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5
Q

OTC HIV Testing?: what is it called? when should it be used?

A

OraQuick In-Home HIV test detects presence of HIV antibodies..Individual with positive result (2 lines) must f/u with confirmatory test.
.
The tests should be used > 3 months from the exposure due to the lag in Ab production; testing sooner can cause a false negative result!

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6
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 1

A

Stage 1: Binding/ Attachment - HIV attach to CD4 receptor and CCR5 or CXCR4 co-receptor (on surface of CD4 host cell)
.
Drug Class/ Drugs
- CCR5 antagonist: Maraviroc
- Attachment inhibitor: Fostemsavir
- Post attachment inhibitor: ibalizumab-uiyk

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7
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 2

A

Stage 2: Fusion - HIV envelope fuse with CD4 cell membrane, HIV enters CD4 cell and release all of it’s material needed for replication.
.
Drug Class/ Drugs
- Fusion inhibitor: Enfuvirtide

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8
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 3

A

Stage 3: Reverse Transcription - HIV RNA is converted to HIV DNA via reverse transcriptase (an HIV enzyme). The HIV DNA can then enter into CD4 cell nucleus.
.
Drug Class/ Drugs
- Nucleoside Reverse Transcriptase Inhibitor (NRTIs): Emtricitabine, Tenofovir, Lamivudine etc.
- Non- Nucleoside Reverse Transcriptase Inhibitor (NNRTIs): Efavirenz, Rilpivirine, etc.

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9
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 4

A

Stage 4: Integration - Once HIV DNA is inside nucleus, Integrase (HIV enzyme) is released and used to insert HIV DNA into host cell DNA
.
Drug Class/ Drugs
- Integrase Strand Transfer Inhibitors (INSTIs): Bictegravir, Dolutegravir, Raltegravir

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10
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 5

A

Stage 5:Replication - Host cell machinery is used to transcribe/ translate HIV DNA to RNA then protein!
.
Drug Class/ Drugs
- NONE

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11
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 6

A

Stage 6: Assembly - New HIV RNA, protein, and enzymes move to cell surface and assemble into immature HIV
.
Drug Class/ Drugs
- NONE

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12
Q

HIV REPLICATION STAGES AND ANTIRETROVIRAL SITES OF ACTION

Describe the stage and what drug class works on that stage?: STAGE 7

A

Stage 7: Budding + Maturation - Immature HIV push out of cell and protease (HIV enzyme), breaks up long viral protein chain = creating mature virus that goes on to infect other cells!!!
.
Drug Class/ Drugs
- Protease Inhibitor: Atazanavir, Darunavir

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13
Q

HIV: INITIAL EVALUATION AND MONITORING

What are the important things to evaluate/ monitor in HIV patietns?

A
  1. CD4+ count: major laboratory indicator of immune function and is used to determine the need for OI prophylaxis.
  2. HIV viral load - indicates how much HIV RNA is in the blood. It is the most important indicator of response to ART. A high viral load can be d/t nonadherence or drug resistance. Goal = UNDETECTABLE!
  3. Hepatitis B and C screening
  4. Pregnancy
  5. HLA-B5710 allele (if considering Abacavir)
  6. Tropism Assay (if considering Maraviroc)
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14
Q

Guidelines recommends BLANK for most patients with newly diagnosed HIV?

A

INSTI- Based Regimens!

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15
Q

Recommended Regimens for Initial ART in Most Treatment-Naive Adults

One pill, once a daily (single tablet regimen): list the brand/ compoments!

A
  1. Biktarvy (Bictegravir/Emtricitabine/ Tenofovir Ala.)
  2. Triumeq (Dolutegravir/Abacarvir/Lamivudine)
  3. Dovato (Dolutegravir/Lamivudine)
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16
Q

Recommended Regimens for Initial ART in Most Treatment-Naive Adults

Two-Pills (once daily for most): list the brand/ compoments!

A
  1. Tivicay (Dolutegravir) + Truvada (Emtricitabine/ Tenofovir Disoproxil fumarate)
  2. Tivicay (Dolutegravir) + Descovy (Emtricitabine/Tenofovir Ala)
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17
Q

Recommended Regimens for Initial ART in Most Treatment-Naive Adults

What is the most preferred regimen? What’s an exception?

A
  • Most preferred regimen contain 2 NRTIs and 1 INSTI
  • Exception: Dovato (which is 1 NRTIs and 1 INSTI) - do not use if patient has hep B!
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18
Q

Tenofovir DF (TDF) VS. Tenofovir AF (TAF)

A

Tenofovir DF (TDF) poses greater risks for renal and bone issues compared to the newer form, tenofovir AF (TAF). Avoid TDF in cases of renal impairment or increased fracture risk (such as low bone mineral density, history of fractures, or in elderly individuals). If TDF is used, consider conducting a DEXA (bone mineral density scan) and supplement with calcium and vitamin D as needed.
.
CrCl < 50: Do not start TDF
CrCl <30: Do not start TAF

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19
Q

Triumeq contains abacavir! What additional testing is needed prior to starting medication?

A

Test for HLA-B*5701!!!. Positive result = higher risk for severe hypersensitivity reaction and any abacavir- containing product!

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20
Q

Fixed dose combinations have less flexibility with renal dosing. What should not be used if CrCl < 30?

A

Biktarvy, Triumeq, Dovato, Truvada, Descovy
.
Note: HIV drugs are dispensed in it’s OG manufacter bottle for 30 days

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21
Q

Drugs used in ART Regimen

List the 6 Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

A
  1. Abacavir -QD or BID
  2. Emtricitabine
  3. Tenofovir Diso TDF (Viread) -QD only
  4. Tenofovir Ala TAF (only in combo product) -QD only
  5. Zidovudine (Retrovir) - admin IV during labor/ delivery to protect baby
  6. Lamivudine (Epivir) - QD or BID
    .
    All NRTIs…decrease dose if renal impaired (except abacavir)
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22
Q

Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs): MOA

A

Competitively inhibits the reverse transcriptase enzyme preventing conversion of HIV RNA to DNA in STAGE 3
.
NRTIs have low barrier to resistance (resistance develop easily)

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23
Q

NRTI Key Feats

All NRTIs: warnings/ SEs

A
  • Warnings: lactic acidosis and hepatomegaly with steatosis (fatty liver)
  • SEs: N/D, HA, increased LFT
  • HBV and HIV coninfection boxed warnings: severe acute HBV exacerbation can occur if emtri, lamivu, or teno containing products are D/C
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24
Q

NRTI: Key Features and Safety Issues

Abacavir

A
  • BW: risk of hypersensitivity rxn = screen for HLA-B*5701 allele! if positive DO NOT USE; never rechallege!
  • Consider avoiding with CVD d/t increase risk of MI
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25
Q

NRTI: Key Features and Safety Issues

Emtricitabine

A

Hyperpigmentation of palms or soles

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26
Q

NRTI: Key Features and Safety Issues

Tenofovir Formulation (higher risk with TDF)

A
  • renal impairment, acute renal failure, and Fanconi syndrome
  • Decrease dose if renally impaired and avoid with other nephrotox drugs
  • Decrease bone density!!! consider calcium/vit D and DEXA scan if at risk
  • Note: monitor lipids if switching from TDF to TAF (TAF has higher lipid abnormalities)
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27
Q

NRTI: Key Features and Safety Issues

You got this!

A
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28
Q

Drugs used in ART Regimen

List the 4 Integrase Strand Transfer Inhibitors (INSTIs)

A
  1. Bictegravir (only in combo product - Biktarvy)
  2. Raltegravir (Isentress)Dolutegravir (Tivicay)
  3. Elvitegravir (only in combo products Genvoya, Stribild)
  4. Dolutegravir (Tivicay)
    .
    Name tip: Think “BRED” and they all end with “-tegravir”
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29
Q

Integrase Strand Transfer Inhibitors (INSTIs): MOA

A

Block the integrase enzyme, preventing HIV DNA from inserting into host cell DNA in STAGE 4.
.
It has a higher barrier to resistance than NRTIs and NNRTIs

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30
Q

Integrase Strand Transfer Inhibitors (INSTIs): Notes on QD and BID dosing, and CrCl restrictions

A
  • QD dosing: Biktarvy, Stribild, Genvoya, Isentress HD, Tivicay
  • BID dosing: Isentress, Tivicay (those with resistance or treatment experienced patients.
  • CrCl<70: do not start Stribild
  • CrCl <50: D/C Stribild
  • CrCl <30: do not start Biktarvy or Genvoya
31
Q

INSTI Key Feats and Safety

INSTI Key Feats and Safety: All INSTIs

A
  • Headache, insomnia, diarrhea, weight gain, rare risk of SI/ depression
  • Cations and INSTIs do NOT go together! Take INSTIs 2 hours before or 6 hours after : aluminum, calcium, magnesium, and iron containing products.
32
Q

INSTI Key Feats and Safety

INSTI Key Feats and Safety: Bictegravir, Dolutegravir

A
  • Increase Scr (by inhibiting tubular secretion)
33
Q

INSTI Key Feats and Safety

INSTI Key Feats and Safety: All Raltegravir, Dolutegravir

A
  • Increase CPK, myopathy, rhabdomyolysis
  • Hypersensitivity reaction: rash, fever, allergic symptoms
34
Q

INSTI Key Feats and Safety

INSTI Key Feats and Safety: Dolutegravir

A

In addition to the other stuff already mentioned, Dolutegravir also hsa SEs of hepatoxicity
.
But this is the preferred medicaiton if you are preggo

35
Q

Drugs used in ART Regimen

List the 2 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

A
  1. Efavirenz
  2. Rilpivirine
    .
    The others that was not bolded: Doravirine, Etravirine
    .
    The name contains “vir” in the middle!
36
Q

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): MOA

A

Non-comeptitively inhibt the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA in STAGE 3

37
Q

NNRTIs Key Feats and Safety issues

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): All NNRTIs

A
  • Used in alternative ART regimen (not first line for most patients): 1 NNRTI + 2 NRTIs
  • SEs: Hepatoxicity and severe rash including SJS/TEN
  • DDI: All NNRTIs are major CYP3A4 substrates: Do not use with strong inducer or inhibitors!
38
Q

NNRTIs Key Feats and Safety issues

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Efavirenz

A
  • Food increases bioavailability and risk for CNS effects: take on empty stomach QHS!
  • Psych SEs include: depression, SI
  • CNS effects: impaired concentration, abnormal dreams, confusion
  • Increase TG/ cholesto
39
Q

NNRTIs Key Feats and Safety issues

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Rilpivirine

A
  • Take with meal + water, require acidic enviroment for absorption! DO NOT use with PPIs and separate from H2RAs and antiacids
  • SEs: Depression, increase Scr, do not use if viral load > 100,000 and/or CD4 < 200 (higher failure risk)
40
Q

Drugs used in ART Regimen

List the 2 Protease Inhibitors (PIs)

A
  1. Atazanavir (Reyataz)
  2. Darunavir (Prezista) notes: caution w/ sulfa allergy!
    .
    The others that was not bolded: Lopinavir/ ritonavir, fosamprenavir
    .
    The name contains “-navir” at the end
41
Q

Protease Inhibitors (PIs): MOA

A

Inhibit the HIV protease enzyme preventing long viral protien from breaking down nto smaller chains needed to produce mature HIV virus in STAGE 7

42
Q

PI Key Feats and Safety Issues

Protease Inhibitors: All PIs

A
  • Used as an alternative ART regimen (not first line for most patients): 1 PI (+booster) + 2 NRTIs
  • Recommedned to take with a booster (ritonavir or cobistat)
  • No renal dose adjustments needed
  • Take with food to decrease GI upset
  • SEs: metabolic abnormalities like hyperglycemia/ insulin resistence, dyslipidemia, can increase CVD risk, increase hepatic dysfunction, and can cause hypersensitiviy rxn/ rash like SJS/TEN
43
Q

PI Key Feats and Safety Issues

Protease Inhibitors: Atazanavir (Reyataz)

A

Needs an acidic gut for absorption!
- antiacids: take Atazanavir 2 hours before or 1 hour after
- H2RAs: avoid or take atazan 2 hrs before or 10 hrs after
- PPIs: avoid with unboosted Atazana or take boosted Atazana at least 12 hrs after PPIs
.
Can cause hyperbilirubinemia

44
Q

PI Key Feats and Safety Issues

Protease Inhibitors: DDI?

A

MANY CPY3A4 INTERACTIONS!
All PIs are major CPY3A4 substrates and most are strong inhibitors as well
Do not use with the following drugs:
- Alfuzosin
- Colchicine
- Dronedarone
- Lovastatin/ Simvastatin (rosuvastain/ ator are perf with PIs)
- CYP3A4 inducers: carbamazepine, pheytoin, rifampin, phenobar, St. john
- Anticoag/anti platelet
- Steroid
- Some hormonal contraceptives

45
Q

Booster that is used with PIs?:

A
  1. Ritonovir (Norvir) : 100-400 mg PO with food
  2. Cobistat (Tybost): 150 mg PO with PI and with food
    .
    Not interchangable! Do not use together!
    .
    Ritonovir is also a PI but it’s used as a booster b/c it is a strong inhibitor and not tolerated well as an antiviral at higher dose. Booster dose is lower than tx dose
46
Q

Booster Drug Interactions

A

Ritonavir and Cobistat are strong inhibitors of CYP3A4 as well as P-gp transporters. Avoid the following drugs!
- Alfuzosin, tamsulosin
- Colchicine
- Lova/ Simvastatin
- Azole drugs
- Cardio drugs: Aminodarone, dronedarone, eplerenone
- PDE-5 inhibitors
- Many tyrosine kinase drugs (-nibs)
- CYP3A4 inducers: Carbamazipine, pheytoin, phenobar, st. john, rifampin

47
Q

Other HIV drugs

Entry + Attachment Inhibitor: CCR5 Antagonist: Name the drug, MOA, and any safety issues/ notes

A
  • Maraviroc
  • MOA: Block HIV from binding the CD4 cell the uses CCR5 co receptor in STAGE 1
  • Safety issues: Hepatotox, hypersensitivity rxn/ rash
  • Need baseline testing: Tropism assay. The HIV virus must only bind to CCR5! If strand can bind to a mix of things (ie. CXCR4 or both) then Maraviroc will not work!
48
Q

Other HIV drugs

Entry + Attachment Inhibitor: Attachment Inhibitor: Name the drug, MOA, and any safety issues/ notes

A
  • Fostemsavir
  • MOA: Converted to Temsavir (active form) which binds to gp120 subunit thus inhibiting interaction between CD4 and HIV in STAGE 1
  • Safety issues: Do not use with strong CYP3A4 inducers
49
Q

Other HIV drugs

Entry + Attachment Inhibitor: Post-Attachement Inbihitor: Name the drug, MOA, and any safety issues/ notes

A
  • Ibalizumab (IV)
  • MOA: monoclonal antibody that binds to part of the CD4 cell receptor in STAGE 1 to block entry
  • Safety issues: infusion rxn
50
Q

Other HIV drugs

Entry + Attachment Inhibitor: Fusion Inhibitor: Name the drug, MOA, and any safety issues/ notes

A
  • Enfuvirtide (SC)
  • MOA: Prevent HIV from fusion to the CD4 cell membrane in STAGE 2
  • Safety issues: risk of bacterial penimonia, local inj site rnx
51
Q

Single Tablet Regimen: INSTI based

Biktarvy

A

Bictegravir/ Emtricitabine/ Tenofovir Alafenamide (TAF)
.
Consider 1st line

52
Q

Single Regimen Tablet: INSTI based

Triumeq

A

Dolutegravir/ Abacavir/ Lamivudine
.
Considered 1st line

53
Q

Single Regimen Tablet: INSTI based

Dovato

A

Dolutegravir/ Lamivudine
.
Considered 1st line

54
Q

Single Regimen Tablet: INSTI based

Cabenuva

A

Cabotegravir/ Rilpivirine
.
IM injection Q month

55
Q

Single Regimen Tablet: INSTI based

Juluca

A

Dolutegravir/ Rilpivirine

56
Q

Single Regimen Tablet: INSTI based

Stribild

A

Elvitegravir/ Cobicistat/ Emtricitibine/ TDF
.
Take with food

57
Q

Single Regimen Tablet: INSTI based

Genvoya

A

Elvitegravir/ Cobicistat/ Emtricitibine/ TAF
.
Take with food

58
Q

Single Regimen Tablet: NNRTI based

Odefsey

A

Rilpivirine/ Emtricitabine/ TAF
.
Take with food (contains Rilpivirine)

59
Q

Single Regimen Tablet: NNRTI based

Complera

A

Rilpivirine/ Emtricitabine/ TDF
.
Take with food (contains Rilpivirine)

60
Q

Single Regimen Tablet: NNRTI based

Delstrigo

A

Doravirine/ Lamivudine/ TDF

61
Q

Single Regimen Tablet: NNRTI based

Atripla

A

Efavirenz/ Emtricitabine/ TDF
.
Take on empty stomach (d/t Efavirenz)

63
Q

Single Regimen Tablet: NNRTI based

Symfi or Symfi Lo

A

Efavirenz/ Lamivudine/ TDF
.
Take on empty stomach (d/t Efavirenz)

64
Q

Single Regimen Tablet: PI based

Symtuza

A

Darunavir/ cobicistat/ emtricitabine/ TAF
.
Take with food

65
Q

Other combination product: MUST BE USED W/ ART TO MAKE COMPLETE REGIMEN

NRTI Combination Products
1. Epzicom
2. Trizivir
3. Descovy
4. Truvada
5. Combivir
6. Cimduo

A
  1. Epzicom - Abacavir/ Lamivudine
  2. Trizivir - Abacavir/ Lamivudine/ Zidovudine
  3. Descovy - Emtricitabine/ TAF (part of 1st line)
  4. Truvada - Emtricitabine/ TDF (part of first line)
  5. Combivir- Lamivudine/ Zidovudine
  6. Cimduo- Lamivudine/ TDF
66
Q

Other combination product: MUST BE USED W/ ART TO MAKE COMPLETE REGIMEN

Common PI combination product!
1. Evotaz
2. Prezcobix

A
  1. Evotaz - Atazanavir/ Cobicistat
  2. Prezcobix - Darunavir/ Cobicistat
67
Q

AIDS-DEFINING CONDITIONS: When is AIDs diagnosed? What are AIDs defining conditions?

A

AIDS is diagnosed when the CD4+ count drops below 200 and/or when AIDS-defining conditions are present:
- Opportunistic infections: like MAC, PCP, Cryptococcus neoformans, Histoplasmosis, severe Candida albicans infections, and tuberculosis.
- Certain cancers such as Kaposi’s sarcoma
- HIV Wasting Syndrome characterized by lipoatrophy (fat loss), muscle mass loss, anorexia, and diarrhea. Options to increase appetite are slim: dronabinol (Syndros) and nabilone, and megestrol (Megace ES), a progestin that stimulates appetite.

68
Q

AIDS-Defining Conditions

Immune reconstitution inflammatory syndrome (IRIS)

A

IRIS - ART can trigger a paradoxical (unexpected) worsening of a pre-existing condition or a latent condition that was suppressed. This occurs as the immune system, bolstered by HIV treatment, is able to mount an inflammatory response, revealing the underlying condition.
.
Key points:
- More likely to occur as viral load decrease and CD4 increase
- Underlying conditions that may emerge includes: OI, hepatitis B and C, Herpes simplex virus (HSV), varicella-zoster virus (VZV), autoimmune disorders, and certain cancers like Kaposi’s sarcoma
- Most IRIS is self-limited. ART should be continued, and the unmasked condition should be treated .

69
Q

HIV TREATMENT DURING PREGNANCY

Recommendations for Treatment Naive Pregnant Patients

A

If already on ART that’s working well? continue that..If not? need to start ASAP!
.
Treatment should consist of 3 drugs: 2 NRTIs (eg. abacavir/lamivudine; TAF/emtricitabine) PLUS 1 INSTI (dolutegravir pref) or a PI-Boosted (Darunavir pref)

70
Q

HIV Prevention/ Treatment Prevention

Pre-Exposure PPX (PrEP): What is it? What are the options?

A

Prevention method whereby people with high risk behaviors who do not have HIV take medication to prevent infection.
.
Oral regimen: Truvada or Descovy (taken daily before high risk activity)
IM injection: Cabotegravir (monthly for 2 doses, then every 2 months)

71
Q

HIV Prevention/ Treatment Prevention

Pre-Exposure PPX (PrEP): What to do before starting PrEP and what does follow up visit consist of?

A

Before starting PrEP
- Confirm patient is HIV negative with HIV antigen/antibody blood test
- Ask about recent symptoms that could indicate infection
- Confirm CrCl > 60 (if using Truvada) or CrCl > 30 (if using Descovy)…NOTE Truvada CrCl is higher in PrEP than treatment
- Screen for Hep B and STIs
.
Follow up Visits
- at each visit test for HIV and confirm negative before refilling meds
- Truvada and Descovy: every 3 month
- Cabotegravir: 1 month after first inj, then q 2 month

72
Q

HIV Prevention

Post Exposure PPX (PEP): What is it? What are the treatment options?

A

PEP is for emergencies where a non-infected person is exposed to body fluids that are known to be or is infected with HIV. There are 2 types of PEP = nonoccupational (nPEP) and occupational (oPEP)
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- nPEP can be used after sex without condom, injection drug use, or other nonoccupational activies
- oPEP is typically for healthcare providers who were exposed to body fluid/ needle stick
- BOTH can be started ASAP within 72 hours (3 days) of the exposure and continued for 28 days
- Options: Truvada + Dolutegravir OR Raltegravir (Isentress)

73
Q

Refresher/ Counseling Points

NRTIs Patient Counseling

A

If you haev Hep B, do not stop taking med! Talk to provider first. Stopping med can worsen Hep B
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Can cause:
o Lactic acidosis.

74
Q

Refresher/ Counseling Points

NNRTIs Patient Counseling

A

Can cause: rash/severe rash, Hepatotoxicity

75
Q

Refresher/ Counseling Points

PI Patient Counseling

A

NAPLEX 2024 (29 decks)

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