Chapter 26: HIV Flashcards
HIV treatment is called
Antiretroviral therapy (ART)
When HIV continues to replicate, the viral load (increases or decreases) and the CD4+ count (increases or decreases)
increases
decreases
AIDS is diagnosed when the CD4+ count falls below ___ cells/mm3
200
What is it called when a woman with HIV spreads it to her child through pregnancy, childbirth or breastfeeding
mother-to-child or vertical transmission
What are the high-risk indicators for becoming infected with HIV
- Sharing drug-injection equipment
- High-risk sexual behaviors
- History of STI, hepatitis or TB infection
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
2 weeks
Positive HIV results should be confirmed with
Antibody Differentiation Immunoassay
What does the Antibody Differentiation Immunoassay differentiate between
differentiates if the antibodies are HIV-1 or HIV-2
Nearly all HIV infection in the US is from which HIV subtype
HIV-1
Antibodies can be detected from most people by - weeks
4-6
What is the OTC HIV test kit called
OraQuick
OraQuick detects the presence of
HIV Ab
Individuals with a positive HIV result from the OraQuick test must
follow up with a confirmatory HIV lab test
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
3
What is stage 1 of the HIV life cycle & which drugs work here
Binding/attachment
- Maraviroc
- Trogarzo
What is stage 2 of the HIV life cycle & which drugs work here
Fusion
-Fuzeon
What is stage 3 of the HIV life cycle & which drugs work here
Reverse transcription
-NNRTIs, NRTIs
What is stage 4 of the HIV life cycle & which drugs work here
Integration
-INSTIs
(both start with I)
What is stage 5 of the HIV life cycle
Transcription & Translation
What is stage 6 of the HIV life cycle
Assembly
What is stage 7 of the HIV life cycle & which drugs work here
Budding
Protease inhibitors
What is the major lab indicator for immune function
CD4+ count
What is the most important indicator of response to ART
HIV viral load
A high viral load can be due to
medication non-adherence
or
drug resistance
What is the treatment goal in HIV
undetectable HIV viral load
What drug-specific testing should be performed if considering using abacavir
HLA-B*5701 allele
What drug-specific testing should be performed if considering using maraviroc
Tropism assay
ART is recommended in all HIV-infected individuals to:
reduce progression and prevent transmission to partners
Adherence must be >/= __% to prevent resistance
95% (i.e., missing no more than 1 dose/month with a once-daily regimen)
What are the names of the HIV combo tablets that contain 2 NRTIs
Truvada
Descovy
The 2 tablet regimens contain which two drug classes
An INSTI by itself + 2 NRTIs in a combo tablet
When should Tenofovir DF (or TDF) be avoided
Renal impairment or high fracture risk
-If using, consider a DEXA and calcium & vitamin D supplementation
Which 1 tablet once a day regimen contains abacavir
Triumeq
The presence of the HLA-B*5701 allele with abacavir indicates a higher risk of
hypersensitivity reaction
Dovato should not be started if the HIV RNA is > ____ copies/mL or if there is a _____ co-infection
500,000
hepatitis B virus
What are the first line ART regimens if treatment-naïve
1 INSTI + 1 or 2 NRTIs (tenofovir/emtricitabine or abacavir/lamivudine)
Why are NRTIs the backbone of HIV therapy
- Good tolerability
- Few drug interactions
- Lack of resistance in ART-naïve patients
older NRTIs have a higher risk of ____ and ____ with ____
lactic acidosis
& hepatomegaly with steatosis
Tenofovir disoproxil fumarate brand name
Viread
Lamivudine brand name
Epivir
Zidovudine brand name
Retrovir
NRTI MOA
competitively inhibit reverse transcriptase enzyme (works at stage 3)
All NRTIs except ___ must be dose adjusted in renal impairment
abacavir
Which NRTI is still given IV during labor and delivery to protect the baby
Zidovudine
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
Abacavir is CI with
HLA-B*5701 allele or with a history of HSR
Which NRTI requires the patient to carry a medical card
abacavir
Stavudine and didanosine have a BW for
pancreatitis
and
severe hepatomegaly with steatosis
Zidovudine has a BW for
anemia (treat with EPO)
must have ferritin & TSAT above certain levels for EPO to be effective
Tenofovir DF has a warning for renal toxicity, including
Fanconi syndrome
Which NRTIs can cause lipodystrophy (body fat redistribution)
stavudine
didanosine
zidovudine
Which NRTIs can cause peripheral neuropathy
Stavudine
diadinosine
Which NRTI can cause hyperbilirubinemia
Stavudine
SE of ALL NRTIs
Nausea
diarrhea