exam 5 - HIV/AIDS treatment

Question 1

pathogenesis of HIV

Answer 1

binds to CD4 receptors and impair the function of cells which are then destroyed by the cytolytic effect

Question 2

what are the stages of HIV

Answer 2

acute, chronic, AIDS

Question 3

what are the routes of transmission for HIV

Answer 3

exposure of mucous membranes or tissue from infected fluids
blood stream exposure
mother to child

Question 4

counseling for a positive rapid test

Answer 4

preliminary screen, seek provider confirmation

Question 5

counseling for a negative rapid test

Answer 5

seroconversion window 3 months. repeat the test if event was in that window
risk reduction and prevention

Question 6

what are the surrogate markers for HIV

Answer 6

CD4 and HIV RNA load

Question 7

how to diagnose AIDS

Answer 7

diagnosis of certain OIs

Question 8

NRTI moa

Answer 8

purine and pyrimidine analogues inhibiting viral DNA elongation

Question 9

NNRTI moa

Answer 9

binds to allosteric site of reverse transcriptase enzyme to decrease function

Question 10

PI moa

Answer 10

inhibit action of viral protease by preventing new virons (assembly, maturation, and release)

Question 11

boosters moa

Answer 11

enhance concentration of ARTs through cyp3A4 inhibition

Question 12

INSTI moa

Answer 12

inhibit HIV integrase and prevent viral DNA integration into cell genome

Question 13

attachment moa

Answer 13

block attachment to CD4 co-receptor

Question 14

post attachment moa

Answer 14

interrupt post attachment steps for HIV cell entry

Question 15

CCR5 moa

Answer 15

binds to CCR5 on CD4 cells to block gp120 and prevent HIV cell entry

Question 16

capsid moa

Answer 16

binds to interface between capsids and interferes w/ viral life cycle

Question 17

dolutegravir doses

Answer 17

INSTI naive: 50mg QD
INSTI exposure: 50mg BID

Question 18

efavirenz administration

Answer 18

empty stomach at bedtime

Question 19

neviripine admin

Answer 19

titrate over 14 days

Question 20

ertavirine admin

Answer 20

w/ food

Question 21

rilpivirine admin

Answer 21

w/ meal (not protein shake)

Question 22

atazanavir admin

Answer 22

w/ food

Question 23

elvitegravir admin

Answer 23

w/ food

Question 24

cabotegravir admin

Answer 24

daily lead in for > 28 days

Question 25

ibalizumab admin

Answer 25

IV

Question 26

lenacapavir admin

Answer 26

subQ

Question 27

NRTI AEs

Answer 27

mitochondrial toxicity and lactic acidosi

Question 28

NNRTI AEs

Answer 28

rash or hypersensitivity

Question 29

PI AEs

Answer 29

GI intolerance, insulin resistance, and lipodystrophy

Question 30

INSTI AEs

Answer 30

weight gain

Question 31

acid reducers DDI

Answer 31

separate antacids from INSTI by 6 hrs no raltegravir w/ Al or Mg no rilpivirine CI

Question 32

benzos DDIs

Answer 32

prefer LOT with PI and cobicistat

Question 33

corticosteroid DDIs

Answer 33

prefer beclomethasone w/ PI and cobicistat

Question 34

statins DDIs

Answer 34

prefer low dose w/ PI and cobicistate increase dose w/ NNRTI

Question 35

biguanide DDI

Answer 35

decrease dose w/ dolutegravir

Question 36

PDE5-inhibitor DDI

Answer 36

very low dose w/ PI and cobicistat

Question 37

cation supplements DDI

Answer 37

space apart by 6hr w/ integrases

Question 38

what ARTs should be renally dose adjusted

Answer 38

all NRTIs except abacavir

Question 39

what labs should be taken before starting abacavir

Answer 39

HLA-B*5701

Question 40

what labs should be taken before starting maraviroc

Answer 40

tropism testing

Question 41

what are the HIV guidelines

Answer 41

HIV. gov

Question 42

what are the goal of HIV treatment

Answer 42

maximize suppression to undetectable restore and preserve immune system reduce complications prevent transmission

Question 43

recommendations for initiating ART

Answer 43

all HIV patients start ASAP (especially OIs, pregnancy, acute HIV) wait to start if meningitis from TB or cryptococcus

Question 44

what are the two main groups of initial treatment regimens for HIV

Answer 44

INSTI + 2 NRTI INSTI + 1 NRTI

Question 45

what are the INSTI + 2 NRTI regimens

Answer 45

bictegravir/tenofovir ala/emtricitabine (50/25/200) dolutegravir/teno ala or dis/emtricitabine or lamivudine (500/25/200 or 300)

Question 46

what are the INSTI + 1NRTI

Answer 46

dolutegravir/lamivudine (50/300)

Question 47

when should resistance be tested

Answer 47

baseline and treatment failure

Question 48

what is the viral load for resistance testing

Answer 48

>500 copies for best results, but >200 may still work

Question 49

what is genetic barrier to resistance

Answer 49

of point mutations required for clinical resistance to develop

Question 50

boosted PI genetic barrier

Answer 50

highest genetic barrier

Question 51

NNRTI genetic barrier

Answer 51

lowest genetic barrier