HIV

Question 1

What are the names of the NRTIs?

Answer 1

Tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), lamivudine(3TC), abacavir (ABC), emtricitabine (FTC), stavudine, didanosine, zidovudine

Question 2

What is the MOA of NRTIs, and what is important about them?

Answer 2

-Nucleoside Reverse Transcriptase Inhibitors prevent the conversion or viral RNA into proviral DNA right before it is integrated into the host cell chromosome, and they are the base of most therapies. -Abacavir is the only one that is not renally adjusted.

Question 3

What are 3 pearls about abacavir?

Answer 3

1. hepatic adjustment is needed
2. It is contraindicated if HLA-B*5701 is positive
3. It is associated with increased risk of MI

Question 4

What are the differences between Tenofovir disoproxil fumarate and tenofovir alafenamide?

Answer 4

• TDF should be avoided in CrCl <70mL/min, is dosed at 300mg and is associated with lower lipid levels.
• TAF can be used down to CrCl=30mL/min and has less bone toxicity

Question 5

Which NRTIs are OATP and p-gp substrates?

Answer 5

Tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF)

Question 6

Which NRTI may cause hyperpigmentation?

Answer 6

Emtricitabine (FTC)

Question 7

Which NRTI is a UGT1A1 substrate?

Answer 7

Abacavir (ABC)

Question 8

What are the 5 first-line therapies for HIV?

Answer 8

1. Biktarvi® (biktegravir/tenofovir alefenamid/emtricitabine)
2. Triumeq® (doletugravir/abacavir/lamivudine)
3. Tivicay® (dolutegravir)
   
   1. plus Truvada® (tenofovir disoproxil fumarate/emtricitabine)
   2. plus Descovy® (tenofovir alafenamide/emtricitabine)
4. Isentress® (raltegravir)
   
   1. plus Truvada® (tenofovir disoproxil fumarate/emtricitabine)
   2. plus Descovy® (tenofovir alafenamide/emtricitabine)
5. ​Dovato® ​(dolutegravir/lamivudine)

Question 9

Which Integrase Inhibitor may cause neural tube defects?

Answer 9

dolutegravir (DTG)

Question 10

Which treatments are now only used as first-line therapy in certain situations, due to higher rates of resistance and more interactions than the other options?

Answer 10

• Stribild® (eltegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine)
• Genvoya® (eltegravir/cobicistat/tenofovir alafenamide/emtricitabine)

Question 11

Which new NNRTI has better tolerability than the rest?

Answer 11

Pifeltro,® (doravirine)

Question 12

Which NNRTI should be eaten with a high-fat meal, is contraindicated with PPIs and may cause QTc prolongation?

Answer 12

rilpivirine (RPV)

Question 13

Which NNRTI is teratogenic, should be taken on an empty stomach and has CNS effects?

Answer 13

efavirenz (EFV)

Question 14

Which NNRTI is contraindicted with strong CYP3A4 inducers?

Answer 14

doravirine (DOR)