HIV

Question 1

Diagnosis of AIDS

Answer 1

1) CD4 < 200

2) AIDS-defining condition: opportunistic infections

Question 2

Transmission of HIV

Answer 2

Blood, Semen, Vaginal, Rectal

BREASTMILK

Question 3

Timing of Diagnosis Testing

Answer 3

1st) @ 2 weeks: HIV-1/HIV-2 Ag/Ab Immunoassay

2nd) @ 4-6 weeks: If (+), then Confirm with Antibody DIFFERENTIATION Immunoassay
- Determines if HIV-1 or HIV-2

3rd) @ 3 months: Ora-Quick Test

Question 4

HIV Replication Steps & Rx Sites of Action: Step 1

Answer 4

Step 1) Binding /Attachment:

Maraviroc (Selzentry) = patient must have Trofile test for (+) CCR5 co-receptor to work

Ibalizumab-uiyk (Trogarzo)

Question 5

HIV Replication Steps & Rx Sites of Action: Step 2

Answer 5

Step 2) Fusion

Enfuvirtide (Fuzeon)

Question 6

HIV Replication Steps & Rx Sites of Action: Step 3

Answer 6

Step 3) Reverse Transcription

NRTI (Nucleoside Reverse Transcriptase Inhibitors)
NNRTI (Non-NRTI)

Question 7

HIV Replication Steps & Rx Sites of Action: Step 4

Answer 7

Step 4) Integration

INSTI (Integrase Stand Transfer Inhibitors)

Question 8

HIV Replication Steps & Rx Sites of Action: Step 5 / 6

Answer 8

Step 5) Transcription / Translation
Step 6) Assembly

NO DRUGS

Question 9

HIV Replication Steps & Rx Sites of Action: Step 7

Answer 9

Step 7) Budding / Maturation

PI (Protease Inhibitors)

Question 10

Initial Evalutation

Answer 10

1) CD4 count
2) HIV RNA Viral Load
3) Test HepB & Hep C
4) Pregnancy

Question 11

Recommended Tx:

Answer 11

INSTI-based (1 INSTI + 1 or 2 NRTI)

Question 12

One Pill, Once Daily

Answer 12

1) Biktarvy
2) Triumeq
3) Dovato

Question 13

Biktarvy

Answer 13

Bictegravir (INSTI)

Emtricitiabine (NRTI)
TAF (NRTI)

Question 14

Triumeq

Answer 14

Dolutegravir (INSTI)

Abacavir (NRTI)
Lamivudine (NRTI)

Question 15

Dovato

Answer 15

Dolutegravir (INSTI)

Lamivudine (NRTI)

Question 16

Two Pills

Answer 16

1) Tivicay + Truvada
2) Tivicay + Descovy
3) Isentress + Truvada
4) Isentress + Descovy

Question 17

Tivicay

Answer 17

Dolutegravir

Preferred in Pregnancy

Question 18

Isentress

Answer 18

Raltegravir

Myopathy / increase in CPK

Question 19

Truvada

Answer 19

Emtricitabine + TDF

Question 20

Descovy

Answer 20

Emtricitabine + TAF

Question 21

Abacavir Brand / pharmacogenetic testing:

Answer 21

Ziagen

HLA-B*5701

Question 22

Dovato Contraindications:

Answer 22

1) HIV RNA > 500k

2) Hep B co-infection

Question 23

TAF vs TDF

Answer 23

TAF has less:

1) Renal toxicity
2) Bone loss

Question 24

TDF by itself Brand Name

Answer 24

Viread

Question 25

NRTI BBW/Warning

Answer 25

``` BBW: stavudine, zidovudine, didanosine 1) Lactic acidosis 2) Hepatomegaly with steatosis ADR = lipodystrophy stavudine / didanosine = pancreatitis zidovudine = anemia ``` Warning: TDF/TAF, abacavir, lamivudine

Question 26

NRTI - HBV Treatments

Answer 26

Lamivudine (Epivir-HBV) | TDF (Vemlidy)

Question 27

INSTI consideration:

Answer 27

Separate Al/Mg +2hr or -6hr Raltegravir OK with Calcium Carbonate Bictegravir OK with Ca or Fe if taken WITH FOOD

Question 28

INSTI Side Effects

Answer 28

weight gain | insomnia

Question 29

NNRTI (non-NRTIs) Brands

Answer 29

Atripla (EFAVIRENZ / emtricitabine / TDF) Efavirenz ADR: psych issues, depression Nevirapine Rilpivirine

Question 30

NNRTI - BBW

Answer 30

1) Hepatotoxicity 2) Severe Rash *Worst with Nevirapine

Question 31

Rilpivirine

Answer 31

1) WITH FOOD > 500 Cal | 2) Requires ACIDIC pH (CI @ PPIs)

Question 32

Protease Inhibitors - Side Effects

Answer 32

Metabolic ADRs: 1) Hyperglycemia 2) Hyperlipidemia 3) Lipodystrophy * Least with: 1) atazanavir 2) darunavir

Question 33

Protease Inhibitors - DDIs

Answer 33

CYP Inhibitors

Question 34

Atazanvir Brand / consideration

Answer 34

Reyataz 1) Do NOT use with acid-lowering medications 2) Hyperbilirubinemia

Question 35

Darunavir Brand

Answer 35

Prezista

Question 36

Sulfa allergy Protease Inhibitors

Answer 36

Darunavir Fosamprenavir Tipranavir

Question 37

Boosters

Answer 37

CYP3A4 Inhibitors: 1) Ritonavir 2) Cobicistat

Question 38

CCR5 Antagonist / consideration

Answer 38

Miraviroc (Selzentry) | - requires CCR5-tropism assay

Question 39

Fusion Inhibitor

Answer 39

Enfuvirtide (Fuzeon) | - SQ injection

Question 40

Post-attachment Inhibitor

Answer 40

Ibalizumab-uiyk (Trogarzo) | - IV injection for MDR HIV only

Question 41

Opportunistic Infections

Answer 41

``` OPPORTUNISTIC INFECTIONS: M. Avium Complex (MAC) Pneumocystis jiroveci pneumonia (PCP) Cryptococcus neoformans Histoplasmosis Severe Candida albicans Tuberculosis ``` Kaposi's sarcoma (cancer) HIV Wasting Syndrome (lipoatrophy, loss of muscle mass)

Question 42

PrEP (Pre-Exposure Prophylaxis)

Answer 42

1) Truvada (TDF / emtricitabine) 2) Descovy (TAF / emtricitabine) Baseline HIV test & HBV Testing q 3 months

Question 43

PEP (Post-Exposure Prophylaxis)

Answer 43

Truvada only (NOT Descovy) PLUS: 1) Dolutegravir (Tivicay) 2) Raltegravir (Isentress) within 72 hrs for 28 days