HIV Flashcards
How does HIV lead to AIDS?
HIV attacks and destroys the infection-fighting CD4 T-cells of the immune system. The loss of CD4 cells make it difficult for the immune system to fight infections, leading to AIDS.
How is HIV transmitted from one person to another?
Having unprotected sexual intercourse with an infected person
Sharing infected syringes and needles
Mother-to-child transmission during pregnancy, at birth or through breastfeeding
Transfusion with contaminated blood and blood products
Who should be tested for HIV? (8)
IV drug users Person who have unprotected sex with multiple partners Man who have sex with man Commercial sex workers Persons treated for STDs Recipients of multiple blood transfusion Persons who have been sexually assaulted Pregnant women
Diagnosis of HIV infection
Serum antibody detection: HIV enzyme immunoassay antibody tests, Western Blot
HIV RNA detection/quantification (viral load): nucleic acid amplification (PCR)
CD4 cell count for AIDS?
AIDS = CD4 <200/mm3
What is viral load?
The amount of plasma HIV RNA
What does CD4 count indicate?
It is an indicator of immune function in HIV-infected patients
What does viral load indicate?
It is an indicator of response to antiretroviral therapy
When do we start ART?
It is recommended for all HIV-infected individuals regardless of CD4 count.
What are the benefits of earlier treatment?
Prevent potentially irreversible damage to the immune system
Decreased risk for HIV-associated complications
Decreased risk for non-opportunistic conditions
Decreased risk of HIV transmission
What are the 5 classes of drugs in the ART armamentarium?
Reverse transcriptase inhibitors Fusion inhibitors Protease inhibitors Integrase inhibitors PK enhancers
What are the recommended combinations for patients naïve to ART?
2 NRTI 1 INSTI
tenofovir + emtricitabine + bictegravir
tenofovir + emtricitabine + dolutegravir
abacavir + lamivudine + dolutegravir
1 NRTI 1 INSTI
emtricitabine + dolutegravir
What drugs are active against HBV?
Emtricitabine, lamivudine, tenofovir
What patients are not eligible for dual therapy of emtricitabine + dolutegravir?
HIV RNA >500,000copies/mL
HBV coinfection
in whom ART is to be started before the results of HIV genotypic resistance testing or HBV testing are available
What are the 5 nucleoside reverse transcriptase inhibitors?
Emtricitabine, tenofovir, abacavir, lamivudine, zidovudine
How are NRTIs cleared?
Renally
Dose adjustments required for renal impaired patients (except abacavir)
What are the class disadvantages of NRTIs?
Adverse effects related to mitochondrial toxicity (rate but serious)
- Lactic acidosis and hepatic steatosis
- lipoatrophy
Renal dose adjustments
What are the adverse effects of lamivudine?
Minimal toxicity
What are the adverse effects of emtricitabine?
Minimal toxicity
What are the adverse effects of tenofovir?
Renal impairment
Decrease in bone mineral density
What are the adverse effects of abacavir?
Hypersensitivity reaction in patients with HLA-B*5701.
What are the adverse effects of zidovudine?
Bone marrow suppression
What are the INSTIs?
Bictegravir, dolutegravir, raltegravir, elvitegravir
What is the adverse effect of raltegravir?
Creatinine kinase elevation (rhabdomyolysis)
What are the NNRTIs?
Efavirenz, rilpivirine
What is the adverse effect of efavirenz?
Neuropsychiatric SE
What are the protease inhibitors?
Ritonavir, lopinavir, atazanavir, darunavir, fosamprenavr (FLARD)
Which class of antivirals have an increased risk for lipohypertrophy?
Protease inhibitors
What is a class disadvantage of PIs?
Increased metabolic complications like dyslipidemia and insulin resistance
What is a fusion inhibitor?
Enfuvirtide
What is an AE associated with enfuvirtide?
Injection site reaction (it is given SC)
What is a CCR5 antagonist?
Maraviroc
What must be done before initiation of maraviroc?
Co-receptor tropism assay to check what receptor the HIV uses to enter the CD4 cell (should be CCR5 receptor)
What are the reasons for treatment failure?
- Drug toxicities leads to non-adherence
- Dosing schedule and requirements
- Drug drug interactions
- Viral resistance
- Regimen potency
- Provider experience
- Adherence > 95%
