HIV Flashcards
What class of drugs does Zidovudine (AZT) belong to?
Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
What are the seven drug classes used to treat HIV?
Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Nucleoside Analogs
Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Protease Inhibitors (PT)
Entry Inhibitors
Integrase Inhibitors
Which two drugs make up Combivir?
Zidovudine (AZT) and Lamivudine
What three drugs make up Trizivir?
Zidovudine (AZT), Lamivudine, and Abacavir
Initial HIV treatment options
Three drugs from two different classes including an integrase inhibitor
- Dolutegravir + Abacavir + lamivudine (Tiumeq)
- Dolutegravir + Emtricitabine/TAF (Descovy)
- Emtricitabine/TAF/elvitegravir with cobicistat boosting (Genvoya)
- Raltegravir + Emtricitabine/TAF (Descovy)
Which two drugs make up Descovy, Truvada
Emtricitabine and Tenofovir Alafenamide (TAF)
Which drug is used for HIV PrEP?
Emtricitabine/Tenofovir Alafenamide
AKA Descovy or Truvada
What route of transmission carries the greatest risk for HIV?
Needle, especially large bore
What route of transmission is the most common in HIV?
Sex
Highest-to-lowest risk: Anal, vaginal, oral
Symptoms of acute HIV infection
Listed by highest frequency to lowest: Fever Morbilliform rash** Pharyngitis Lymphadenopathy Headache Mucocutaneous ulcers Thrombocytopenia Leukopenia Transaminase elevations
Differential: Mononucleosis
Dx: Monospot
Key differences: EXUDATIVE pharyngitis, rash rare unless PCN-like drug given, no ulcers, rarely GI symptoms, abundant atypical lymphocytes
HIV detection times for 3rd and 4th generation antibody tests
3rd gen: 21-24 days
4th gen: 14-15 days
Plasma HIV RNA within about 10 days
HIV Confidentiality Laws
Disclosed on a “Need to Know” basis only
HIV Testing Laws
Mandated to offer HIV testing to 13+
Must disclose 7 points of info r/t HIV available to patient
Verbal consent allowed
Must arrange follow-up if positive
HIV info may be released to medical providers and insurance without patient consent
Delivering HIV results
Negative - may be informal, remote
Positive - in person only
Reporting of Positive HIV Results
Mandated reporting to DOH
Identify partners/exposed
Can HIV+ individuals transmit the virus if their levels are undetectable?
No
Management of HIV+ women in pregnancy
AZT (ZDV) administered orally during second and third trimester (14-34 weeks of pregnancy)
AZT IV infusion before and during delivery
AZT administered to infant for six weeks
Indications for PEP
Occupational exposure
Sexual assault
nPEP - isolated incidence of exposure (sex, needle)
Initiating PEP
Best within 2 hours or up 24 hours
Case-by-case basis if >36 hours (efficacy wanes)
Continue for 28 days
PEP Regimens
Truvada [TRV]
(tenofovir [TDF] 300 mg/emtricitabine [FTC] 200 mg) one tablet daily + Isentress (raltegravir [RAL]) 400 mg BID
Duration X 28 days (or until PUI ruled out for HIV)
Follow-up x 12 weeks
Baseline LFTs, BUN, creatinine, CBC. HIV test, pregnancy test
Repeat LFTs, BUN, creatinine, CBC at 2 & 4 wks
HIV test at 4 and 12 weeks
Injectable PrEP
Apretude (Cabotegravir)
Long-acting
Initiation: Give IM monthly x 2 months
Given every 2 months
May give PrEP to adolescents without parental consent
Baseline data prior to initiating PrEP
4th generation HIV test, perform NAAT/viral load if acute HIV is suspected
Basic metabolic panel- PrEP contraindicated if CrCl<60ml/min for F/TDF; CrCl<30ml/min for F/TAF
Urinalysis
Serology for Hepatitis A, B, C - Vaccinate for A and B in non-immune individuals
STI screening. Perform 3 site (genital, rectal, pharyngeal) NAAT screening for GC, Chlamydia and RPR
Pregnancy test
Monitoring during PrEP therapy
HIV test and NAAT/Viral Load q3m for oral regigen
HIV test and NAAT/Viral Load q2m for CAB inj
Confirm negative before refilling
STI testing q6m
Pregnancy test q3m
BUN, Cr, HepC, U/A q12m
