HIV Flashcards
What is the marker of disease progression in HIV?
CD4 count
Viral load
Reverse transcriptase inhibitors
- Lamivudine= 3TC
- Abacavir= ABC
- Emtricitabine= FTC
- Efavirenz= EFV
Viral mutation inhibitors
- Ritonavir= RTV
- Atazanavir=ATV
- Darunavir= DRV
Integration, transcription, and translation inhibitors
- Raltegravir= RAL
- Integrase inhibitors = INSTI
- Dolutegravir= DTG
- Elvitegravir= EVG
what are the 5 primary goals of ART’s?
- Maximal and durable viral suppression
- Restoration and preservation of immune function (CD4 count)
- Improved quality of life
- Reduced HIV related opportunistic infection
- Reduced morbidity and mortality
First-line therapy
INSTI + 2 NRTIs
- BIC/FTC/TAC
- DTG/ABC/3TC
- DTG + XTC + (TAF or TDF)
- RAL + XTC + (TAF or TDF)
INSTI + 1 NRTI
-DTG/3TC
First-line therapy for pregnancy and non-pregnant women who are trying to conceive
Preferred:
Dual NRTI backbone pluse INSTI or boosted PO
Alternative:
Dual NRTI backbone and NNRTI
What agents are NOT recommended in pregnancy
- BIC, DOR, IBA, FTR
- EVG/COBI, ATV/COBI, and DRV/COBI
Should you start ART on day of therapy?
If patient is ready, emerging strategy to reduce loss to follow-up and decrease time to viral suppression
Adverse effects for integrase inhibitors?
GI distress, CNS disturbances, rash, false elevation in creatinine, and weight gain
Integrase drug interactions
- Cations (acid reducers)
- Metformin
Adverse effects for NNRTIs (except doravarine)
- liver toxicity
- rash usually 6 weeks
- hyperlipidemia
- hyperglycemia
- Neuropsychiatric effects for Efavirenz and Rilpivirine
NNRTIs drug interactions (except doravarine)
- Efavirenz, nevirapine and etravirine are CYP3A inhibitors
- Rilpivirine is a substrate of CYP3A
When would you use an Entry inhibitor?
mainly used for heavily treatment experienced patients
Challenges with boosted PI
o Drug-drug interactions o GI intolerance o Hyperlipidemia o CV risk for some PIs o Metabolic syndromes o Not part of fully formulated regimen
