HIV Flashcards
1
Q
AIDS
A
- CD4 < 200
- AIDS defining condition
2
Q
AIDS-defining Condition
A
Opportunistic Infections:
- MAC
- PJP
- Severe Candida albicans
- Thrush
- TB
Cancers:
-Kaposi’s sarcoma
Other: HIV Wasting Syndrome
3
Q
Screening/Diagnosis
A
- Everyone once between 19-64 yo
- High-risk for infection annually
- High-Risk: sexual behaviors, injecting drugs, STIs/TB hx
4
Q
Acute HIV
A
- Flu-like sxs (occurs in 50-70%)
- About 2 weeks post-infection high enough viral load for HIV RNA/p24 antigen to be connected (use HIV1/2 antigen/antibody screening)
- Positive screening + positive confirmatory = HIV diagnosis
5
Q
OraQuick
A
- At home HIV antibody test
- Done 3+ months post-exposure
- Earlier can give false negative
- Requires positive confirmatory test for diagnosis
6
Q
Stage 1
A
- Binding/attachment
- Binds to CD4 receptor by CCR5 and/or CXCR4
7
Q
Maraviroc
A
- Works on stage 1
- CCR5 antagonist
- Only works if patient only has CCR5 receptors
8
Q
Fostemsavir
A
- Works on stage 1
- Attachment inhibitor
9
Q
Ibalizumeb-uiyk
A
- Works at stage 1
- Post attachment inhibitor
- Uncommonly used
- IV injection
- For MDR HIV
10
Q
Stage 2
A
- Fusion
- Virus fuses with cell membrane and release HIV RNA/enzymes/proteins
11
Q
Fuzeon
A
- Enfurvirtide
- Fusion inhibitor
- SQ injection
- Works at stage 2
12
Q
Stage 3
A
- Reverse transcription
- RNA converted to DNA by reverse transcriptase and enters nucleus
13
Q
NRTIs
A
- Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
- Works at stage 3
- Ex: Tenofovir, Emtricitabine
- Only abacavir DOESN’T need renal adjustment
- Drug Class Warning: lactic acidosis, hepatomegaly w/ steatosis
- SE: nausea, diarrhea, HA, increased LFT
- Some used to treat HBV too, DON’T D/C if HBV positive
14
Q
NNRTIs
A
- Non-nucleoside reverse transcriptase inhibitors
- Works at stage 3
- Drugs contain “-vir-“
- Ex: Efavirenz, rilpivirine
- Box Warning: rash/severe rash, hepatotoxicity
15
Q
Stage 4
A
- Integration
- Integrase (HIV enzyme) released and HIV DNA incorporated into host DNA
16
Q
INSTIs
A
- Integrase strand transfer inhibitors
- Works at stage 4
- Drugs end in “-gravir”
- Preferred tx with NRTI backbone in patient naive
- Separate Al/Mg antacids from INSTIs (2 before, 6 after)
- SE: HA, insomnia, diarrhea. weight GAIN
17
Q
Stages 5/6
A
- Replication
- Assembly
- No drug associations
18
Q
Stage 7
A
- Budding/Maturation
- Protease breaks up long viral chains to make them mature, infectable HIV
19
Q
PI
A
- Protease inhibitors
- Works at stage 7
- Drugs end in “-navir”
- SE: metabolic problems (sugars/chol.), lipodystrophy
- Lowest risk: atazanavir and darunavir
20
Q
Initial Evaluation
A
- CD4 count (goal: normal levels)
- HIV viral load (goal: undetectable)
- Hep B/C screening
- Pregnancy test
- HLA-B*5701 (abacavir req., CI if positive, severe allergic rxn risk)
- Tropism assay (maraviroc req.)
21
Q
Preferred ART Therapy
A
- 2 NRTIs and 1 INSTI
- Descovy or Truvada are common for 2 NRTI backbone
- NEVER use lamivudine and emtricitabine together (redundant)
- If renally insufficient, harder to use combo products (use individuals)
22
Q
Dovato
A
- Dolutegravir/Lamivudine
- Don’t use in naïve pts with RNA >500K, known HBV coinfection, or no genotyping
- One pill per day
- Dolutegravir: Increases SCr w/o eGFR
23
Q
Triumeq
A
- Dolutegravir/Abacavir/Lamivudine
- Abacavir requires HLA-B*5701 testing, CI if positive, severe allergic rxn risk
- One pill per day
- Dolutegravir: Increases SCr w/o eGFR
24
Q
Biktarvy
A
- Bictegravir/Emtricitabine/TAF
- One pill per day
- Emtricitabine: risk for hyperpigmentation in hands/feet
- Can be given with iron/calcium IF taken with food
- Bictegravir: Increases SCr w/o effect on GFR
25
Q
NRTI Backbone
A
-TAF OR TDF OR ABACAVIR
PLUS
-Emtricitabine OR Lamivudine
-Then combined with INSTI, NNRTI, or PI for regimen
26
Q
Z LATTE
A
NRTI pneumonic: Z - Zidovudine (only used L&D now if RNA > 1000, protect baby) L - Lamivudine A - Abacavir T - TDF T - TAF E - Emtricitabine
27
Q
Descovy
A
- Emtricitabine/TAF
- Emtricitabine: risk for hyperpigmentation in hands/feet
28
Q
Truvada
A
- Emtricitabine/TDF
- Emtricitabine: risk for hyperpigmentation in hands/feet
- CrCl should be > 60
29
Q
Tivicay
A
- Dolutegravir
- INSTI
- Dolutegravir: Increases SCr w/o eGFR
30
Q
Isentress
A
- Raltegravir
- INSTI
- Can be used in HD patients
- Used multiple times a day
- SE: myopathy/increased CPK/rhabdo, rash risk
- Can be taken with calcium carbonate
- Used in PEP
31
Q
BRED
A
INSTI Pneumonic: B: Bictegravir R: Raltegravir E: Elvitagravir D: Dolutegravir
32
Q
Tenofovir Formulations
A
- Viread: TDF
- Vemlidy: TAF (monotherapy not available)
- NRTIs
- NOF Risks: nephrotoxicity, osteoporosis, Fanconi syndrome
- TAF has less toxicities compared to TDF
33
Q
Epivir
A
- Lamivudine
- NRTI
- Used for HBV AND HIV (different brands, use right one for indication)
34
Q
Emtriva
A
- Emtricitabine
- NRTI
- Risk for hyperpigmentation in hands/feet
35
Q
Ziagen
A
- Abacavir
- NRTI
- Require HLA-B*5701
36
Q
Retrovir
A
- Zidovudine
- NRTI
- Anema (treat with erythropoietin)
- Give IV during L&D if RNA > 1000 to protect baby
37
Q
Atripla
A
- Efavirenz/Emtricitabine/TDF
- Efavirenz can cause depression/psych issues => take at bedtime on empty stomach to reduce these SE
- Emtricitabine has risk for hyperpigrmentation in hands/feet
- FIRST one pill QD, so some still on it
38
Q
Rilpivirine
A
- NNRTIs
- MUST be take with full meal > 500 kcal
- CI with PPIs
- Don’t use if viral load >100K or CD4 < 400
- H2RAs/antacids need to be separated
39
Q
Reyataz
A
- Atazanavir
- PI
- CI: acid lowering medications
- SE: hyperbilirubinemia (“bananavir”)
40
Q
Prezista
A
- Darunavir
- PI
- Caution with sulfa allergy
- SJS/TEN Risk
41
Q
Norvir
A
- Rilpivirine
- ONLY used with PI
- PK booster
- Numerous DDI!
- 43% alcohol: avoid with metronidazole, disulfiram, etc.
42
Q
Tybost
A
- Cobicistat
- PK booster
- No ART activity
- Can be used with other ART classes
- Numerous DDI!
43
Q
Wasting Syndrome Tx
A
- Characterized by loss muscle mass, loss of appetite, diarrhea
- Cannabis related products like Syndros (dronabinal) or nabilone help improve appetite
- Megace ES (megesterol) is a progestin that also stimulates appetite
44
Q
IRIS
A
- Immune reconstitution inflammatory syndrome
- Worsening of underlying condition after starting ART (unmasks condition)
- Self-limited, DON’T start ART
- More likely to occur as viral loads drop and CD4 rises
45
Q
Preggo Tx Options
A
- Abacavir/Lamivudine OR TDF/Emtricitabine (or Lamivudine here) with a boosted PI OR INSTI
- Boosted PI Options: Atazanavir or darunavir with ritonavir
- INSTI Options: Raltegravir or dolutegravir
- *NO TAF**
46
Q
PrEP
A
- Confirm negative HIV test first
- Screen recent sxs, CrCl >= 60, HepB/STI screening
- Treat with Truvada or Descovy
- Follow-up in 3 months to ensure HIV negative status and check kidneys/STIs
47
Q
PEP
A
- Start ASAP (w/in 72 hours) no matter then circumstance
- Baseline HIV test, follow-up in 4-6 weeks, 3 months, and 6 months
- Treat with Truvada + Tivicay OR Raltegravir
- Raltegravir preferred for preggo/childbearing age
