HIV Flashcards
Which of the following best describes how HIV lab parameters would be expected to change if antiretroviral therapy isn’t started?
a. The viral load will decrease and the CD4+ count will increase
b. The viral load will increase and the CD4+ count will decrease
c. The viral load will increase and the CD4+ count will stay the same
d. The viral load will remain the same and the CD4+ count will increase
e. Both the viral load and the CD4+ count will decrease
b
CS is a 37 y/o female presenting to the HIV clinic for a routine appointment. During the physical exam, it’s noted that her skin and sclera are yellow. What med is she likely receiving that’s causing this side effect?
a. Atazanavir
b. Darunavir
c. Elvitegravir
d. Enfuvirtide
e. Cobicistat
a
Which antiretroviral drug is available as an IV form that’s used to prevent perinatal transmission of HIV?
a. Efavirenz
b. Maraviroc
c. Zidovudine
d. Stavudine
e. Tenofovir alafenamide
c
Administered during labor in HIV-infected pregnant women to prevent HIV transmission to the infant
Which of the following represents a significant side effect of zidovudine?
a. Peripheral neuropathy
b. Depression
c. Intracranial hemorrhage
d. Anemia
e. Hyperbilirubinemia
d
Cobicistat is used in antiretroviral therapy regimens as a/an:
a. Integrase Strand Transfer Inhibitor
b. Protease Inhibitor
c. CYP3A4 Inhibitor
d. CYP3A4 Inducer
e. Non-Nucleoside Reverse Transcriptase Inhibitor
c
Which of the following HIV meds should be taken with food?
a. Rilpivirine
b. Efavirenz
c. Complera
d. Genvoya
e. Atripla
a, c, d
Efavirenz and Atripla should be taken on an empty stomach
Which of the following is a recommended regimen for initial HIV treatment according to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV?
a. Dolutegravir + emtricitabine + TDF
b. Abacavir + lamivudine + nevirapine
c. Emtricitabine + lamivudine + zidovudine
d. Etravirine + nevirapine + ritonavir + saquinavir
e. Darunavir + ritonavir + efavirenz
a
This regimen includes an NRTI backbone (2 agents) plus an INSTI
A phlebotomist had an accidental needle stick injury while drawing a blood sample from an HIV-positive patient. Which drug combo is the preferred regimen for post-exposure prophlyaxis?
a. Emtricitabine + TAF
b. Efavirenz + TDF + emtricitabine
c. Raltegravir + TDF + emtricitabine
d. Dolutegravir + abacavir + lamivudine
e. Rilpivirine + emtricitabine + TAF
c
Post-exposure prophylaxis guidelines recommend 28 days of Truvada + Isentress
Which of the following meds is administered via SC injection?
a. Enfuviritde
b. Ibalizumab-uiyk
c. Maraviroc
d. Indinavir
e. Didanosine
a
Fuzeon is a fusion inhibitor given via SC injection. It has no significant drug interactions, but almost 100% of patients experience injection site reactions
KD is a 35 y/o female who’s HIV-neg and is married to an HIV-pos man. She’s interested in tx to decrease her chances of contracting HIV. Which of the following would be an appropriate recommendation?
a. Emtricitabine + TDF
b. Raltegravir + emtricitabine + TDF
c. Abacavir + lamivudine + dolutegravir
d. Lamivudine + zidovudine
e. Rilpivirine + emtricitabine + TAF
a
Truvada is approved for PrEP. Descovy is an alternative agent for PrEP, but it’s not indicated in patients assigned female at birth.
Which of the following is a warning for all drugs classified as Nucleoside Reverse Transcriptase Inhibitors (NRTIs)?
a. Hematologic toxicities
b. Psychiatric symptoms
c. SJS
d. Lactic acidosis
e. Insulin resistance
d
Warnings common to the class of NRTIs include lactic acidosis and hepatomegaly with steatosis
What is the integrase strand transfer inhibitor (INSTI) component of Triumeq?
a. Rilpivirine
b. Abacavir
c. Dolutegravir
d. Elvitegravir
e. Cobicistat
c
Which of the following is the correct drug class for emtricitabine?
a. Nucleoside reverse transcriptase inhibitor
b. Non-nucleoside reverse transcriptase inhibitor
c. CCR5 receptor antagonist
d. Integrase strand transfer inhibitor
e. Protease inhibitor
a
What is the minimum amount of time that a pt should wait after an HIV exposure before the OraQuick In-Home HIV Test?
a. 2 weeks
b. 1 month
c. 2 months
d. 3 months
e. 6 months
d
-HIV p24 antigens can be detected as early as 2 weeks post-infection
-The OraQuick test detects the presence of HIV antibodies formed by the body in response to the antigen
-Antibodies typically take 4-6 weeks after the infection to be detected
-OraQuick should be used at least 3 months from exposure d/t the lag in antibody production - testing sooner can lead to a false-neg result
JR is a 45 y/o male who was recently diagnosed with HIV. He brings his current med list to the clinic during a routine checkup.
Prezista 800 mg PO daily
Ritonavir 100 mg PO daily
Truvada 1 tab PO daily
Lovaza 2 g PO BID
HCTZ 25 mg PO daily
Simvastatin 40 mg PO daily
The pharmacist should contact the medical provider about which of the following interactions?
a. Simvastatin and ritonavir
b. Prezista and ritonavir
c. Lovaza and Truvada
d. Prezista and simvastatin
e. HCTZ and ritonavir
a, d
Which of the following is a risk associated with didanosine?
a. Abnormal dreams
b. Pancreatitis
c. Nephrolithiasis
d. Injection site reactions
e. Hyperbilirubinemia
b
A healthcare worker has started post-exposure prophylaxis therapy for a needle stick injury. How long should the tx be continued?
a. 2 weeks
b. 4 weeks
c. 6 weeks
d. 12 weeks
e. 24 weeks
b
The primary goals of antiretrovirals are to:
a. Reduce the progression of HIV
b. Suppress the HIV viral load
c. Decrease CD4+ lymphocyte counts
d. Decrease the incidence of opportunistic infections
e. Prevent transmission of HIV
a, b, d, e
Which of the following could cause an allergic reaction in a pt with a sulfa allergy?
a. Atazanavir
b. Bictegravir
c. Abacavir
d. Emtricitabine
e. Darunavir
e
PS is a 65 y/o male who’s been HIV-pos for 20 years. He reports that for the past 6 months he hasn’t had an appetite and has lost significant muscle mass. Which of the following drugs could be recommended to address PS’s concerns?
a. Megace ES
b. Prednisone
c. Dronabinol
d. Lyrica
e. Nabilone
a, c, e
The patient’s symptoms indicate that he’s likely experiencing HIV Wasting Syndrome. Options to increase appetite include dronabinol (Syndros), nabilone, and megestrol (Megace ES)
What antiretroviral class should be administered separately from antacids?
a. NRTIs
b. PIs
c. NNRTIs
d. INSTIs
e. CCR5 antagonists
d
INSTIs should be taken 2 hours before or 6 hours after cation-containing products, including antacids
Which of the following is a major benefit of TAF when compared to TDF?
a. No renal dose adjustment required
b. Formulated to improve adherence
c. Lower risk of nephrotoxicity
d. Easier storage
e. Lower risk for hep B exacerbation
c
Both have a boxed warning for severe acute exacerbation of hep B upon d/c of therapy
Which combo antiretroviral contains TAF?
a. Epzicom
b. Truvada
c. Complera
d. Biktarvy
e. Stribild
d
EM has been on ART therapy for 3 years and has been adherent. His doctor recently noticed some side effects from the medicines he’s taking. EM is experiencing dyslipidemia, an abnormal fat deposit at the base of his neck and high blood sugar. These side effects most commonly occur with the following class of meds:
a. NRTIs
b. NNRTIs
c. PIs
d. INSTIs
e. Entry inhibitors
c
Dyslipidemia, lipohypertrophy (peripheral fat loss with central fat accumulation), and insulin resistance commonly occur with PI therapy.
HIV is a single-stranded ___ retrovirus that uses the machinery in host ________________ to replicate. When HIV continues to replicate, the viral load ___________ and the CD4 count ____________.
RNA; CD4 T-helper cells; increases; decreases
What are the 2 ways that a patient can be diagnosed with AIDS?
if the CD4 count falls below 200 cells/mm3 or the patient develops an AIDS-defining condition
Type of transmission when the infection is spread from a women with HIV to her child
vertical transmission
How often should somebody be screened for HIV according to the CDC?
At least once for all patients 13-64 y/o; if a patient is at high risk for HIV, they should be screened at least annually
Patients at high risk for acquiring HIV
- Sharing drug-injection equipment
- High-risk sexual behaviors: MSM, multiple sexual partners, history of STD
- History of hepatitis or tuberculosis infection
Acute HIV presents with what?
non-specific flu-like symptoms
What antigens can be detected 2 weeks post-infection?
HIV RNA and HIV p24 antigens
What screening test is used to detect HIV RNA and HIV p24 antigens?
HIV-1/HIV-2 antigen/antibody screening test
Positive results from an HIV-1/HIV-2 antigen/antibody screening test should be confirmed with what?
antibody differentiation immunoassay
What does the antibody differentiation immunoassay do?
differentiates HIV-1 antibodies from HIV-2 antibodies
Antibodies can be detected in most people how long after contracting the disease?
4-12 weeks
OTC test that detects the presence of HIV antibodies and provides immediate results
OraQuick In-Home HIV Test
When should OraQuick be used and what could happen if used sooner?
> /= 3 months from exposure; testing sooner can cause a false negative result
The major indicator of immune function used to determine the need for opportunistic infection prophylaxis
CD4 count
The most important indicator of response to ART
HIV viral load
A pt should be tested for what if considering using abacavir?
HLA-B*5701 allele
What should a pt have done if considering using maraviroc?
tropism assay
Why is treatment adherence essential for patients on ART?
to prevent drug resistance
What are the ART regimens that are available in one pill taken once daily?
Biktarvy, Triumeq, Dovato
Biktarvy
bictegravir
emtricitabine
TAF
Triumeq
dolutegravir
abacavir
lamivudine
Dovato
dolutegravir
lamivudine
What are the ART regimens that are available in two pills, usually taken once daily?
Tivicay + Truvada
Tivicay + Descovy
Tivicay
dolutegravir
Truvada
emtricitabine
TDF
Descovy
emtricitabine
TAF
Most preferred ART regimens contain what?
2 NRTIs and 1 INSTI
What two drugs in preferred ART regimens are interchangeable but shouldn’t be used together?
lamivudine and emtricitabine
Dovato should not be used in treatment-naive patients if HIV RNA is > ___________ copies/mL, there is known _______________ co-infection (or if status is unknown, or HIV genotype testing is not yet available.
500,000; hepatitis B
Which HIV drugs cannot be used in CrCl < 30 mL/min?
Biktarvy, Triumeq, Dovato, Truvada, Descovy
A complete HIV ART regimen has what?
one base plus 2 NRTIs
Name the NRTIs
abacavir, emtricitabine, lamivudine, TDF/TAF, zidovudine
Administered IV during labor and delivery in patients with HIV RNA > 1,000 copies/mL (to protect the baby)
Zamivudine
What are the 2 warnings for all NRTIs?
lactic acidosis and hepatomegaly with steatosis
Severe acute HBV exacerbation can occur if what NRTIs are are discontinued?
emtricitabine, lamivudine, and tenofovir-containing products
Name the NRTI:
BBW: Risk for hypersensitivity reaction
- Screen for HLA-B*5701 allele before starting; contraindicated if positive
- Patients must carry a med card
Consider avoiding with CVD d/t a potential increased risk of MI
abacavir
Name the NRTI:
Can cause hyperpigmentation of the palms of the hands or the soles of the feet
emtricitabine
Name the NRTI:
- Can cause renal impairment, including acute renal failure and Fanconi syndrome (renal tubular injury with hyperphosphatemia)
- Can cause decreased bone mineral density
TDF and TAF
TDF or TAF: Associated with a higher risk of lipid abnormalities
TAF
Name the NRTI with these safety concerns:
- Hematologic toxicity - neutropenia and anemia (increased MCV is a sign of adherence)
- Myopathy
zidovudine
Stribild should not be started in CrCl < __ mL/min and it should be discontinued in CrCl < __ mL/min.
70; 50
Biktarvy and Genvoya should not be started in patients with CrCl < __ mL/min.
30
Name the INSTI with these safety concerns:
- Increased SCr with no effect on GFR
bictegravir, dolutegravir
Name the INSTI with these safety concerns:
- Increased CPK, myopathy, and rhadomyolysis
Raltegravir
Which INSTI has a safety concern for proteinuria?
elvitegravir
Name the INSTI with these safety concerns:
- HSR with severe rash and organ dysfunction. including hepatotoxicity
- Small risk of neural tube defects in a developing fetus (still a preferred drug for tx of HIV in pregnancy)
- Increased CPK, myalgia
dolutegravir
What are side effects of all INSTIs?
headache, insomnia, diarrhea, weight gain, rare risk of depression and suicidal ideation in patients with pre-existing psychiatric conditions (except bictegravir)
INSTIs should be taken __ hours before or __ hours after aluminum, calcium, magnesium, and iron-containing products.
2; 6
Which INSTis can be taken with oral calcium or iron if also taken with food?
dolutegravir and bictegravir
Which NNRTI needs an acidic environment for absorption?
rilpivirine
T/F: Efavirenz should be taken with food.
false; food increases the bioavailability and risk for CNS effects. Efavirenz should be taken on an empty stomach at night to decrease CNS effects.
All NNRTIs can cause what things?
hepatotoxicity and severe rash, including SJS/TEN
Rilpivirine should not be used if viral load is > __________ copies/mL and/or CD4 count < ___ cells/mm3.
100,000; 200
With rilpivirine:
- Do not use ___
- Take H2RAs at least __ hours before or __ hours after
- Take antacids at least _ hours before or __ after
PPIs
12; 4
2; 4
