HIV Flashcards
What is HIV/AIDS caused by?
- Human immunodeficiency Virus
*member of the Lentivirus genus and Retroviride family
*will destroy to CD4 cells
What is AIDS characterized?
Most advanced stage of HIV infection
1. CD4 cell count below 200
2. CD4 cell % of total lymphocytes less than 15%
3. Obtaining an opportunistic illness
What is the binding/attachment stage of HIV
- Binding of HIV to CD4 receptor
What is the fusion stage of HIV?
- HIV envelop fuses with CD4 membrane. Releasing HIV RNA and enzymes
What is the Reverse transcription stage of HIV?
Reverse transcriptase coverts HIV RNA into DNA that enters the CD4 nucleus
What is the integration stage of HIV?
The integrase protein integrate the HIV DNA into the host cells DNA
What is the replication stage of HIV?
Replication of host/HIV DNA occurs and translation of HIV proteins
What is the assembly stage of HIV?
New HIC RNA and protein move to CD4 surface and form immature HIV
What is the budding stage of HIV?
The new HIV pushes itself outside of the CD4 cell and releases protease to form infectious HIV
What is the most important part/goal for drug therapies?
Adherence at least 95% or greater
*Missing no more than 1dose/month of once-daily regimen
What is the 1 pill regimen for HIV (newly diagnosed)? (1 integrase strand transfer INSTI + 1-2 Nucleotide reverse transcriptase inhibitors NRTIs)
- Biktarvy = bictegravir/emtricitabine/tenofovir alafenamide (TAF)
- Triumeq = Dolutegravir/ abacavir/ lamivudine
- Dovato = Dolutegravir/lamivudine
What is the CI of Dovato?
- Hepatitis B infection
- HIV viral load >500,000 copies
What is the 2 pill regimen for HIV (newly acquired)?
- Trivicay (Dolutegravir) + Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
- Trivicay (Dolutegravir) + Descovy (emtricitabine/tenofovir alafenamide) (TAF)
- Isentress (raltegravir) + Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
- Isentress (raltegravir) + Descovy (emtricitabine/tenofovir alafenamide) (TAF)
What is PREP for (pre-exposure prophylaxis)
High risk sexual behavior
What needs to be completed before starting PREP?
- HIV -
- Screen for Hep B/STIs
- Confirm renal function
What are the options for PREP?
- Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
- Descovy (emtricitabine/tenofovir alafenamide) (TAF)
- Apretude (cabotegravir)
*1&2 tablets
*3 injection
What is the monitoring schedule for PREP?
Every 3 months
When should the PEP for HIV be taken?
- Within 72 hours and taken for 28 days
What are the options for HIV PEP?
- Truvada (emtricitabine/tenofovir disoproxil fumarate) (TDF)
PLUS - Tivicay (Dolutegravir)
OR - Isentress (raltegravir)
*use once daily for 28 days
***Do NOT wait for HIV results to start PEP
What should be used during childbirth if the mom has HIV?
- Use Zidovudine IV if viral load is greater than 1000 copies/mL at delivery or unknown
What are options of infant PEP?
- 3 dose of nevirapine during the first week of life and zidovudine
- 3 drug regimen of zidovudine, lamivudine,and nevirapine or raltegravir
What drug is involved at the binding stage of HIV?
Maraviroc
*CCR5 anatagonist
What drug is involved at the fusion stage of HIV?
Enfuvirtide
*Fusion inhibitor
What drug is involved at the reverse transcription stage of HIV?
(Non) Nucleotide transcriptase inhibitors
*NNRTIs/NRT
What drug is involved at the budding stage of HIV?
Protease inhibitors
*Saquinavir
What drug is involved at the integration stage of HIV?
Integrase inhibitors
What is the MOA of CCR5 anatagonist (Maraviroc)
Blocks HIV from binding to the CCR5 co-receptor preventing binding
What is the special note about CCR5 antagonist? (Maraviroc)
- Works only with CCR5
*not useful with CXCR4 or mixed CXCR4 and CCR5
What is the MOA of fusion inhibitors (Enfuvirtide)
Prevents HIV from fusing to CD4
What are the Nucleotide reverse transcriptase inhibitors? (NRTIs)
- Tenofovir disoproxil fumarate (TDF)
- Tenofovir alafenamide (TAF)
- Lamivudine
- Abacavir
- Zidovudine
What is the BBW of NRTIs?
- Do not discontinue NRTIs if HBV + patients w/o adequate HBV treatment
*Abacavir; must screen for HLA B 5701 before starting
What are the AE of NRTIs?
- Tenofovir
*renal toxicity (worse with TDF)
*TDF will decreased bone mineral density
What is the first line ART (anti-retroviral therapy) regimen?
NRTIs
What are the NNRTIs?
- Efavirenz
- Rilpivirine
What is the BBW of NNRTIs?
- Heptotoxicity
- Severe rash
What is the CI about Rilpivirine?
DO NOT use with PPIs
*eat with food
What is a special note about efavirenz?
- Take on an empty stomach at night
What are the integrase inhibitors
- Bictegravir
- Dolutegravir
- Raltegravir
What is the preferred treatment for HIV?
Integrase inhibitors
What is the BBW about Dolutegravir and raltegravir?
D: neural tube defects (preferred drug in pregnancy), hypersensitivity rash, hepatoxicity
R: myopathy
What are the special notes about integrase inhibitors?
- Do not give with cations (AI or Mg supplements)
What are the protease inhibitors?
- Atazanavir
- Darunavir
Why are protease inhibitor no longer 1st line treatment?
Bc of the DDI and AE, and increased resistance
What are the special notes about protease inhibitors?
- ALL PI are substrates and strong inhibitors of CYP 3A4
*creates DDI
*3A4 inducers will decrease PI potency
*DO NOT GIVE PI with a 3A4 inducer
What is the CI about cyctochrome P450 inhibitors (boosting agents)?
Do not use with 3A4 inducers
What are the special notes about CYP P450 inhibitors (boosting agents)?
- They inhibit CYP3A4, CYP2D6, and P-gp transporters
- Not interchangeable, have to be on the same one
What is the strongest predictor for virologic failure?
Lack of adherence
What are the Cytochrome P450 inhibitors (boosting agents)?
- Ritonavir
- Cobicistat
What is the MOA of Cytochrome P450 inhibitors (boosting agents)?
- Inhibitor of CYP 3A4
- Will inhibit ART metabolism
- ART effect will be enhanced
