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HIV Flashcards

1
Q

how is HIV transmitted?

A

Bodily fluid

High risk: blood, semen, vaginal & cervical secretion, breast milk

Medium risk: amniotic, cerebrospinal, peritoneal, pericardial, synovial, pleural

Low risk: saliva, tears, sweat, urine, feces, bite, sharing sex toes

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2
Q

Clinical presentation

A

acute infection–> clinical latency–> AIDs, OI CD4 < 200cells/mm^3

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3
Q

Clinical Presentation
acute retrovirus syndrome

A

flu like/mononucleosis
onset:2-4 wks after exposure
duration <
test + or - or indeterminate

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4
Q

Clinical presentation seroconversion

A

onset: up to 6 months
test positive after ab production

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5
Q

clinical presentation
clinical latency

A

asymptomatic

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6
Q

HIV Testing

A

-one time testing for 13-64 yo + sexually activ e
-opt out testing
no speerate consent for HIV
-pretest counseling not required
-repeat HIV testing left to discretion of provider

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7
Q

when to screen annually

A

unprotected sex
>1 sex partner since last test
STI,TB, or hepatitis
IVDU
exchange $ or drug for sex
partner HIV + or with any of these criteria

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8
Q

diagnosis for HIV

A

CD4/CD4%
-tells immune function

Nucleic Acid Test**
-confirmatory test
-detects HIV RNA (aka viral)

4th Gen HIV p24 Ag+ EIA**
-detects the presence of infection early on

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9
Q

Monitoring parameters for HIV

A

surrogate markers
-CD4 (as high as possible, >200)
-Viral load (goal = undetected)

Resistance testing
-genotype: baseline and failure
-phenotype: failure; similar to MICs and not routine

Adherence
-decrease morbidity and mortality

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10
Q

treatment naive antiretroviral initiation

A

-ART for ALL patients with HIV/AIDS
-Treat and treat

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11
Q

Classes of HIV Medications

A

NRTI
NNRTI
Protease Inhibitors
Fusion Inhibitor
Entry Inhibitor
Integrase Inhibitors
Post attachment Inhibitor

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12
Q

NRTI
Co-formulations

A

Abacacvir/lamivudine (epzicome)

Tenofovir disoproxil fumarate/ emtriocitabine (Truvada)

Tenofovir alafenamide/emtricitabine (descovy)

Lamiudine/ Tenofovir disoproxil fumarate (Cimduo)

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13
Q

Possible NRTI adverse effects class effect

A

pancreatitis and lactic acidosis

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14
Q

lamiviudine (NRTI) elimination and side effect

A

elimination: renal

minimal toxicity

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15
Q

abacavir (NRTI) elimination and side effects

A

hepatic

hypersensitivity reaction
check HLAB*5701

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16
Q

Tenofovir disoproxil fumarate (NRTI) elimination and side effect

A

renal

renal insufficiency (increased Scr), decreased BMD, Fanconi syndrome, HA, N/V/D

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17
Q

Emtricitabine (NRTI) elimination and side effect

A

renal

Minimal toxicity, palmar-plantar hyperpigmentation

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18
Q

Tenofovir alafenamide (NRTI)
elimination and side effects

A

carboxyl-esterses; Pgp, BRCP

HA, N/D, LESS nephrotoxicity and LESS decreases in BMD, reverse alopecia,

increase TC and HDL, weight gain, cough, ab pain, fatigue

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19
Q

what is the difference between TDF and TAF

A

lower TAP serum concentration improves bone and kidney safety profile

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20
Q

NRTI and CYP450

A

Do not inhibit or induce CYP450 isoenzymes

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21
Q

how is Tenofovir alafenamide best absorbed

A

with a high fat meal

22
Q

p-gp substrate

23
Q

HBV activity

A

lamivudine, TDF, emtricitabine ,TAF

-abrupt d/c may cause severe acute exacerbations
-hepatic function monitored closely with with clinical and laboratory f/u for at least severe month if pt d/c anti-HBV therapy, resumption may be warranted

24
Q

chain terminators

25
Q

CYP3a4 inhibitors

A

Protease inhibitors

26
Q

Protease inihibitors

A

Ritonovir (very potent, given to other PI makes= more tolerable

Atzanavir

Darynavir (less SE)

27
Q

Possible Side effects of Protease inhibitors

A

dyslipidemia, glucose intolerance,GI doors, lipodystrophy, GI (N/V/D), hepatotoxicity, rash, weight gain

take with food to decrease GI upset and enhance absorption of some PIs.

28
Q

does ritonavir have retroviral activity?

A

no, boost concentration

29
Q

Ritonavir Side effect

A

taste perversion, parathesias, asthenia

30
Q

atazanavir

A

hyperbilirubinemia (scleral icterus) nephrolithiasis, PR prolongation

31
Q

darunavir

A

see class effects, sulfonamide

32
Q

CYP Inducers

33
Q

Integrase Inhibitors

A
  • Raltegravir (Isentress®, Isentress HD®)
  • Elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide (Stribild®)
  • Dolutegravir (Tivicay®)
  • Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy®)
  • Cabotegravir (Vocabria®, Apretude®)
34
Q

Dolutegravir possible side effects

A

HA, insomian N/D, HSR, hepatototicity, wt gain, depression, and suicidal ideations (rare)

35
Q

DDI of Dolutegravir

A

-UGT1A1 and CYP3A inducers

-AI or Mg-containing: separate INSTI administration > 2 hrs before or >6 hrs after antacid

-Fe and Ca-containing: take together with food or administer INSTI > 2hrs before or >6hrs after supplement

-Metformin start low and titrate slow

36
Q

how is Dolutegravir taken

A

Once or BID taken with or without food

37
Q

Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) adverse effects

A

HA, N/D, wt gain

38
Q

Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) metabolism

A

UGT1A1 and CYP3A

39
Q

Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) DDI

A
  • UGT1A1 and CYP3A inducers
  • Al or Mg-containing: INSTI can be taken under fasting conditions ≥ 2 hrs
    before. Avoid simultaneously with or 2 hrs after polyvalent cations
  • Fe or Ca-containing: take together with food. Do not coadminister INSTI
    under fasting conditions simultaneously with, or 2 hrs after
40
Q

how is Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) taken

A

Once daily taken with or without food!

41
Q

Renal impairment for INSTI?

A

no dose adjustment

42
Q

post-attachment inhibitor

A
  • Ibalizumab-uiyk (Trogarzo®)
43
Q

post-attachment inhibitor

A
  • Heavily treatment experienced
  • Administration: Loading dose, 2000 mg IV infusion; maintenance dosage,
    800 mg IV infusion every 2 week
  • Side effects: N/D, dizziness, and rash
44
Q

Capsid Inhibitor

A

Lenacapavir (Sunlenca)

45
Q

Lenacapavir (Sunlenca)

A
  • Inhibits capsid formation disrupting release of HIV from CD4 cells after replication
  • 927 mg SC once every 6 months (Oral lead-in period) * Sustrate: CYP3A, UGT1A1, p-gp
  • Inhibitor: Moderate CYP3A
  • Role in therapy: Treatment experienced patients
46
Q

Initial ARV-Naive Combination

A

2 NRTI or 1NRTI + Integrase inhibitor

47
Q

Treatment-Naïve Preferred Regimens
Once-Daily Single Tablet Regimens

A
  • Biktarvy (Bictegravir/emtricitabine/tenofovir alafenamide)
  • Triumeq (Dolutegravir/lamivudine/abacavir)*
  • Dovato (Dolutegravir/lamivudine)
  • Symtuza (Darunavir/cobicistat/emtricitabine/tenofovir alafenamide)
48
Q

Treatment-Naïve Preferred Regimens
Multi Tablet Regimens

A
  • Tivicay (Dolutegravir) + Descovy (emtricitabine/tenofovir alafenamide) or Truvada (emtricitabine/tenofovir disoproxil fumarate)
  • Prezcobix (Darunavir/cobicistat)+ Descovy (emtricitabine/tenofovir alafenamide) or Truvada (emtricitabine/tenofovir disoproxil fumarate)
49
Q

Barrier to Resistance

A

NNRTs (lowest barrier to resistance)
NRTIs
INSTIs
PIs (highest barrier to resistance)

50
Q

PrEP

A
  • Tenofovir DF/emtricitabine (Truvada®) PO daily for high-risk adults and adolescents ≥ 35 kg (FDA approved July 2012)
  • Tenovir AF/emtricitabine (Descovy®) PO daily for at-risk adults and adolescents ≥ 35 kg excludes receptive vaginal sex (FDA approved Oct 2019)
  • Cabotegravir (Apretude®) long-acting inj IM once every 2 mo. for high-risk adults and adolescents ≥ 35 kg ± PO (Vocabria®) lead-in x1 mo. (FDA approved Dec 2021)
  • ADEs: inj site reaction, HA, N/D, ab pain or discomfort
  • Substrate: UGT1A1&raquo_space; UGT1A9
  • Contraindications: rifampin, rifapentine, AEDs (CBZ, oxcarbazepinem phenobarbital, phenytoin)
51
Q

Postexposure Prophylaxis (PEP)

A
  • Occupational vs. Non-Occupational
  • Time to initiation: 72 hours
  • Duration of treatment: 28 days

ID (27 decks)

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