HIV Flashcards
Dolutegravir
Tivicay
Tivicay
Dolutegravir
Dolutegravir/lamivudine
Dovato
Dovato
doluteg/lamivudine
dolutegravir/lamivudine/abacavir
triumeq
triumeq
dolutegravir/lamivudine/abacavir
dolutegravir/emt/TAF
Biktarvy
biktarvy
dolut/emt/TAF
emt/TDF
Truvada
truvada
emt/TDF
emt/TDF
truvada
descovy
emt/TAF
emt/TAF
descovy
rilpivirine/emt/TDF
Complera *w food
Complera *w food
rilpivirine/emt/TDF
rilpivirine/emt/TAF
odefesy *w food
odefesy
rilpivirine/emt/TAF
abacavir/lamivudine
Epzicom
What are the types of based ART regimens that are COMPLETE regimens
INSTI based
NNRTI based
PI based
NRTIs
pneumonic for drugs
ADE of all
Pearls
LATTE
Lamivudine (LAM)
Abacavir
TDF
TAF
Emtracitibine
ADE all: lactic acidosis, hepatomegaly with steatosis, NVD, HA, inc LFTs
BBW: SCREEN ALL PATIENTS FOR HEP C AND HEP B FIRST
ABACAVIR: Screen for HLA-B*5701 allele
Lamivudine
Brand name
MOA
in which regimens
Epivir
NRTI
in QD and BID regimens
Abacavir
MOA
What is special about abacavir
NRTI
Screen for HLA-B*5701 allele
BBW for hypersensitivity rxn, if occurs patient must carry card saying abacavir HSRxn
Emtracitibine
MOA
ADE
NRTI
hyperpigmentation of palms and soles of feet
TDF and TAF
adverse effects of each
TDF (D for Dumpy)
- renal impairment, acute renal failure and fanconi
- dec dose in renal imp (CI CrCl <50)
- must avoid nephrotoxins (NSAIDS, AGs)
- dec MBD: dexa scans, CA and Vit D!
TAF
- hyperlipidemia
these ADE are not mutually exclusive, are just more predominant in one or other
NNRTIs “-virine”
pneumonic for drugs
what regimens are these part of
REDEN
Rilpivirine
Efavirenz
Doravirine
Etavirine
Neviripine
NNRTI-based regimens with NNRTI +2NRTIs
why are there no NRTI based regimens
NRTIs have low barrier to resistance
rilpivirine
MOA
regimens part of
Pearls
NNRTI
NNRTI-based regimens with 2 NRTIs
RPV/EMT/TDF = Complera
RPV/EMT/TAF = Odefesy
take with FOOD and WATER (NO PROTEIN DRINKS)
CI with PPI, H2RA, antacids
Do not use if viral load >100,000 or CD4 <200 (high failure rate)
ADE: depression, inc SCr
efavirenz
MOA
regimens part of
Pearls
NNRTI
Part of NNRTI-based regimens Atripla (D/C’d) and Symfilo (EFA/LAM/TDF)
take on EMPTY STOMACH qhs
ADE: CNS tox (sleep) so take at night, food would inc F but inc CNS tox
depression, suicidal thoughts
INSTIs
drugs
ADE
dolutegravir, cabotegravir, elvitegravir, raltegravir
ADE: HA, insomnia, D, weight gain, depression, suicidal ideation
exacerbation of preexisting psych conditions
Protease inhibitors (-navir)
ADE all
DDI/do not use with
ADE: inc LDL, inc TG, inc body fat, inc BG, insulin resistance. abdominal adiposity –> metabolic syndrome
inc LFTs, hepatitis
SJS/TEN, angioedema, bronchospasm
D/N
inc CVD risk
ALL ARE 3A4 SUBSTRATES AND INHIBITORS
DDI/do not use with
alfuzosin
colchicine
dronaderone
lovastatin, simvastatin
3A4 inducers (carbamazepine, penobarbital, rifampin, SJ Wort, phenytoin)
DOACs, ticagrelor
Hep C antivirals
hormonal contraceptives
steroids
atazanavir
MOA
ADE
Pearls
PI
hyperbilirubinemia
needs ACDIC gut
take atazanavir 2 hours before or 1 hour after for tums and 10 hours after for H2RA
which PIs should be used with caution in sulfa allergy
darunavir, tipranavir, fosamprenavir
ritonavir DDI specific
ritonavir solution contains 43% alcohol –> avoid with metronidazole 2/2 disulfiram reaction
why is ritonavir used as booster and not a PI
doses needed for ART are too high to tolerate and lower doses are used for boosting others
cobicistat
MOA
booster, inhibits 3A4
are boosters (rilpivirine and cobicistat) taken with or without food?
with food
Miraviroc
MOA
pearls
CCR5 inhibitor
need tropism test beforehand to ensure HIV strain uses CCR5 or else ineffective (CXCR4/CCR5 mixed does not qualify)
CI CrCl <30 or use with 3A4 inducers or inhibitors
fostemsavir
MOA
when to use
attachment inhibitor
used with other ARV in patients who are treatment experienced and not responding to current therapy
ibalizumab-uiyk (Troganzo IV)
post-attachment inhibitor
used with other ARV in patients who are treatment experienced and not responding to current therapy
enfuvirtide (Fuzeon)
MOA
ADE
fusion inhibitor
ADE: bacterial PNA, HSRxn, inj site reaction
opportunistic infections possible in AIDS
MAC (mycobacterium avium complex)
pneumocystis jirovecii pneumo (PCP)
cryptococcus neoformans
histoplasmosis
severe candida infections (thrush, TB)
Cancer thats common in AIDS
Kaposi’s sarcoma
HIV wasting syndrome s/sx and tx options
dec appetite
dec body fat
dec muscle mass
dronabinol, megestrol inc appetite
HIV in pregnancy
if on tx vs tx naive
continue current treatment
if naive, INSTI-based regimens with 2 NRTIs preferred (Biktarvy, Triumeq, Striblid, Genvoya)
CANNOT BREASTFEED
PrEP
when given
meds preferred
before high risk activity
Truvada (EMT/TDF)
Descovy (EMT/TAF)
PEP
when given
preferred meds
monitoring
within 72 hours after high risk activity
Raltegravir (Isentress) or Dolutegravir (Tivicay) PLUS Truvada
get baseline HIV Ab, repeat at 4-6 weeks, 3 months, 6 months
