HIV Flashcards
First line ART regimens and their contraindications?
- AZT/3TC+EFV
- ANAEMIA, hx psychosis - TDF/3TC/EFV
- uncontrolled BP, diabetes, renal failure - ABC/3TC+LPV/r
- hypersensitivity) - TDF/3TC/DGT (standard ≥ 30kgs adults)
- uncontrolled BP, diabetes, renal failure, epilepsy, hepatitis B &C - AZT/3TC+ DTG
- anemia, epilepsy, hepatitis - ABC/3TC+ DTG
- hypersensitivity, epilepsy, hepatitis - ABC/3TC+ RAL
- hepatitis, hypersensitivity - ABC/3TC+ EFV
- Hypersensitivity, history of psychosis
Second line ART regimens and their contraindiations?
- TDF/3TC+ATV/r
- uncontrolled BP, diabetes, renal failure, patient on RIF, preexisting jaundice/suspected hepatitis - AZT/3TC+ATZ/r
- anemia, patient on RIF, preexisting jaundice/suspected hepatitis - TDF/3TC+LPV/r
- uncontrolled BP, diabetes, renal failure - AZT/3TC+LPV/r
- anemia - TDF/3TC/DGT (standard ≥ 30kgs adults)
- uncontrolled BP, diabetes, renal failure, epilepsy, hepatitis B &C
Third line regimens and their contraindications?
DRV+r+DTG
- epilepsy
Side effects of EFV?
- Mild skin rush, nightmares, psychosis
- Breast enlargement in children and men
Side effects of ATZ/r and what you can substitute with it instead?
- can cause jaundice
- No combination RIF+ ATV/r
- Pre-existing jaundice/suspected hepatitis: no ATV/r instead LPV/r
- jaundice=cosmetic concern
- Do LFT, if only indirect raised stop drug, if no LFT available stop ATV/r
Side effects of ABC?
Fever, body pains, vomiting, cough/breathing problems and sore throat ; life-threatening SE of ABC
- Stop and never restart ABC
DTG and antiepileptic drugs and what to do in case you have to use both together?
- Never combine DTG with standard antiepileptic’s drugs
e.g. carbamazepine, phenobarbital, phenytoin - Consider regimen without DTG
- Give antiepileptic’s with double dose of DTG
- Check VL 6-monthly to confirm suppression
Benefits of DTG in pregnant women?
- Faster and durable in VL suppression
- Lower risk of maternal OIs and death
- Risk of HIV transmission to sex partners and to child
Side effects of DTG in pregnant women?
Potential risk of tube neural defect is now considered very low
Side effects of DTG?
DTG and RAL are well tolerated
1. Mild headache
2. insomnia
3. nausea
4. diarrhea usually subsides
5. DTG and RAL worsen liver damage, but rarely cause hepatotoxicity
- Check transaminases before and after initiation of DGT in patients with known hepatitis B/C
6. DTG is associated by with a risk of obesity in some patients
Who uses 13A and what can you use instead?
13A cannot be used in < 20 kg children due the high dose of TDF:
1. 15P : 20-24.9 Kg
2. 15A: 25-29.9 Kg
- Monitor weight and routinely move to 13 a once they reached 30 Kgs
- Confirm VL suppression in the last 6 months before making this transition
Combining ARVs and TB treatment?
- DTG and RAL regiments (13,14,15 and 16) are good combination with TB 1st line treatment, but:
- Daily dose of DTG and RAL needs to be doubled while on RIF
- Take double the regular RAL-dose regimen in the morning and in the evening
- Doubling of DTG and RAL also applies to children - Continue double dose 7 days after last dose of RIF
Describe urine LAM/serum CrAg screening?
- Serum CrAg +: LP, treat for active meningitis if CSF testing ( CrAg, Indian ink, Gxpart) result is positive
- LP negative: pre-emptive antifungal therapy
Management of urine LAM/serum CrAg positive?
- Admit patient
- Option 1: Induction phase: liposomal amphotericin-B + Fluocytosine for 7/7
- Option 2: Fluconazole +fluocytosin for 14 days
- Option 3: liposomal amphotericin-B + fluconazole for 14 days
Option 1 in the Induction phase in treatment for positive urine LAM/ serum CrAg?
- Adult: liposomal amphotericin : 3-4mg/kg IV over 6hours, 24 hourly ( but 6m/kg in case of treatment failure or serious disease)
child: 6mg/Kg IV over 6hrs, 24 hourly - Flucytosine tabs: 100mg/kg/day divided into 4 , 6 hourly
Option 2 in the Induction phase in treatment for positive urine LAM/ serum CrAg?
- This option requires FBC monitoring: at baseline, and 2-3 times in the second week of treatment
- Adults: fluconazole tabs: 1200mg 24-hourly, child: 12mg/kg (max 800mg) 24-hourly
- Flucytosin tabs: 100mg/kg/day divided into 4 doses (6-hourly)
Option 3 in the Induction phase in treatment for positive urine LAM/ serum CrAg?
requires FBC, creatinine, and K+ monitoring; baseline, 2-3 times second week of Rx
1. Liposomal amphotericin B: 3-4 mg/kg iv over 6 hours 24-hourly or 6 mg/kg for Rx failure or serious diseases
2. Fluconazole tabs: adults: 1200 mg 24-hourly; child: 12 mg/kg (max 800 mg) 24-hourly.
Consolidation and maintenance phases in treatment for positive urine LAM/ serum CrAg?
- Fluconazole tab for 8 weeks:
- Adults: 800 mg 24 hourly
- Children: 12 mg/kg (800 mg) 24-hourly - Maintenance phase for life
- Adults: 200 mg 24-hourly
- 6 mg/kg 24-hourly
Key things to remember when treating cryptococcal?
- Early diagnosis and management= life-saving
- Liposomal amphotericin B has lower toxicity than the regular amphotericin B; there can be given at higher dosage
- Before giving liposomal amphotericin B: pre-hydrate, supplement electrolytes
Indications for TB preventive therapy?
- Hiv infected children and adults regardless of TST status
- Children under 5 living with patients on TB Rx (sputum positive/negative/LAM positive): 6 months IPT
Do you need to take TBT again if you have taken it before?
Those who completed 6-Months of IPT in the past do not need another course of TPT
When not to take TPT?
No TPT if any sign of TB
- full investigation of TB and start full TB drugs if positive
Who needs to take TBT?
- New patients: ARV+TPT+CPT
- Already on ART: start TPT regardless the time of ART
- Give TPT regardless of previous TB treatment
Side effects of TBT?
- Most side-effects minor and disappear within 3 months
- Major rare SE: hypersensitivity, neuropathy, and severe hepatitis
- well tolerated by most patients