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RxPrep > HIV > Flashcards

HIV Flashcards

1
Q

How is HIV transmitted?

A
  1. direct contact between infected body fluid (blood, semen, vaginal/rectal secretions, and breast milk)
  2. direct contact with mucous membranes or open wounds (IV drug use)
  3. mother-to-child/ vertical transmission through pregnancy, childbirth, or breastfeeding
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2
Q

How often is HIV testing recommended for all patients 13-64 y/o?

A

once unless other RF

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3
Q

What patients should have HIV screening annually?

A
  1. history of other STIs, hepatitis, or TB
  2. those engaging in high-risk activities (sex with multiple partners/unknown sexual history, MSM, anal/vaginal sex with someone who has HIV, sharing needles/syringes for IV drugs)
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4
Q

What are the symptoms of acute HIV infection?

A
  1. non-specific flu-like symptoms few days to several weeks (fever, myalgia, headache, lymphadenopathy, pharyngitis, rash)
  2. asymptomatic
  3. no antibody response for weeks -months
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5
Q

When is AIDs diagnosed?

A

CD4 count <200 cells/mm3
OR
Aids defining condition:
1. opportunistic infection
2. cancers (Kaposi’s sarcoma)
3. HIV wasting syndrome

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6
Q

What medications can be utilized to treat HIV wasting syndrome?

A
  1. dronabinol (Marinol, Syndros)
  2. megestrol (a progestin)
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7
Q

How is HIV diagnosed?

A
  1. initial screening for antibodies or antigens
  2. confirmatory test
  3. nucleic acid test detecting HIV RNA viral load (if confirmatory test is negative/ indeterminant)
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8
Q

How long does it take for HIV antibodies to be detected?

A

4-12 weeks after infection; up to 6 months

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9
Q

What OTC HIV test detects the presence of antibodies and provides immediate results?

A

OraQuick In-Home HIV Test

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10
Q

What are counseling points for OraQuick In-Home HIV Test?

A
  1. swab upper and lower gums with the test stick then insert into a test tube containing liquid
  2. result can be read in 20 minutes
  3. 1 line (control) is a negative result; 2 lines is a positive result
  4. testing <3 months after exposure can lead to false negative due to a lag in antibody production
  5. positive result must follow up for a confirmatory test
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10
Q

What type to virus is HIV?

A

RNA retrovirus that uses host cell processes to replicate

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11
Q

What are the 8 stages of HIV replication?

A
  1. blinding and attachment
  2. fusion
  3. reverse transcriptase
  4. nuclear import
  5. integration
  6. transcription/translation
  7. assembly
  8. budding and maturation
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12
Q

Why is it important that patients with HIV are adherent to ART (antiretroviral therapy)?

A

prevent resistance and prolong life

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13
Q

What is tested as an indicator of immune function and will determine the need to prevent OIs?

A

CD4 count

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14
Q

What is tested as an indicator of ART response?

A

HIV viral load

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15
Q

What should happen to CD4 count and HIV viral load as a result of starting ART?

A
  1. increased CD4
  2. decreased HIV viral load
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16
Q

What should be monitored for the efficacy of ART?

A
  1. CD4 count
  2. HIV viral load
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17
Q

What are warnings with NRTIs?

A
  1. lactic acidosis
  2. hepatomegaly with steatosis (fatty liver)
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18
Q

What are SEs with NRTIs?

A
  1. nausea
  2. diarrhea
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19
Q

What are the treatment goals of ART?

A
  1. achieve and maintain an undetectable viral load
  2. restore and maintain immune function
  3. reduce HIV-related morbidity (OIs)
  4. reduce mortality
  5. prevent transmission
20
Q

What are the preferred once-daily, single-tablet regimens for initial ART?

A
  1. Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)
  2. Triumeq (dolutegravir/abacavir/lamivudine)
  3. Dovato (dolutegravir/ lamivudine)
21
Q

What are the preferred once-daily, two-tablet regimens for initial ART?

A
  1. Tivicay + Truvada (dolutegravir + emtricitabine/tenofovir disoproxil fumarate)
  2. Tivicay + Descovy (dolutegravir + emtricitabine/ tenofovir alafenamide)
22
Q

What drug classes are preferred to include in ART?

A

2 NRTIs + 1 INSTI

23
Q

What are the 2 most common NRTI regimens?

A
  1. emtricitabine/ tenofovir alafenamide (Descovy)
  2. emtricitabine/tenofovir disoproxil fumarate (Truvada)
24
Q

Which 2 NRTIs are both cytosine analogs that would result in antagonism of each other and should not be used together?

A

lamivudine and emtricitabine

25
Q

Which medication should not be used for initial treatment if HIV viral load >500,000 or Hep C co-infection (or unknown status)?

A

Dovato (dolutegravir/lamivudine)

26
Q

What medication requires HLA-B* 5701 allele testing and what does it mean?

A
  1. Triumeq (dolutegravir/abacavir/lamivudine)
  2. A positive result indicates a higher risk of for severe hypersensitivity reaction in any abacavir-containing product and is CI
27
Q

What medication has more flexible dosing for CrCl<30?

A

Biktarvy; the individual components (bictegravir/emtricitabine/tenofovir alafenamide) can be given separately to allow for renal dosage adjustment

28
Q

How should most HIV medications be dispensed?

A

dispensed in the manufacturer’s bottle; most medications will come in a 1 month’s supply in the original container

29
Q

Why are alternative ART regimens using single products/combination products less ideal?

A
  1. increased resistance (except PIs)
  2. decreased patient tolerability
  3. higher potential for drug interactions
30
Q

What drugs make up an alternative ART regimen?

A

1 base (PI (boosted) / NNRTI/INSTI) + 2 NRTIs

31
Q

How should pregnant patients be treated for HIV?

A
  1. continue if already taking ART
  2. most HIV meds are considered safe in pregnancy
32
Q

What are preferred regimens in ART-naive pregnant patients?

A

INSTI (dolutegravir preferred) OR boosted PI (darunavir preferred)
PLUS 2 NRTIs

33
Q

What medication can be given around the time of delivery to prevent verticle transmission of HIV?

A

IV zidovudine to mother and newborn

34
Q

What is immune reconstitution inflammatory syndrome (IRIS)?

A

unexpected (paradoxical) worsening of a known or unidentified underlying condition after ART is started or starting a more effective ART; the immune system is now capable of mounting an immune response

35
Q

What conditions may typically worsen due to IRIS?

A
  1. OIs
  2. Hep B and C
  3. HSV/VZV (shingles)
  4. autoimmune conditions
  5. some cancers
36
Q

When does IRIS typically occur?

A

when a low CD4 count begins to recover

37
Q

How is IRIS managed?

A

continue ART as symptoms are usually self-limiting; treat the unmasked condition

38
Q

How can the NRTIs be remembered?

A

Z LATTE

39
Q

What drugs are in the NRTI class?

A

Zidovudine
Lamivudine
Abacavir
Tenofovir disoproxil fumarate
Tenofovir alafenamide
Emtricitabine

40
Q

What is the MOA of NRTIs?

A

competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA

41
Q

What NRTI does NOT need renal dosage adjustment?

A

Abacavir

42
Q

Why are 2 NRTIs included in a typical ART regimen?

A

low barrier to resistance (high rates of resistance)

43
Q

What NRTIs are available as once-daily regimens?

A
  1. both forms of Tenofovir
  2. abacavir
  3. lamivudine
44
Q

What NRTIs are available as twice-daily regimens?

A
  1. Zidovudine
  2. abacavir
  3. lamivudine
45
Q
A
46
Q

What are boxed warnings with Zidovudine?

A
  1. lactic acidosis
  2. hepatomegaly with steatosis (fatty liver)
47
Q

What are the boxed warnings for HBV and HIV co-infections?

A
  1. severe acute HBV exacerbation can occur if abacavir, emtricitabine, lamivudine, and tenofovir is D/C
  2. Do NOT use Epivar-HBV for the treatment of HIV (contains lower dose of lamivudine than what is needed to treat HBV)

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