HIV Flashcards
HIV Monitoring Parameters
CD4 Count
Viral Load
CMP, CBC
Hep B+C Screening
Pregnancy test
Preferred Initial Regimen in Treatment Naive Patients
Bictegravir/Emtricitabine/TAF - Biktarvy 1 tab QD
Dolutegravir/Abacavir/Lamivudine - Triumeq 1 tab QD
- Requires HLA-B5701 allele testing because of HSR due to abacavir
Dolutegravir/Lamivudine - Dovato 1 tab QD
- Do not use if viral load >500,000, Hep B coinfection, or HIV genotyping not available
Dolutegravir + Emtricitabine/TDF - Tivicay + Truvada 2 tab QD
Dolutegravir + Emtricitabine/TAF - Tivicay + Descovy 2 tab QD
1 INSTI + 2 NRTI
Biktarvy, Triumeq, Dovato, Truvada, Descovy: DO NOT USE IF CrCl <30 ml/min
Adherence is the most important
There is no CURE
Goal = undetectable b/c
undetectable = untransmissible
Alternative ART Regimens
1 “BASE” + 2 NRTI “BACKBONE”
Base can be INSTI, NNRTI, or PI
Backbone must be Emtricitabine OR Lamivudine + TDF OR TAF
Nucleoside Reverse Transcriptase Inhibitors (NRTI)
Drug Class Warning: Lactic acidosis and hepatomegaly with steatosis
Boxed Warning: HBV and HIV coinfection:
- Severe acute HBV exacerbation can occur if NRTI is discontinued
Abacavir (Ziagen)
- Risk for HSR, test patient for HLA-B5701 allele
Emtricitabine (Emtriva)
- Can cause hyperpigmentation of palms or soles (harmless)
Lamivudine (Epivir)
- Do not use Epivir-HBV to treat HIV, lower dose
Tenofovir disoproxil fumarate (Viread)
- Can cause renal impairment and decrease bone mineral density
Tenofovir alafenamide
- Lower risk than TDF
Zidovudine
- Given IV during labor to protect baby if mother’s HIV RNA is unknown or >1000
TDF - DO NOT START if CrCl <50
TAF - DO NOT START if CrCl <30
Integrase Strand Transfer Inhibitors (INSTI)
Separate INSTIs with polyvalent cations (aluminum, magnesium, calcium, iron)
- 2 hours before or 6 hours after
Bictegravir
- Can increase SCr
Cabotegravir (Apretude)
- IM injection for PrEP
Dolutegravir (Tivicay)
- Can increase SCr
- Cause rhabdo, HSR, hepatotoxicity
- Preferred in pregnancy
Elvitegravir (Genvoya, Stribild)
- Do not start if CrCl <70
- Do not discontinue if CrCl <50
Raltegravir (Isentress)
- Can cause rhabdo, HSR
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Can cause hepatotoxicity, SJS/TEN, psychiatric symptoms
Major CYP3A4 subtrates.
- Do not use with CYP3A4 inducers
Efavirenz (Sustiva)
- Take on empty stomach to lower CNS effects
Rilpivirine (Edurant)
- Take with food
- Needs acidic environment for absorption
- Do not use if CD4 <200 or Viral Load >100,000
- Do not use PPIs concurrently, separate from H2RAs and Antacids
Protease Inhibitors (PI)
Use with PK boosters: Ritonavir, cobicistat
No renal adjustment needed
Take with food
SE:
- Elevated LDL, TG, LFT, BG, Insulin Resistance
- Lowers HDL
Has MANY drug interactions b/c CYP3A4 substrates
Azatanavir (Reyataz)
- Needs acidic environment for absorption
- Can cause hyperbilirubinemia
Darunavir (Prezista)
- Caution with sulfa allergy
Ritonavir is used as PK booster ONLY
Pharmacokinetic Booster
Strong inhibitors of CYP3A4 - MANY drug interactions
Ritonavir (Norvir)
- Not well tolerated at high doses as PI, so only used in lower dose for boosting
Cobicistat (Tybost)
- Can be co-formulated with other ART drugs
- Taken with food
Entry + Attachment Inhibitors
Maraviroc (Selzentry)
- CCR5 antagonist
- causes hepatotoxicity, HSR
- Tropism Assay is required
Fostemsavir (Rukobia)
- Attachment inhibitor
INSTI-based Combination Antiretroviral Products
Biktarvy - Bictegravir/Emtricitabine/TAF
Cabenuva - Cabotegravir/Rilpirivine
Triumeq - Dolutegravir/Abacavir/Lamivudine
Dovato - Dolutegravir/Lamivudine
Stribild - Elvitegravir/Cobicistat/Emtricitabine/TDF
Genvoya - Elvitegravir/Cobicistat/Emtricitabine/TAF
NNRTI-based Combination Antiretroviral Products
Complera - Rilpivirine/Emtricitabine/TDF
Odefsey - Rilpivirine/Emtricitabine/TAF
PI-based Combination Antiretroviral Products
Symtuza - Darunavir/Cobicistat/Emtricitabine/TAF
NRTI Combination Products
Must be used with additional ART drugs
Epzicom - Abacavir/Lamivudine
Descovy - Emtricitabine/TAF
Truvada - Emtricitabine/TDF
AIDS
CD4 <200
Opportunistic Infections
Karposis sarcoma
HIV wasting symptoms
IRIS = Worsening of HIV after ART initiated
HIV treatment in Pregnancy
Continue ART regimen or start ASAP in naive patients
2 NRTI + INSTI (dolutegravir preferred) or boosted PI (darunavir preferred)
Zidovudine IV
