HIV Flashcards
1
Q
Where was HIV thought to orginate?
A
chimps
2
Q
Can HIV be passed through breastfeeding?
A
yes
3
Q
What was the first HIV drug?
A
AZT
4
Q
What event caused a drastic decline in AIDs deaths?
A
HAART
5
Q
What is the most common risk factor for HIV?
A
PWID
6
Q
What risk factor for HIV is starting to rise quickly?
A
heterosexual sex
7
Q
Who should get tested for HIV?
A
- do not know
- sexually active
- all pregnant
- illicit drug use
- endemic countries
- signs of HIV
8
Q
What is the standard test for HIV? Why is it used?
A
4th gen Ab+Ag
100% sensitive and takes 3 days to know results
9
Q
If 4th gen test comes back positive what happens next?
A
confirm with geenius 1/2
10
Q
What do HIV screens test for?
A
P24 antigen which is an HIV protein used in a capsid
11
Q
If needing a quick result of a test what should we use?
A
POC rapid test= results in minutes still must confirm if positive
12
Q
When would a dried blood spot HIV test be used?
A
better confidentiality
no immediate results which may be beneficial
13
Q
Where can you go to get tested?
A
any community lab or street team
14
Q
What does HIV do?
A
targets CD4 T lymphocytes and these are used to coordinate immune response by stimulating other cells
15
Q
What is AIDs?
A
end stage HIV where the CD4 count is less than 200 or an AIDS defining illness
16
Q
What is an aids defining illness?
A
pneumocystis pneumonia, mycobacterium avian complex, cytomegalovirus
17
Q
Which type of HIV is more common?
A
Type 1
18
Q
Where are mucous membranes?
A
rectum, vagina, penis and mouth
19
Q
Under what viral load is no risk of transmission?
A
<200
20
Q
True or false: HIV will vertically transmit always?
A
NO
21
Q
What is a normal CD4 count?
A
800-1200
22
Q
At any CD4 count what is common?
A
TB
23
Q
At <250 CD4 count what is common?
A
coccidiomycosis
24
Q
At <200 CD4 count what is common?
A
Pneumocystis
25
At <150 CD4 count what is common?
Histoplasmosis and crytpococcus
26
At <50 CD4 count what is common?
MAC,CMV,PAL
27
Under how many copies is suppressed viral load?
<50
28
If a viral load test comes back as undetected what does this mean?
no viral copies found
29
Typically how long until patients with HIV get suppressed status?
1-2 months
30
What is the basic MOA of antiretrovirals?
block viral replication= stop destruction of CD4
31
How many active antiretrovirals do we need?
>1
32
How do NRTIs work?
acts as host nucleotide decoy= stops elongation of HIV DNA chain
33
How do NNRTIs work?
Bind to enzyme of HIV reverse transcriptase and stops it
34
How do INSTIs work?
block integrate strand transfer step
35
How do PIs work?
inhibit protease activity= can't infect new cells
36
How many active agents do you need and from how many classes?
3 active and from 2 different classes
37
Which agents do NOT count as active?
ritonavir and cobicistat
38
What are the NRTI drugs?
Lamivudine
emtricitabine
abacavir
TAF
TDF
39
What is TDF often paired with?
emtricitabine or lamivudine
40
S/e of TDF?
BMD, renal toxicity, DNV
41
WHat happens with most HIV medications if d/c
may exacerbate hepatitis if connected with HBV
42
What must you be careful taking with TDF?
PPI and calcium
43
What is TAF combined with?
Emtricitabine
44
What booster worsens TDF renal tox?
ritonavir or cobicistat
45
Stand out s/e of TAF?
less BMD effect, weight gain
46
What brand name of TAF has a food interaction?
Odefsey
47
What is abacavir paired with?
lamivudine
48
Stand out S/e of abacavir?
hypersensitivity, HEART ATTACK
49
What must you check before giving abacavir?
GENE HLA-B5701
50
What is stand out se of lamivudine?
MINIMAL toxcicity
51
What are the NNRTI drugs?
doravirine, efavirenz, rilpivirine, nevirapine,
52
Stand out s/e of doravirine?
abnormal dreams, VERY tolerated
53
Dosing instructions for efavirenz?
bedtime with NO food
54
Stand out s/e of efavirenz?
neuropsychiatric, high lipids and QT prolonging
55
Stand out s/e with rilpavine?
depression, insomnia, QT prolonging
56
Stand out s/e of nevirapine?
SJS, hepatitis (CD4 based)
57
What are the INSTI drugs?
'gravir'
58
Stand out s/e with bictegravir?
WEIGHT GAIN
59
Stand out s/e with dolutegravir?
WEIGHT GAIN THE WORST, insomnia, hypersensitivity
60
Which INSTI is the most potent?
Bictegravir, dolutegravir
61
What INSTI can be used in pregnancy?
dolutegravir- some neural tube issues but still used
62
Special administration of Cabotegravir?
INJECT
63
Stand out s/e of cabotegravir?
weird dreams, TOLERATED, insomnia
64
Stand out s/e of elvitegravir?
right, sleep issues
65
Stand out s/e of raltegravir?
weight, CK diarrhea
66
When do we use darunavir?
if resistance
67
MOA of darunavir?
PI
68
What must ALWAYS be used when on darunavir?
PK booster of ritonavir, cobicistat
69
S/e of darunavir?
BAD Gi, CVD, rash, hepatotoxicity
70
How often is cabotegravir ?
monthly or q2 months
71
Before you give cabotegravir, a checklist must be ensured, what is on it?
good renal, liver, not pregnant, virally suppressed
72
What does a patient get before cabotegravir?
oral cabotegravir to ensure tolerance
73
A patient has HIV from another country, what is the first step?
get genotype of HIV
74
What is rapid start for HIV?
start within 2 weeks before genotype results if at high risk
75
When is biktarvy used more?
if renal issues
76
What are the two new options in HIV?
lenacapavir and bNABS (TAB, ZAB)
77
WHats good about lenacapvir?
long acting= q6 months
78
How often should labs be for HIV?
4-6 weeks after starting, then q3-6 months
79
What HIV medications have issues with the heart?
Abacavir and darunavir
80
What medications have issues with OP?
TDF has most
81
What medications cause dyslipidemia?
TAF, abacvir, boosted PI, elvitegravir, efavirenz
82
What ones may be an issue in renal?
TDF, atazanavir, lopinavir
83
What medications cause the most weight gain?
INSTIs
84
What medications cause psychiatric effects?
efavirenz, dolutegravir, doravirine
85
When is NSAIDs maybe an issue in HIV patients?
if TDF because increase in Scr
86
Difference between trasnmitted and acquired resistance?
transmitted= acuires a resistant strain from someone
Acquired= while on drugs
87
How many copies of virsu needed to identify resistance?
>250
88
What happens in a M184V mutation?
methionine to a valine on 184 codon
89
What database is used to identify resistance?
stanford
90
What drugs have high barriers to resistance?
Dolutegravir, bictegravir, darunavir
91
What is viralogicall failure?
cant get under 200 copies after 24 weeks of consecutive tests
92
How much is a realistic drop in viral load each month?
by 1-2 logs
93
If using an INSTI how long to become suppressed?
3 months
94
What is the most common OI of HIV? at what CD?
oral yeast infection
<200
95
What drug for oral yeast infection?
oral fluconazole 100mg /day
96
When is PJP a risk?
<200 CD4 or <14%
97
WHat do we use for PJP prophylaxis?
Septra DS until CD4>200
Alt= Dapsone, pentamidine or atovaquone
98
WHat is PJP treatment?
Septra DS 2 tabs TID then need secondary prophylaxis after 21 days of primary
99
WHen is MAC a risk?
<50 CD4
100
WHat is MAC prophylaxis?
NOT recommended but Azithro 1250mg weekly
101
What is MAC treatment? for how long?
>2 drugs MINIMUM
Clarithro 500mg BID
Ethambutol 15mg/kg/day
rifabutin 300mg q24hrs
12 months and CD4>100
102
How to treat IRIS?
NSAIDs= mild
Steroids= severe
103
What is IRIS?
exaggerated immune response after infection
104
Common interactions with ARV?
Steroids (ALL)
rifampin
statins
antidepressants,etc
alpha adrenergic
105
WHen would you FOR sure test DI?
if boosters in therapy
106
If renal function is very very low what can we give?
Vemlidy
107
If a patient has undetectable viral load, can they still transmit the virus?
NO
108
What are the two PrEP options?
TDF+Emtricitabine
TAF +Emtricitabine
109
How much can PrEP reduce HIV transmission?
>90%
110
When would we use TAF over TDF for PrEP?
renal insufficiency but TAF NOT covered
111
ON demand PrEP sig?
TDF+E 2 pills 2-24 hrs before sex then 1 pill daily for 2 days
112
Is TDF+E PrEP ok for pregnancy?
YES
113
When is TDF CI in renal?
<60ml/min
114
How long to meet adequate PrEP levels?
7 days
115
New agents coming for PrEP?
Inject Cabotegravir= superior to TDF
Dapivirine= vaginal ring
116
When must PEP start?
WITHIN 72 HOURS OF EXPOSURE
117
What is PEP?
28 days of TDF+E and dolutegravir both once daily
118
What is in a PEP kit?
5 days of TDF+E and dolutegravir
119
IN what populations does PrEP have good evidence for?
MSM
PWID
NOT as well for heterosexual prob due to adherence
120
Follow up for PEP?
HIV tests 4-6 weeks after then q3 months
