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