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HIV Flashcards

EOR exam 5

1
Q

what type of virus is HIV?

A
  1. HIV is a single stranded RNA retrovirus
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2
Q

what cells does HIV target and destroy?

A
  1. HIV targets and destroys CD4 T-helper cells
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3
Q

How does HIV replicate in the body?

A

1.HIV uses the host’s CD4 T cells to replicate; once replicated, the virus bursts through the CD4 cell membrane, destroying the cell.

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4
Q

What is the consequence of increased viral load?

A
  1. As HIV replicates and the viral load increases, the CD4 count decreases.
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5
Q

What happens when the CD4 count falls below 200 cells/mm³?

A
  1. The immune system can no longer ward off opportunistic infections (OIs) and AIDS-related malignancies (e.g., Kaposi’s sarcoma).
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6
Q

How is HIV transmitted?

A
  1. HIV is transmitted by direct contact with infected body fluids, including blood, semen, vaginal or rectal secretions, or breast milk.
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7
Q

What parts of the body allow HIV entry?

A
  1. Through mucus membranes or open wounds
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8
Q

What are common routes of HIV infection?

A
  1. Unprotected vaginal or rectal sex
  2. Sharing injection drug equipment (e.g., needles)
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9
Q

Can HIV be passed from mother to child?

A
  1. Yes, during pregnancy, childbirth, or breastfeeding.
  2. It is called mother-to-child transmission or vertical transmission.
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10
Q

How often does the CDC recommend HIV screening for individuals aged 13–64?

A
  1. At least once for all patients in this age group.
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11
Q

Who should receive annual HIV testing?

A
  1. Patients with a history of sexually transmitted infections (e.g., syphilis, gonorrhea)
  2. Hepatitis
  3. Tuberculosis
  4. And those engaging in high-risk activities.
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12
Q

What are considered high-risk activities for HIV transmission?

A
  1. Sex with multiple partners or with someone whose sexual history is unknown
  2. Men who have sex with men
  3. Anal or vaginal sex with someone infected with HIV
  4. Sharing drug injection equipment (e.g., needles, syringes)
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13
Q

What are symptoms of acute HIV infection?

A
  1. Non-specific flu-like symptoms such as fever, myalgia, headache, lymphadenopathy (swollen lymph nodes), pharyngitis, and rash.
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14
Q

Why can patients become asymptomatic after the initial HIV phase?

A
  1. Because the antibody response takes time to develop (weeks to months), and although symptoms fade, the virus continues to replicate and can still be transmitted.
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15
Q

When is AIDS diagnosed?

A
  1. When the CD4 count is less than 200 cells/mm³ or
  2. An AIDS-defining condition is present.
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16
Q

What are examples of AIDS-defining conditions?

A
  1. OI’s
  2. Several cancers including Kaposi’s Sarcoma
  3. HIV wasting syndrome
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17
Q

What is HIV wasting syndrome?

A
  1. A condition with loss of fat tissue (lipoatrophy), muscle mass, appetite (anorexia), and diarrhea.
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18
Q

What drugs can stimulate appetite in HIV wasting syndrome?

A
  1. Dronabinol (Marinol, Syndros) – cannabis-related
  2. Megestrol – a progestin
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19
Q

What does initial HIV diagnostic testing involve?

A
  1. Screening for HIV antibodies and/or antigens.
  2. Followed by a confirmatory test that distinguishes HIV-1 from HIV-2
  3. A nucleic acid testing detecting HIV RNA(viral load) may also be used
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20
Q

When can antibodies be detected after infection?

A
  1. In most people, approximately 4–12 weeks after infection.
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21
Q

what is the Diagnostic testing algorithm in HIV

A
  1. Initial screening: HIV-1 & 2 AG/AB immunoassay → test for p24 AG and/or HIV-1/2 AB
  2. If positive → Confirmatory test HIV 1 & 2 AB differentiation immunoassay
  3. Indeterminate or negative → HIV nucleic Acid test: quantifies viral load
  4. Positive → HIV diagnosis and subtype confirmed
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22
Q

what is the name of the over the counter HIV test?

A
  1. The OraQuick, an In home HIV test that detects the presence of HIV antibodies and provides immediate results
  2. Individuals with a positive result must follow up with a confirmatory lab test
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23
Q

how does the OraQuick test work?

A
  1. The upper and lower gums are swabbed with a test stick and then inserted into a test tube
  2. After 20 min the result can be read
  3. testing sooner than 3 months after an exposure can lead to a false negative due to a lag in antibody production
  4. 1 line = negative
  5. 2 line = positive
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24
Q

What happens during the binding and attachment stage of HIV replication?

A
  1. HIV attaches to a CD4 receptor and a co-receptor (CCR5 and/or CXCR4) on the surface of the host CD4 T cell
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25
Q

what drugs classes inhibit the binding and attachment stage?

A
  1. CCR5 antagonist: Maraviroc
  2. attachment inhibitor: fostemsavir
  3. Post attachment inhibitor: Ibalizumab-uiyk
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26
Q

What happens during the fusion stage of HIV replication?

A
  1. The HIV viral envelope fuses with the cell membrane
  2. HIV enters the cell and releases its inner capsid, containing HIV RNA and viral enzymes
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27
Q

what drugs classes inhibit the fusion stage?

A
  1. Fusion inhibitor: Enfuvirtide
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28
Q

What happens during the Reverse transcription stage of HIV replication?

A
  1. HIV RNA is converted to HIV DNA by reverse transcriptase (an HIV enzyme)
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29
Q

what drugs classes inhibit the reverse transcription stage?

A
  1. NRTI’s (emtricitabine)
  2. NNRTI’s (Rilpivirine)
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30
Q

What happens during the nuclear import stage of HIV replication?

A
  1. The HIV capsid is transported into the cell nucleus through a nuclear pore
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31
Q

what drugs classes inhibit the nuclear import stage?

A
  1. Capsid inhibitor: Lenacapavir
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32
Q

What happens during the integration stage of HIV replication?

A
  1. Inside the cell nucleus, integrase ( an HIV enzyme) inserts HIV DNA into host cell DNA
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33
Q

what drugs classes inhibit the integration stage?

A
  1. INSTI (Bictegravir, dolutegravir)
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34
Q

What happens during the transcription translation stage of HIV replication?

A
  1. Host cell machinery is used to transcribe and translate HIV DNA into HIV RNA and long chain proteins (HIV building blocks)
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35
Q

what drugs classes inhibit the transcription and translation stage?

A

none

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36
Q

What happens during the assembly stage of HIV replication?

A
  1. New HIV RNA, proteins and enzymes (including protease) assemble at the cell surface
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37
Q

what drugs classes inhibit the assembly stage?

A
  1. Capside inhibitor: Lenacapavir
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38
Q

what happens during the Budding and Maturation stage?

A
  1. An immature virus pinches off the cell.
  2. Protease ( an HIV enzyme) breaks up the long viral protein chains, forming the viral capsid and a mature virus that can infect other cells.
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39
Q

what drugs classes inhibit the budding and maturation stage?

A
  1. PI (darunavir)
  2. Capsid inhibitor: Lenacapavir
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40
Q

what does the CD4 count indicate?

A
  1. The major indicator of immune function; determines the need for OI ppx. The CD4 count increases with ART
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41
Q

what is the HIV viral load?

A
  1. Indicated how much HIV RNA is in the blood. it is the most important indicator of ART response
  2. The viral load should decrease after starting ART.
  3. A high viral load after starting ART can be due to medication non adherence or drug resistance
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42
Q

what genotypic testing should HIV patients undergo?

A
  1. Hep B and C screening
  2. pregnancy test
  3. HLA-B*5701 allele (if considering abacavir) or
  4. Tropism assay ( if considering maraviroc)
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43
Q

what are the goals of ART treatment?

A
  1. achieving and maintaining an undetectable viral load
  2. Restoring and preserving immune function
  3. reducing HIV associated morbidity (OI)
  4. Preventing transmission
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44
Q

what are the preferred once daily single tablet HIV regimens?

A
  1. Biktarvy
  2. Triumeq
  3. Dovato
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45
Q

what are the preferred two pills once daily HIV regimens?

A
  1. Tivicay + truvada
  2. Tivicay + descovy
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46
Q

what drug classes do the preferred HIV regimens include?

A
  1. 1 INSTI
  2. 2 NRTI
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47
Q

what drugs should not be used if CrCl < 30?

A
  1. Biktarvy
  2. Triumeq
  3. Dovato
  4. Truvada
  5. Descovy
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48
Q

what are the general components of the alternative ART regimens?

A
  1. One ‘base’ plus 2 NRTI (backbone)
  2. The base can be a PI, NNRTI, INSTI
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49
Q

what drugs can be used for INSTI based alternative drug regimens?

A
  1. Elvitegravir (only combo)
  2. Raltegravir
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50
Q

what drugs can be used for PI based alternative drug regimens?

A
  1. Darunavir
  2. Atazanavir
    boosted with cobicistat or ritonavir
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51
Q

what drugs can be used for NNRTI based alternative drug regimens?

A
  1. Efavirenz
  2. Rilpivirine
  3. Doravirine
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52
Q

what does the NRTI backbone consist of in alternative ART regimen?

A
  1. NRTI backbone 2 drugs, 1 from each row
  2. TDF or TAF or Abacavir PLUS
  3. Emtricitabine or lamivudine
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53
Q

Should pregnant patients with HIV take antiretroviral therapy (ART)?

A
  1. yes, all pregnant patients with HIV should take ART during pregnancy for their own health and to prevent mother-to-child transmission.
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54
Q

Are HIV medications considered safe during pregnancy?

A
  1. Yes, most HIV medications are considered safe to use and do not increase the risk of birth defects
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55
Q

Why is breastfeeding not recommended for patients with HIV?

A
  1. Breastfeeding increases the risk of HIV transmission to the infant. Instead, replacement feeding with formula or banked pasteurized milk is preferred.
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56
Q

What should a pregnant patient do if she is already on an effective ART regimen?

A
  1. She should continue using the same regimen throughout pregnancy.
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57
Q

What is the recommended ART regimen for pregnant patients?

A
  1. A combination of two NRTIs (abacavir/lamivudine or tenofovir alafenamide/emtricitabine) plus either:
  2. 1 INSTI (e.g., dolutegravir preferred), or
  3. 1 boosted PI (e.g., darunavir preferred)
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58
Q

What should be done near the time of delivery if the mother is newly diagnosed with HIV or has a high viral load?

A
  1. If the viral load is >1,000 copies/mL, or if HIV status is unknown, IV zidovudine is administered to both the mother and the newborn to prevent perinatal HIV transmission
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59
Q

What is Immune Reconstitution Inflammatory Syndrome (IRIS)?

A
  1. IRIS is a paradoxical (unexpected) worsening of a known underlying condition, or a previously unidentified condition, after ART is started or treatment is changed to a more effective regimen.
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60
Q

Why does IRIS occur after starting ART?

A
  1. As the immune system begins to recover, it becomes capable of mounting an inflammatory response, and symptoms of the underlying condition can become unmasked.
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61
Q

When is IRIS more likely to occur?

A
  1. IRIS is more likely to occur when the CD4 count is low and begins to recover.
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62
Q

What are examples of underlying conditions that can appear or worsen due to IRIS?

A
  1. Common OIs
  2. hepatitis B and C
  3. herpes simplex virus (HSV)
  4. varicella zoster virus (VZV, shingles), 5. autoimmune conditions
  5. some cancers (e.g., Kaposi’s sarcoma)
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63
Q

What should be done if IRIS occurs?

A
  1. ART should be continued, and the unmasked condition should be treated.
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64
Q

what are the drugs of the NRTIs drug class ?

A
  1. Abacavir (ziagen)
  2. Emtricitabine (emtriva)
  3. Lamivudine (epivir)
  4. TAF - only available in combo products for HIV. Vemlidy is a single entity product for HBV
  5. Zidovudine (retrovir)
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65
Q

what is the MOA of NRTIs?

A
  1. Competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA
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66
Q

How often is tenofovir (both formulations) taken?

A
  1. Once daily
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67
Q

What are the dosing options for abacavir and lamivudine

A
  1. They can be taken once daily or in twice daily regimens.
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68
Q

Which NRTI does not require renal dose adjustment?

A
  1. Abacavir; all other NRTIs require dose adjustment in renal impairment.
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69
Q

When is IV zidovudine administered and why?

A
  1. Zidovudine is administered IV during labor and delivery to prevent perinatal HIV transmission to the newborn.
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70
Q

What are the major warnings associated with all NRTIs?

A
  1. Lactic acidosis
  2. hepatomegaly with steatosis (fatty liver); zidovudine has a boxed warning.
71
Q

What are common side effects of NRTIs?

A
  1. Nausea and diarrhea
72
Q

What drugs can cause severe acute HBV exacerbation if discontinued in patients with HBV/HIV co-infection?

A
  1. emtricitabine
  2. lamivudine
  3. tenofovir-containing products
73
Q

Why should Epivir-HBV not be used for HIV treatment?

A
  1. It contains a lower dose of lamivudine than what is needed to treat HIV.
74
Q

What is the boxed warning for abacavir?

A
  1. Risk for hypersensitivity reaction (HSR)
  2. Screen for HLA-B*5701 allele; abacavir is contraindicated if positive.
  3. never re-challenge such patients.
75
Q

What should patients taking abacavir carry?

A
  1. A medication card indicating that HSR symptoms (e.g., fever, rash, nausea, vomiting, diarrhea, fatigue, dyspnea, cough) are an emergency.
76
Q

What skin-related side effect is associated with emtricitabine?

A
  1. Hyperpigmentation of the palms of the hands or soles of the feet.
77
Q

Which tenofovir formulation has a higher risk profile?

A
  1. TDF (tenofovir disoproxil fumarate) compared to TAF (tenofovir alafenamide).
78
Q

What are the risks associated with Tenofovir?

A
  1. Renal impairment, including acute renal failure and Fanconi syndrome
  2. Decreased bone mineral density; Calcium/vitamin D supplementation and a DEXA scan
  3. TDF> TAF
  4. Lipid abnormalities with TAF
79
Q

What are the hematologic toxicities associated with zidovudine?

A
  1. Neutropenia and anemia
80
Q

What lab finding is a sign of adherence to zidovudine?

A
  1. Macrocytosis (high MCV)
81
Q

what Drugs belong to the class INSTI?

A
  1. Bictegravir - only in the combo drug biktarvy
  2. Cabotegravir (Vocabria, apretude)
  3. Dolutegravir (Tivicay)
  4. Elvitegravir - only in combo genvoya, stribild
  5. Raltegravir (isentress, Isentress HD)
82
Q

What is the mechanism of action of INSTIs?

A
  1. INSTIs block the integrase enzyme, preventing HIV DNA from inserting into the host cell DNA.
83
Q

Which INSTIs are taken once daily?

A
  1. Biktarvy, Stribild, Genvoya, Isentress HD, Tivicay, Triumeq, and Dovato
84
Q

Which INSTI is taken twice daily?

85
Q

When should Stribild not be started due to renal function?

A
  1. If CrCl < 70 mL/min, do not start Stribild.
86
Q

When should Stribild be discontinued?

A
  1. If CrCl < 50 mL/min, discontinue Stribild.
87
Q

What is Apretude used for?

A
  1. Cabotegravir extended-release intramuscular injection (Apretude) is indicated only for pre-exposure prophylaxis (PrEP).
88
Q

When should Biktarvy or Genvoya not be started?

A
  1. If CrCl < 30 mL/min, do not start Biktarvy or Genvoya.
89
Q

What are the general side effects and warnings for all INSTIs?

A
  1. Weight gain, insomnia, and a rare risk of depression and suicidal ideation in patients with pre-existing psychiatric conditions.
90
Q

What do bictegravir and dolutegravir do to serum creatinine (SCr)

A
  1. They cause an increase in SCr by inhibiting tubular secretion, but this has no effect on GFR.
91
Q

What are the adverse effects associated with raltegravir and dolutegravir?

A
  1. ↑ CPK (creatine phosphokinase)
  2. Myopathy and rhabdomyolysis
  3. Hypersensitivity reactions: syndrome of rash, fever, and symptoms of an allergic reaction
92
Q

What liver-related toxicity is associated with dolutegravir?

A
  1. Hepatotoxicity, especially if there is coinfection with hepatitis B or C.
93
Q

What is a common side effect of intramuscular cabotegravir?

A
  1. Injection site reactions
94
Q

What interaction occurs between INSTIs and polyvalent cations?

A
  1. Taking them together (e.g., antacids, supplements) can cause chelation, which decreases efficacy.
95
Q

How should oral INSTIs be separated from products containing polyvalent cations (e.g., Al, Ca, Mg, Fe)?

A
  1. Take the INSTI 2 hours before
  2. Or 6 hours after cation-containing products
96
Q

What drugs belong to the NNRTI class?

A
  1. Efavirenz
  2. Rilpivirine (edurant)
  3. Doravirine (pifeltro)
  4. Etravirine (intelence)
  5. Nevirapine
97
Q

What is the mechanism of action of NNRTIs?

A
  1. NNRTIs non-competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA.
98
Q

How should oral rilpivirine be taken?

A
  1. It should be taken with a meal and water (not substituted with a protein drink).
99
Q

What kind of environment is required for rilpivirine absorption?

A

1.An acidic environment is required for absorption.

100
Q

What medications should not be used or should be separated when taking rilpivirine?

A

1.Do not use with PPIs, and separate from H2RAs and antacids.

101
Q

What is the intramuscular formulation of rilpivirine part of?

A
  1. It is part of the combination product Cabenuva.
102
Q

How does food affect efavirenz?

A
  1. Food increases bioavailability and the risk for CNS effects.
  2. Take it on an empty stomach at bedtime (QHS) to reduce and sleep through CNS effects.
103
Q

What serious adverse effects are associated with all NNRTIs?

A
  1. Hepatotoxicity and rash/severe rash, including SJS/TEN; highest risk is with nevirapine.
104
Q

What symptoms are associated with efavirenz?

A
  1. Depression and suicidal thoughts
  2. CNS effects; Impaired concentration, abnormal dreams, confusion—these generally resolve in 2–4 weeks in most patients.
  3. Increased total cholesterol and triglycerides
105
Q

What side effects are associated with rilpivirine?

A

1.Depression
2. ↑ SCr (serum creatinine) with no effect on GFR

106
Q

When should rilpivirine not be used?

A
  1. If initial viral load > 100,000 copies/mL and/or
  2. CD4 count < 200 cells/mm³ (due to higher failure rate)
107
Q

What is the CYP metabolism characteristic of all NNRTIs?

A
  1. All NNRTIs are major CYP3A4 substrates, and some are substrates of other CYP enzymes.
    2.
108
Q

What drugs should be avoided with rilpivirine and doravirine?

A
  1. Do not use with strong CYP3A4 inducers (e.g., phenytoin, rifampin, rifapentine, carbamazepine, oxcarbazepine, phenobarbital, St. John’s wort)
109
Q

Can rilpivirine be taken with PPIs?

A
  1. No, do not use with PPIs.
110
Q

How should rilpivirine be taken with H2RAs?

A

1.Take H2RAs at least 12 hours before or 4 hours after rilpivirine.

111
Q

How should rilpivirine be taken with antacids?

A
  1. Take antacids at least 2 hours before or 4 hours after rilpivirine.
112
Q

what are the drugs in the class protease inhibitors?

A
  1. Atazanavir ( Reyataz)
  2. Darunavir ( Preszista)
  3. Fosamprenavir
  4. Lopinavir/ ritonavir
  5. Tipranavir
113
Q

What is the mechanism of action of protease inhibitors (PIs)?

A
  1. PIs inhibit the HIV protease enzyme, preventing long viral protein chains from being broken down into smaller chains needed to produce mature (infectious) virus during the budding and maturation stage of the HIV life cycle.
114
Q

What is recommended with all PIs for optimal effectiveness?

A
  1. All PIs are recommended to be taken with a booster (ritonavir or cobicistat).
115
Q

Do protease inhibitors require renal dose adjustments?

A
  1. No, there are no renal dose adjustments needed.
116
Q

How should darunavir and atazanavir be taken?

A
  1. Take with food to reduce GI upset
117
Q

What kind of environment is required for atazanavir absorption?

A

1.Atazanavir needs an acidic gut for absorption.

118
Q

What is ritonavir used for in PI regimens?

A
  1. Ritonavir is a protease inhibitor, but it is used only at low doses for pharmacokinetic boosting.
119
Q

What metabolic abnormalities are associated with protease inhibitors?

A
  1. Hyperglycemia/insulin resistance
  2. Dyslipidemia (↑ LDL, ↑ TGs)
  3. ↑ body fat and lipodystrophy
  4. Increase CVD risk
120
Q

What hepatic side effects can occur with PIs?

A

1.↑ LFTs
2. Hepatitis
3. Exacerbation of preexisting hepatic disease

121
Q

What types of hypersensitivity reactions can occur with PIs?

A

1.Rash (including SJS/TEN)
2. Angioedema
3. Bronchospasm
4. Anaphylaxis

122
Q

What are common side effects of PIs?

A
  1. Diarrhea and nausea
123
Q

What is the effect of strong CYP3A4 inducers on PI concentrations?

A
  1. They decrease PI concentrations.
124
Q

What PI require allergy caution to sulfa?

A
  1. darunavir
  2. fosamprenavir
  3. tipranavir
125
Q

What is a special concern with lopinavir/ritonavir (Kaletra) oral solution?

A
  1. It contains 42% alcohol and can cause a disulfiram reaction if taken with metronidazole.
126
Q

What reversible condition is associated with atazanavir?

A

1.Hyperbilirubinemia (jaundice or scleral icterus; “bananavir”); it is reversible and does not require discontinuation.

127
Q

What environment is required for atazanavir absorption?

A
  1. It requires an acidic gut.
  2. Separate from antacids and H2RAs.
  3. Avoid PPIs with unboosted atazanavir.
128
Q

How should boosted atazanavir be timed if used with PPIs?

A
  1. Take it at least 12 hours after the PPI, and the PPI dose should not exceed omeprazole 20 mg (or equivalent).
129
Q

what drugs belong to the class pharmacokinetic boosters?

A
  1. Ritonavir (Norvir)
  2. Cobicistat (Tybost)
130
Q

How is ritonavir administered?

A
  1. 100–200 mg PO once or twice daily with the boosted drug (e.g., darunavir, atazanavir) and with food.
131
Q

How is cobicistat administered?

A
  1. 150 mg PO daily with the boosted drug and with food.
132
Q

What effect do ritonavir and cobicistat have on serum creatinine (SCr)?

A
  1. They ↑ SCr with no effect on GFR.
133
Q

What is the mechanism of ritonavir and cobicistat as boosters?

A
  1. They are inhibitors of CYP3A4, which inhibits ART metabolism, increasing (boosting) ART levels and therapeutic effect.
134
Q

Why is ritonavir not used for its antiviral activity?

A
  1. Ritonavir is a PI but is not well tolerated at higher doses needed for antiretroviral activity; instead, lower booster dosing is used to reduce side effects.
135
Q

Can ritonavir and cobicistat be used interchangeably?

A
  1. No, they are not interchangeable and should not be used together.
136
Q

What types of drugs are contraindicated or should generally be avoided with boosted PIs due to significant interaction risk?

A
  1. Alpha-1A blockers: alfuzosin, silodosin, tamsulosin
  2. Antiarrhythmics: amiodarone, dronedarone
  3. Anticoagulants/antiplatelets: apixaban, rivaroxaban, ticagrelor
  4. Azole antifungals: voriconazole, posaconazole, itraconazole, isavuconazole
  5. Hepatitis C protease inhibitors: grazoprevir, glecaprevir
  6. Statins: lovastatin, simvastatin
  7. PDE-5 inhibitors for pulmonary hypertension: sildenafil, tadalafil
  8. Strong CYP3A4 inducers: carbamazepine, phenytoin, rifampin, St. John’s wort
  9. Systemic, inhaled, and intranasal steroids: except beclomethasone
137
Q

What is the mechanism of action of maraviroc?

A
  1. It blocks HIV from binding (and subsequently entering) the CD4 cell in virus strains that use the CCR5 co-receptor.
  2. CCR5 antagonist
138
Q

What baseline test is required before starting maraviroc?

A
  1. A tropism assay, to confirm the HIV strain only binds to the CCR5 co-receptor.
  2. If the HIV strain can bind to CXCR4 or is mixed (CXCR4/CCR5), then maraviroc will not work, and HIV will still be able to enter the CD4 cell.
139
Q

What is the mechanism of action of fostemsavir?

A
  1. It is converted to temsavir (active form), which binds to the gp120 subunit of HIV envelope proteins, inhibiting the interaction between the virus and the CD4 host cell.
  2. Attachment inhibitor
140
Q

What is the mechanism of action of ibalizumab-uiyk?

A
  1. It is a monoclonal antibody that binds to a select domain of CD4 cell receptors, blocking entry of the virus into the cell.
  2. Post- attachment inhibitor
141
Q

What is the mechanism of action of enfuvirtide?

A
  1. It prevents HIV from fusing to the CD4 cell membrane, preventing virus entry into the cell.
  2. Fusion inhibitor
  3. Injection site reaction (SC)
142
Q

What is the mechanism of action of lenacapavir?

A

1.It inhibits multiple stages of the HIV life cycle, including capsid transport into the nucleus, virus assembly, and capsid formation, resulting in a malformed capsid.
2. capsid inhibitor

143
Q

What is the brand name for bictegravir / emtricitabine / tenofovir alafenamide?

A
  1. Biktarvy
  2. First-line regimen
144
Q

What is the brand name for cabotegravir / rilpivirine?

145
Q

How is Cabenuva administered?

A
  1. IM once monthly by a healthcare professional; may be preceded by oral cabotegravir to assess tolerability.
146
Q

What is the brand name for dolutegravir / abacavir / lamivudine?

147
Q

What is the brand name for dolutegravir / lamivudine?

148
Q

What is the brand name for dolutegravir / rilpivirine?

149
Q

When should tenofovir disoproxil fumarate–containing products be avoided?

A

1.If CrCl < 50 mL/min
(Do not use Stribild if CrCl < 70 mL/min)

150
Q

When should tenofovir alafenamide–containing products be avoided?

A
  1. If CrCl < 30 mL/min
151
Q

What is the brand name for elvitegravir / cobicistat / emtricitabine / tenofovir disoproxil fumarate?

152
Q

What is the brand name for elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide?

153
Q

What is a key administration note for Stribild and Genvoya?

A
  1. Take with food (due to the cobicistat component)
154
Q

How should efavirenz-containing products be taken?

A
  1. On an empty stomach
155
Q

How should rilpivirine-containing products be taken?

156
Q

What is the brand name for rilpivirine / emtricitabine / tenofovir disoproxil fumarate?

157
Q

What is the brand name for rilpivirine / emtricitabine / tenofovir alafenamide?

158
Q

What is the brand name for darunavir / cobicistat / emtricitabine / tenofovir alafenamide?

A
  1. Symtuza
  2. Take with food
160
Q

What is the brand name for abacavir / lamivudine?

A
  1. Epzicom
  2. must be used with other ARTs to make a complete regimen
161
Q

What is the brand name for emtricitabine / tenofovir alafenamide?

A

1.Descovy
2. must be used with other ARTs to make a complete regimen

162
Q

what baseline test is needed before using Epzicom?

A
  1. HLA-B*5701 testing (due to abacavir
163
Q

What is the brand name for emtricitabine / tenofovir disoproxil fumarate?

A
  1. Truvada
  2. must be used with other ARTs to make a complete regimen
164
Q

What is PrEP?

A
  1. PrEP is a strategy of prescribing ART to prevent HIV infection in patients who engage in high-risk activities.
165
Q

What are the available oral PrEP regimens?

A
  1. Truvada or Descovy, taken daily.
166
Q

What long-acting PrEP option is available?

A
  1. Intramuscular cabotegravir (Apretude)
167
Q

How is Apretude administered?

A
  1. Monthly for 2 doses, then every 2 months by a healthcare provider.
168
Q

What test must confirm HIV status before starting PrEP?

A
  1. An HIV antigen/antibody blood test must confirm the patient is HIV-negative.
169
Q

What should be done at each PrEP follow-up visit?

A
  1. Test for HIV and confirm a negative result before refilling or administering PrEP
  2. (Truvada and Descovy) Every 3 months
170
Q

When is PEP used?

A
  1. For emergency situations when a non-infected person is exposed to HIV-contaminated body fluids.
171
Q

What are the two types of PEP?

A

1.Nonoccupational (nPEP): After sex without a condom, sexual assault, condom break, unplanned sex, injection drug use, or other nonoccupational exposure.
2. Occupational (oPEP): For healthcare personnel exposed to body fluids, especially from needlestick injuries.

172
Q

How soon should PEP be started after exposure and continued for how long?

A
  1. Within 72 hours (3 days) of the exposure.
  2. Continued for 28 days
173
Q

What are PrEP options?

A
  1. Oral daily: Truvada or Descovy*
  2. IM injection: Cabotegravir (Apretude), monthly x2 doses, then every 2 months
174
Q

What drugs are used for PEP?

A
  1. Truvada (if CrCl ≥ 60) +
  2. Dolutegravir (Tivicay) or raltegravir (Isentress)

infectious disease (8 decks)

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