HIV Flashcards
How do you screen and confirm HIV?
Screen with ELISA test
Confirm with western blot test
As HIV progresses, CD$ T cell count goes ___ and viral load goes __. And AIDS diagnosis is when CD4 is ____
Down
Up
<200cells/mm
Fostemsavir
Brand
MOA and receptor
Indication
Dose
ADE
Contraindication
Rukobia
Binding entry inhibitor that targets gp120
HIV-1 with MDR
600mg ER BID
Hepatotox, QT prolongation
Strong 3A4 inducers (rifampin, st.john’s wort, carbamazepine)
Ibalizumab-uiyk
Brand
MOA and receptor
Indication
Dose
ADE
Trogarzo
Binding entry inhibitor that targets CD4R
HIV with MDR
800mg Q2wks IV
Increase uric acid, dizzy
Selzentry
Brand
MOA and receptor
Indication
Dose
ADE
Drug interaction
Maraviroc
Binding entry inhibitor that targets CCR5
HIV
300mg BID PO
Hepatotox (BWW) , OH, heart problems
St.Johns wort
Enfuvirtide
Brand
MOA and receptor
Indication
Dose
ADE
Fuzeon
Fusion inhibitor that tarets gp41
HIV
90mg BID SC
Infection
NRTI ADE
Headache
lactic acidosis
hepatic steatosis
Renal (except abacavir)
Zidovudine
Brand
MOA
Indication
Dose
ADE
Retrovir
NRTI
HIV
300mg BID PO/IV
Myelosuppression, purple discoloration of nails, myopathy
Abacavir
Brand
MOA
Indication
Dose
ADE
Testing
Ziagen
NRTI
HIV
300mg BID PO
Rash
HLAB5701
Lamivudine
Brand
MOA
Indication
Dose
ADE
Epivir
NRTI
HIV and hepatitis B
150mg BID
Normal class ADE
Emtricitabine
Brand
MOA
Indication
Dose
ADE
Emtriva
NRTI
HIV
200mg PO QD
240mg PO solution in fridge
Darkening of palms and soles ; hepatitis B flare up
Tenofovir disoproxil fumarate
Brand
MOA
Indication
Dose
ADE
Viread
NRTI
HIV >2y.o
Hep B >12y.o
300mg QD PO
Rash, fat distribution, osteoporosis , acute renal failure
Tenofovir alafenamide
Brand
MOA
Indication
Dose
Vemlidy
NRTI
Chronic hepatitis B
25mg QD with FOOD
Ripivirine
Brand
MOA
Indication
Dose
ADE
Edurant
NNRTI
HIV
25mg QD PO with FOOD
Depression, hepatotox, rash, insomnia
Nevirapine
Brand
MOA
Indication
Dose
ADE
Viramune
NNRTI
HIV
200mg QD x 14d then 200mg BID
Life-threatening hepatotox, SJS
Efavirenz
Brand
MOA
Indication
Dose
ADE
Sustiva
NNRTI
HIV
600mg HS PO on EMPTY STOMACH
CNS (vivid dreams) , false CBD test, hepatotox, rash
Etravirine
Brand
MOA
Indication
Dose
ADE
Intelence
NNRTI
HIV
200mg BID PO after meal
SJS , TENS
Doravirine
Brand
MOA
Indication
Dose
ADE
Contraindications
Pifeltro
NNRTI
HIV
100mg PO QD
dizzy, HA, abdominal pain
Strong 3A4 inducers
INSTI ADE and Counseling
ADE - diarrhea, nausea, headache, insomnia, dizzy, fatigue
Counseling - take with or without food and separate from antacids
Raltegravir
Brand
MOA
Indication
Dose
ADE
Isentress
INSTI
HIV
400mg BID or 1200mg QD PO (also comes in chewable tabs)
SJS, myopathy, rhabdo , increase ALT, increase glucose
Doultegravir
Brand
MOA
Indication
Dose
ADE
Tivicay
INSTI
HIV
50mg QD PO
Increase LFT , increase glucose
Apretude
Generic
MOA
Indication
Dose
ADE
Cabotegravir
INSTI
PReP for HIV
600mg IM every 2 months
Vocabria
Generic
MOA
Indication
Dose
ADE
Cabotegravir
INSTI
Short term to assess tolerability before starting cabenuva ( cabotegravir + ripivirine)
30mg PO QD x 1 month
Depression, hepatotox
Who would be best to give apretude?
CrCl <30
Aderence to oral meds is concerning
Patient’s want less frequent dosing
Protease inhibitor class ADE and drug interaction and counseling
N/V/D
Lipodystrophy
Hyperglycemia
Hyperlidiemia
Increased risk of myocardial infarction and bleeding
Hepatotox
ALL PI’s are contraindicated with st.johns wort , avoid PPI, avoid simvastatin and lovastatin
Give MOST with FOOD
Lopinavir + Ritonavir
Brand
MOA
Indication
ADE
Clinical comments
Kaletra
PI
HIV
Pancreatitis
Contains 42% alcohol and has propylene glycol
Atazanavir
Brand
MOA
Indication
Dose
ADE
Drug interaction
Reyataz
PI
HIV - typically given with ritonavir or cobicistat to boost levels
100/200/300 mg QD PO with food
Nephrolithiasis and cholelithiasis
Can decrease clarithromycin by 50% ;
Viread can decrease Reyataz
Nelfinavir
Brand
MOA
Indication
Dose
ADE
Can it be boosted?
Viracept
PI
HIV
750mg PO TID
Explosive diarrhea
NO
Darunavir
Brand
MOA
Indication
Dose
ADE
Allergy
Prezista
PI
HIV - treatment naive
Can be boosted with ritonavir or cobicistat
Contains SULFA
Fosamprenavir
Brand
MOA
Indication
Dose
Allergy
Lexiva
PI
HIV
700mg BID with ritonavir
Contains SULFA
Ritonavir
Brand
MOA
Indication
Dose
Contraindication
Norvir
3A4 inhibitor
to BOOST
600mg BID PO
Amiodarone and eletriptan
Tipranavir
Brand
MOA
Indication
Dose
ADE
Allergy
Aptivus
PI
HIV
500mg BID WITH ritonavir 200mg with food
Intracranial bleeding , hepatotox
Contains SULFA
Cobicistat
Brand
MOA
Indication
Dose
ADE
Contraindication
Tybost
CYP3A4 inhibitor
To BOOST
150mg PO QD with FOOD
Renal tox
CrCL <70
Combivir Generic
Lamivudine + Zidovudine
Epzicom generic
Lamivudine + + abacavir
Triumeq
Lamivudine + Abacavir + dolutegravir
Dutrebis
Lamivudine + + Raltegravir
Cimdue
Lamivudine + TDF
Delstrigo
Lamivudine + doravirine + TDF
Symfi
Lamivudine + efavirenz + TDF
Symfi LO
Lamivudine + efavirenz (lower than symfi) + TDF
Truvada
Generic
Indication
Renal adjustment
Emtricitabine + TDF
Prevention of HIV infection in adults
not for crcl <30
Descovy
Generic
Indication
Renal adjustment
Emtricitabine + TAF
HIV prevention in >12y.o and >35kg
Not for crcl <30
Atripla
Generic
Efavirenz + emtricitabine + TDF
Complera generic
Renal adjustment
Rilpivirine + emtricitabine + TDF
not for crcl <50
Odefsey generic
Renal adjustment
Rilpivirine + entricitabine + TAF
not for crcl < 30
Symtuza generic
Renal adjustment
Darunavir + cobicistat + emtricitabine + TAF
Not for CrCl <30
Stribild generic
Renal adjustment
Elvitegravir + cobicistat + emtricitabine + TDF
not for Crcl < 70
Genvoya generic
renal adjustment
Elvitegravir + cobicistat + emtricitabine + TAF
not for crcl <30
Biktarvy generic
Renal adjustment
Bictegravir + emtricitabine + TAF
Not for crcl <30
Juluca generic
When to use (4)
ADE
Dolutegravir + rilpivirine
- Virologically suppressed
- On stable antiretroviral regimen for >6 months
- No history of treatment failure
- No resistance to dolutegravir or rilpivirine
Suicidality, rash, hepatotox
Dovato generic
Indication
Dolutegravir + lamivudine
Two drug regimen for HIV patients who have never received treatment
Cabenuva generic
Indication
Dose
Storage
Cabotegravir + Rilpivirine
IM monthly or every two months
Refrigerated
What is the recommendation for treatment naive HIV patients?
2 NRTI’s with a third agent from a different class
Recommendation for pregnant HIV patients?
What about during labor?
Do you give anything to the baby?
Three drug combination
Then during labor give zidovudine IV until deliver
For the infant, give zidovudine oral syrup within 6-12 hours after birth
What is a good treatment-naive option for pregnant HIV patients?
TAF + emtricitabine + dolutegravir
Which 2 HIV meds must be taken on an empty stomach?
Efavirenz = sustiva
Fosamprenavir - lexiva oral suspension in ADULTS
Which 3 HIV meds must be taken with food?
Rilpivirine
Etravirine
All PI’s (fosamprenavir with food in pediatrics)
What is the regimen for post-exposure prophylaxis?
Start ASAP for at least 28 days
2 NRTI’s + a 3rd agent
What are the 3 PrEP options? brand name.
Truvada
Descovy
Apretude
When is it okay to give MMR or varicella to AIDS patients? IS it different for HIV?
NEVER for AIDS
Can give to asymptomatic HIV patients with CD4 > 200
