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ID 1183 > HIV 2 > Flashcards

HIV 2 Flashcards

1
Q

Recommended initial treatment

A

INSTI + 2 NRTIs

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2
Q

NRTIs

A
  • Nucleoside/nucleotide reverse transcriptase inhibitors
  • Work in the cytoplasm @ stage 3
  • lactic acidosis/hepatic steatosis
  • tenofovir disoproxil fumarate(Viread)
  • tenofovir alafenamide-only in combo products except Vimlidy which is specifically for Hep B
  • emtricitabine (Emtriva)
  • abacavir (Ziagen)-hypersensitivity, î MI risk
  • lamuvidine (Epivir) Epivir HBV is for HepB
  • zidovudine (Retrovir)-myopathy and macrocytic used IV in labor
  • stavudine (Zerit) pancreatitis
  • didanosine (Videx) pancreatitis

“Z-STALED”

teNOF: nephro, osteporosis, Fanconi- less in alf

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3
Q

NRTIs that have activity against Hep B

A

LET me treat your Hep B

lamuvidine (Epivir)

emtricitibine (Emtriva)

Tenofovir

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4
Q

Combinations containing emtricitabine

A

emtricitabine (Emtriva) is an NRTI

  • Biktarvy (bictegravir/emtricitabine/ten alf)
  • Truvada (emtricitabine/ten dis)
  • Descovy (emtricitabine/ten alf)
  • Stribild (elvitegravir/cobicistat/emtricitabine/ten dis)
  • Genvoya (elvitegravir/cobicistat/emtricitabine/ten alf)
  • Atripla (efavirenz/emtricitabine/ten dis)
  • Complera (rilpivirine/emtricitabine/ten dis)
  • Odefsey (rilpivirine/emtricitabine/ten alf)

BAD GOATS-to remember

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5
Q

INSTI based complete ART regimen

A

Biktarvy (bictegravir/emtricitabine/ ten alf)

Triumeq (bictegravir/emtricitabine/ ten dis)

Genvoya (elvitegravir/cobicistat/emtricitabine/ten alf)

Stribild (elvitegravir/cobicistat/emtricitabine/ten dis)

Tivicay + Descovy (dolutegravir + emtrictabine/ten alf)

Tivicay+Truvada (dolutegravir + emtrictabine/ten dis)

Isentress+Descovy (raltegravir +emtrictabine/ten alf)

Isentress+Truvada (raltegravir +emtrictabine/ten dis)

4 one pill options

4 two pill options

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6
Q

combinations containing abacavir

A

abacavir (Ziagen) NRTI

must test HLA-b*5701

  • Ziagen (abacavir)
  • Epzicom (abacavir/lamuvidine) 2 NRTIs
  • Triumeq (dolutegravir/abacavir/lamuvidine) INSTI+2 NRTIs
  • Trizivir (abacavir/lamuvidine/zidovudine) 3 NRTIs

comes with warning card

high hypersensitivity risk

alcohol î AUC

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7
Q

NNRTIs

A

non-nucleoside reverse transcriptase inhibitors

work in cytoplasm @ stage 3

hepatotoxicity, rash (SJS/TENS-greatest w/ nevirapine)

  • RENE
  • rilpivirine (Edurant)NO PPIs-avoid VL>100,000, depression, insomnia
  • efavirenz (Sustiva)CNS-abnormal dreams T@HS
  • nevirapine (viramune)14 day lead in to decrease hepato/rash risk
  • etravirine (Intelence)
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8
Q

PIs

A

Protease Inhibitors -navir

Stage 7 Work Outside Cell

Taken with a booster (ritonavir or cobicistat)

Metabolic abnormalities-hyperlipidemia, lipohypertrophy/insulin resistance/hyperglycemia

**Dont wanna be fat when you “LIFT SAND”

  • lopinavir+ritonavir (Kaletra)
  • indinavir (Crixivan)
  • fosamprenavir (Lexiva)
  • tipranavir (Aptivus)
  • saquinavir (Invirase)
  • atazanavir (Reyataz)-separate from acid reducers 2hr before/10 hrs after H2ra, nephrolithiasis, hyperbili
  • nelfinavir (viracept)
  • darunavir (Prezista)
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9
Q

Boosters

A
  • Needed with PIs
  • Ritonavir (Norvir) is a PI but is used as booster due to strong 3A4 inhibition. Box: INTERACTS WITH MANY MEDS-potentially fatal adverse!!
  • cannot be co-formulated
  • Cobicistat (Tybost) can be co-formulated, no box warning, less interactions
  • BOTH: Take with food
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10
Q

INSTIs

A

Integrase Strand Transfer Inhibtitors

Work at stage 4 in the nucleus

-tegravir “BRED”

  • bictegravir (only in combo-Biktarvy)
  • raltegravir (Isentress, Isentress HD) -HD is 1200 daily, other is BID îCPK, myopathy, rhabdo
  • elvitegravir (only in combo Stribild, Genvoya)
  • dolutegravir (Tivicay) insomnia
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11
Q

CCR5 Antagonist

A

Binds co-receptor (step one on surface)

maraviroc (Selzentry)

Must test tropism- only works in CCR5 tropic disease

Pt needs to be neg for CxCR4 or dual/mixed tropic disease

Box: hepatotoxiticity

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12
Q

Regimens for naive pregnant women

(if becomes pregnant while on ART, contine ART regimen)

A

2 NRTIs + boosted PI OR INSTI

NRTI combos:

  • abacavir/lamivudine (Epzicom)
    • ​HLA-B*5701 abacavir-hypersensitivity No rechallenge
    • Do not start if CrCl < 50 (lamuvidine)
  • tenofovir disoproxil fumarate/emtricibine (or lamuvidine) (Truvada, Cimduo-lamuvidine combo)
    • original container- truvada
    • original container- Cimduo

INSTI:

  • raltegravir (Isentress)

​PI:

  • Atazanavir + ritonavir
  • Daruanavir + ritonavir (BID regimen only)
    • Ritonavir- not available in a combo formulation
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13
Q

zidovudine

A

NRTI

SE:

myopathy, macrocytic anemia

IV zidovudine given in labor for HIV infected pregnant women

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14
Q

fusion inhibitor

A

enfurvirtide (Fuzeon)-

SC injection BID

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15
Q

CD4 attachment inhibitor

A

ibalizumab (Trogarzo)

administered IV- used for multidrug resistant HIV

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16
Q

PrEP

A

prevent HIV

emtricitibine/tenofovir (Truvada) 1 tab PO daily

recommended for high risk sexual exposure and active IV drug users

17
Q

nPEP

A

nonoccupational post exposure

rape, drug use, etc

test HIV Ab at baseline, 4-6 weeks, and 6 months after exposure

Start within 72 hours, continue 28 days (4 weeks)

  • Preferred: (INSTI based)
    • emtricitabine + tenofovir disoproxil (Truvada) 1 tablet daily
      • raltegravir 400 mg PO BID OR dolutegravir 50 mg PO daily
  • Alternative (PI based)
    • Truvada 1 tab daily
      • darunavir 800mg + ritonavir 100 mg dauly
18
Q

WITHOUT FOOD

A

“SAFE I Dont eat”

  • Symfi and Symfi Lo (has efavirenz)
  • Atripla (has efavirenz)
  • Fosamprenavir (oral sus)
  • Efavirenz
  • Indinavir (unboosted)
  • Didanosine

Not bold are rarely used

19
Q

With FOOD

A

All PIs

Genvoya

Stribild

Rilpivirine (500 kcal)

Complera

Juluca

Odefsey

etravirine (after meals)

symtuza

tenofovir Powder (tastes bad)

20
Q

Oringinal container

A

Atripla

Biktarvy

Cimduo

Complera

Descovy

Genvoya

Juluca

Odefsey

Stribild

Symfi & lo

Symtuza

Triumeq

truvada

darunavir

dolutegravir (10 mg only)

etravirine

indinavir

nelfinavir

raltegravir

ritonavir

rilpivirine

ten dis

21
Q

CrCl

A

<70 Dont give

  • Stribild (stop if <50)
  • Evotaz (Atazanavir/cobicistat)
  • darunavir (use Prescobix datunavir+cobicistat with ten dis instead)

<50 don’t give

  • Triumeq

<50 decrease

  • lamuvidine
  • emtricitabine
  • ten dis

<30 don’t give

  • Biktarvy
  • Genvoya

ID 1183 (19 decks)

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