HIV 2 Flashcards
Recommended initial treatment
INSTI + 2 NRTIs
NRTIs
- 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
NRTIs that have activity against Hep B
LET me treat your Hep B
lamuvidine (Epivir)
emtricitibine (Emtriva)
Tenofovir
Combinations containing emtricitabine
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
INSTI based complete ART regimen
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
combinations containing abacavir
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
NNRTIs
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)
PIs
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)
Boosters
- 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
INSTIs
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
CCR5 Antagonist
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
Regimens for naive pregnant women
(if becomes pregnant while on ART, contine ART regimen)
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
zidovudine
NRTI
SE:
myopathy, macrocytic anemia
IV zidovudine given in labor for HIV infected pregnant women
fusion inhibitor
enfurvirtide (Fuzeon)-
SC injection BID
CD4 attachment inhibitor
ibalizumab (Trogarzo)
administered IV- used for multidrug resistant HIV
PrEP
prevent HIV
emtricitibine/tenofovir (Truvada) 1 tab PO daily
recommended for high risk sexual exposure and active IV drug users
nPEP
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
WITHOUT FOOD
“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
With FOOD
All PIs
Genvoya
Stribild
Rilpivirine (500 kcal)
Complera
Juluca
Odefsey
etravirine (after meals)
symtuza
tenofovir Powder (tastes bad)
Oringinal container
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
CrCl
<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
