HIV Flashcards
0
Q
Role of CD4+ count?
A
Major lab indicator of immune fxn in pts infected with HIV
Serves as a key factor in determining both the urgency of antiretroviral therapy (ART) initiation
Need for prophylaxis against opportunistic inf
1
Q
What’s HIV?
A
HIV is a RNA retrovirus that attacks the immune system, mainly the CD4+ T cells => progressive decrease in CD4+ T cell count.
2
Q
What should be measured in pts who are on tx? Why?
A
Plasma HIV-1 RNA (viral load)
Bcuz viral load is the most important indicator of response to antiretroviral therapy
3
Q
What does viral load quantifies?
A
The degree of viremia by measuring the amt of HIV RNA in the blood and used to
Assess dx progression AND possible drug resistance
4
Q
Howz HIV transmitted?
A
Infected blood, serum and vaginal secretions
5
Q
How does vertical transmission of HIV occur?
A
Pregnancy
At birth
Through breastfeeding
6
Q
Effect of ART (antiretroviral therapy)?
A
Dramatically reduced HIV-associated morbidity and mortality
7
Q
What are the primary goals of antiretroviral therapy (ART)?
A
Restore and preserve the immune system
Suppress HIV viral load to undetectable levels
Reduce HIV-associated morbidity, prolong survival and prevent transmission
8
Q
What’s recommended in ALL HIV-infected individuals?
A
ART is recommended
Also recommended for HIV-infected individuals for the prevention of HIV transit mission including to sexual partners
9
Q
What needs to be done by pts for ART regimen to be effective long-term?
A
Adherence rate of 95% or higher in order for ART regimen to be effective
10
Q
Whats the 1st step in HIV replication cycle? Agent(s) that work here?
A
Fusion of HIV to the host cell surface
Fusion inhibitor and CCR5 antagonist
11
Q
Whats the 2nd step in HIV replication cycle? Agent(s) that work here?
A
HIV RNA reverse transcriptase, Integrase and other viral proteins enters the host cells
None
12
Q
Whats the 3rd step in HIV replication cycle? Agent(s) that work here?
A
Viral DNA is formed by reverse transcription
NRTIs and NNRTIs
13
Q
Whats the 4th step in HIV replication cycle? Agent(s) that work here?
A
Viral DNA is transported across the nucleus and integrates into the host DNA
Integrase Strand Transfer Inhibitors
14
Q
Whats the 5th step in HIV replication cycle? Agent(s) that work here?
A
New viral RNA is used as genomic RNA and to make viral proteins
None
15
Q
Whats the 6th step in HIV replication cycle? Agent(s) that work here?
A
New viral RNA and proteins move to the cell surface and a new, immature, HIV forms
None
16
Q
Whats the 7th step in HIV replication cycle? Agent(s) that work here?
A
The virus mature by protease releasing individual HIV proteins
PIs
17
Q
What lab parameters must be done as baseline b4 therapy starts?
A
CD4+ count + HIV RNA viral load (prior to ART initiation or modification, 2-8 wks post initiation, then Q3-6months thereafter)
Drug resistance testing (ART initiation and modification)
Lipid panel, blood chemistry, CBC with differential (prior to ART initiation, modification and Q6-12 months)
18
Q
What does an increase in HIV RNA viral load indicate?
A
Drug resistance and/or inadequate tx response
19
Q
What does a decrease in CD4+ count indicate?
A
Predictor of dx progression
20
Q
What are some common complications of ART?
A
Lactic acidosis and severe hepatomegaly with steatosis
Immune reconstitution inflammatory syndrome (IRIS or IRS)
Lipodystrophy/lipoatrophy
Fat redistribution/lipohypertrophy
Diarrhea
21
Q
How do u deal with Lactic acidosis and severe hepatomegaly with steatosis (common complications of ART)?
A
Suspend tx.
Most common with NRTIs
22
Q
What’s Immune reconstitution inflammatory syndrome (IRIS or IRS)?
A
A paradoxical worsening of a preexisting opportunistic inf when ART is initiated
23
Q
What’s the most common pathogens associated with Immune reconstitution inflammatory syndrome (IRIS or IRS)?
A
M. tuberculosis M. avium Pneumocystis jirovecii pneumonia (PCP) Herpes simplex virus (HSV) Herpes zooster Cytomegalovirus (CMV) Cryptococcus Hepatitis B
24
How's Immune reconstitution inflammatory syndrome (IRIS or IRS) managed?
Start or continue therapy for opportunistic infection
Continue ART
Add corticosteroids (sometimes)
25
Whats Lipodystrophy/lipoatrophy?
Loss of subcutaneous fat in the face, arms, legs and buttocks
Most common with PIs and Stavudine
26
Whats Fat redistribution/lipohypertrophy?
Fat accumulation in the upper back (buffalo hump) and abdominal area and increased breast size in females and males.
Most common with PIs and Stavudine
27
Which is the most common SE of ART use?
Diarrhea
28
What was most recently approved for tx of non-infectious diarrhea in adults with HIV/AIDS on ART?
Crofelemer (Fulyzaq)
29
What's the initial combo for ART-naive HIV pts?
NNRTI-based regimen (Efavirenz/Tenofovir/Emtricitabine)
PI-based regimens
(Atazanavir+Ritonavir+Tenofovir/Emtricitabine)
(Darunavir+Ritonavir+Tenofovir/Emtricitabine)
```
INSTI-based regimens
(Raltegavir+Tenofovir/Emtricitabine)
(Elvitegavir/Cobicistat/Tenofovir/Emtricitabine)
(Dolutegravir+Abacavir/Lamivudine)
(Dolutegravir+Tenofovir/Emtricitabine)
```
30
What's the NNRTI-based regimen used in ART-naive HIV pts?
Efavirenz/ Tenofovir/ Emtricitabine
31
What's the PI-based regimen used in ART-NAIVE HIV pts?
Atazanavir+Ritonavir+Tenofovir/Emtricitabine
Darunavir+Ritonavir+Tenofovir/Emtricitabine
32
What's the INSTI-based regimen used in ART-naive HIV pts?
Raltegavir+Tenofovir/Emtricitabine
Elvitegavir/Cobicistat/Tenofovir/Emtricitabine
Dolutegravir+Abacavir/Lamivudine
Dolutegravir+Tenofovir/Emtricitabine
33
In what Grp of pts should Atazanavir be avoided?
Those using > 20mg Omeprazole
34
When should Elvitegavir/Cobicistat/Tenofovir/Emtricitabine be initiated?
In pts with CrCl >= 70mL/min
| Avoid use with other ART or with other nephrotoxic drugs
35
What's the preferred initial combo for ART-NAIVE in HIV pregnant women?
PI-based regimen
(Lopinavir/Ritonavir + Zidovudine/Lamivudine)
(Atazanavir + Ritonavir + Zidovudine/Lamivudine)
NNRTI-based regimen
(Nevirapine + Zidovudine/Lamivudine)
36
What's the preferred PI-based regimen in pregnant HIV women that are ART-naive?
Lopinavir/Ritonavir + Zidovudine/Lamivudine
Atazanavir + Ritonavir + Zidovudine/Lamivudine
37
What's the preferred NNRTI-based regimen in pregnant HIV women that are ART-naive?
Nevirapine + Zidovudine/Lamivudine
38
What types of dosing Lopinavir/Ritonavir is used in pregnant women?
Twice daily dosing of Lopinavir/Ritonavir
NEVER use once daily dosing
39
What are the alternative regimens in ART-naive HIV pts?
NNRTI-based regimens
(Efavirenz + Abacavir/Lamivudine)
(Rilpivirine/Tenofovir/Emtricitabine)
(Rilpivirine + Abacavir/Lamivudine)
PI-based regime
(Atazanavir + Ritonavir + Abacavir/Lamivudine)
(Darunavir + Ritonavir + Abacavir/Lamivudine)
(Fosamprenavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine)
Lopinavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine)
INSTI-based regimens
(Raltegavir + Abacavir/Lamivudine)
40
What's the NNRTI-based regimen used as ALTERNATIVE regimen in ART-naive HIV pts?
Efavirenz + Abacavir/Lamivudine
Rilpivirine/Tenofovir/Emtricitabine
Rilpivirine + Abacavir/Lamivudine
41
What's the PI-based regimen used as ALTERNATIVE regimen in ART-naive HIV pts?
Atazanavir + Ritonavir + Abacavir/Lamivudine
Darunavir + Ritonavir + Abacavir/Lamivudine
Fosamprenavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine
Lopinavir + Ritonavir + either (Abacavir/Lamivudine or Tenofovir/Emtricitabine
42
What's the INSTI-based regimen used as ALTERNATIVE regimen in ART-naive HIV pts?
Raltegravir + Abacavir/Lamivudine
43
When is the use of Rilpivirine CI?
In pts with pretx HIV RNA > 100,00 copies/ml
Combo with proton pump inhibitors, is also CI
44
Is once daily Lopinavir/Ritonavir recommended in HIV positive pregnant women?
No!
Twice daily is
45
When is the use of Abacavir CI?
Pts who test positive for HLA-B*5701
46
MOA of Nucleoside/Tide Reverse Transcriptase Inhibitors (NRTIs)? What step in the HIV replication cycle does it work at?
Binds to catalytic site of reverse transcriptase, interfering with HIV viral RNA-dependent DNA polymerase and resulting in inhibition of viral replication.
Step 3
47
What's the black box warning of ALL NRTIs? Which agents are most responsible?
Lactic acidosis and Severe hepatomegaly with steatosis
Stavudine, Didanosine and Zidovudine
48
List NRTIs agents
Abacavir ABC (Ziagen)
Didanosine ddl (Videx, Videx EC)
Emtricitabine FTC (Emtriva)
Lamivudine 3TC (Epivir)
Stavudine d4T (Zerit)
Tenofovir TDF (Viread)
Zidovudine ZDV or AZT (Retrovir)
49
What's the black box warning of Abacavir, ABC (Ziagen)? - NRTIs
Hypersensitivity rxn (don't re-challenge he)
50
What screening MUST be done to pts about to start Abacavir, ABC (Ziagen)? Why? - NRTIs
HLA-B*5701 allele (if positive, don't use ABC)
Cuz of hypersensitivity rxn
51
What's the black box warning of Didanosine, ddl (Videx; EC)? - NRTIs
Pancreatitis (sometimes fatal)
52
What's the SE of Didanosine, ddl (Videx; EC)? - NRTIs
DIP
Diarrhea
Increased LFTs
Peripheral neuropathy
53
Howz Didanosine, ddl (Videx EC) taken? - NRTIs
Take on an empty stomach
54
Storage and stability of Didanosine, ddl (Videx; EC) and Stavudine, d4T (Zerit) - NRTIs?
Stable for 30 days if refrigated
55
Black box warning of Emtricitabine, FTC, (Emtriva) and Tenofovir, TDF (Viread) - NRTIs?
May exacerbate Hepatitis B once drug is d/c or HBV resistance may develop
56
SE of Emtricitabine, FTC, (Emtriva) - NRTIs?
Hyper pigmentation
57
Is there any benefit in combining Emtricitabine, FTC, (Emtriva) - NRTIs with Lamivuding, 3TC?
No!
Both are cytosine analogs: FTC and 3GC
58
What's the dose of Emtricitabine, FTC, (Emtriva) - NRTIs capsule? How often?
200mg Daily
59
What's Atripla?
Emtricitabine, FTC + Efavirenz + Tenofovir
60
Howz Atripla (Emtricitabine, FTC + Efavirenz + Tenofovir) used?
Once daily, On an empty stomach, preferably at HS (bedtime)
61
What's the black box warning of Lamivudine, 3TC (Epivir)?
Don't use Epivir-HBV for HIV tx (contains lower doses of Lamivudine)
May exacerbate Hepatitis B once drug is d/c or HBV resistance may develop
62
SEs of Stavudine, d4T (Zerit)?
Increased LFTs
| Peripheral neuropathy
63
What's the dosing of Tenofovir, TDF (Viread) - NRTIs?
300mg daily
64
SEs of Tenofovir, TDF (Viread) - NRTIs?
FORR
Fanconi syndrome
Osteomalacia
Renal insufficiency
Reduced bone density
65
Black box warning of Zidovudine, ZDV or AZT (Retrovir)?
Hematologic toxicities (neutropenia and anemia), esp in advanced HIV
Symptomatic myopathy and myositis (associated with prolonged use)
66
SEs of Zidovudine, ZDV or AZT (Retrovir)?
Increased LFTs
67
Role of IV Zidovudine, ZDV or AZT (Retrovir) in therapy? Exception?
IV Zidovudine, ZDV or AZT (Retrovir) used in labor for HIV+. Women
Unless viral load is < 400 copies/m
68
List NRTIs agents that should be avoided if possible?
Didanosine, ddl (Videx, Videx EC)
Stavudine, d4T (Zerit)
Zidovudine, ZDV or AZT (Retrovir) - except in pregnancy, when it's preferred
69
Advantage of NRTIs over PIs and NNRTIs?
NRTIs don't undergo hepatic transformations via CYP metabolic pathway, t4 they have fewer significant drug interactions
70
Which med should be avoided with ALL NRTIs bcuz of increased risk of lactic acidosis?
Ribavirin
71
Why is the combo of Didanosine, ddl and Stavudine, d4T CI?
Combo increases risk of Pancreatitis, Peripheral Neuropathy and Hyperlactatemia
72
Why is the combo of Didanosine, ddl and Tenofovir, TDF CI?
Due to resistance and virologic failure as well as increased Didanosine, ddl conc
73
Whys the combo of Emtricitabine and Lamivudine; Zidovudine and Stavudine avoided?
No benefit
74
MOA of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)? Step in HIV replication cycle?
Binds to reverse transcriptase and blocks the RNA-dependent and DNA-dependent DNA polymerase activities including HIV-1 replication
Step 3 (same as NRTIs)
75
What's the SE of all agents in NNRTIs?
Rash (SJS/TEN) -monitor erythema, facial edema, skin necrosis, blisters, tongue swelling
Hepatoxicity - monitor LFTs
76
List NNRTIs agents
NEED R
Nevirapine, NVP, (Viramune, Viramune XR)
Efavirenz, EFV, (Sustiva)
Etravine, ETR, (Intelence)
Delavirdine, DRV, (Rescriptor)
Rilpivirine, RPV, (Edurant)
77
Which NNRTIs agent is preferred? When is it not preferred?
Efavirenz, EFV (Sustiva)
Not preferred In women who are planning to be pregnant or are sexually active (except the woman is on Atripla and is already in her 1st trimester, them she may continue)
78
Which NNRTIs agent is for tx in experienced pts?
Etravirine, ETR, (Intelence)
79
What's the abbreviation of Efavirenz? Brand name?
EFV
Sustiva
80
SEs of Efavirenz, EFV, (Sustiva)?
CNS - impaired conc, drowsiness, vivid dreams, resolves btw 2-4wks
Psychiatric Sx - depression, paranoia, mania, suicide
81
Dosing of Efavirenz, EFV, (Sustiva)?
600mg daily
Take on an empty stomach, preferably at bedtime
82
Pregnancy category of Efavirenz, EFV, (Sustiva)?
D
83
Howz Etravirine, ETR, (Intelence) dosed?
200mg bid AFTER meals
84
Which NNRTI is gen avoided, except in pregnancy when it's then preferred?
Nevirapine, NVP (Viramune, Viramune XR)
85
What's unique about the use of Nevirapine, NVP (Viramune, Viramune XR)?
Needs 14 day lead-in period
86
Black box warning of Nevirapine, NVP (Viramune, Viramune XR)?
Severe hepatotoxic rxn may occur (liver failure, death)
Severe, life-threatening skin rxns (SJS/TEN)
87
Main SEs of Nevirapine, NVP (Viramune, Viramune XR)?
Increased LFTs
88
Howz Rilpivirine, RPV (Edurant) dosed?
25mg daily with a meal
89
SEs of Rilpivirine, RPV (Edurant)?
CNS - depression, mood changes, suicidal ideation, insomnia
90
What should be done b4 placing a pt on NNRTIs?
Always run a drug interaction check on ALL pts receiving NNRTIs
91
MOA of Protease Inhibitors (PIs)? What step of HIV replication cycle does PIs work on?
Inhibits HIV-1 protease and renders the enzyme incapable of cleaving the Gag-Pol polyprotein, resulting in productions of immature, no infectious virions.
Step 7 (virus matures by protease releasing individual HIV proteins)
92
Class SEs of PIs?
Hyperglycemia/ Insulin resistance/ Diabetes
Lipoatrophy, fat maldistribution, hyperlipidemia
Hepatitis and hepatic decompensation
Immune reconstitution syndrome
93
Which PIs agents have the lowest occurrence of Lipoatrophy, fat maldistribution, hyperlipidemia?
Atazanavir and Darunavir
94
Which PIs have the highest occurrence of hepatitis and hepatic decompensation?
Tipranavir
95
List the preferred PIs agents
RAD
Ritonavir, RTV (Norvir)
Atazanavir, ATV (Reyataz)
Darunavir, DRV, (Prezista)
96
What's the dosing of Atazanavir, ATV (Reyataz)?
300mg + 100mg Ritonavir daily
Take with food and water (better absorption)
97
SEs of Atazanavir, ATV (Reyataz)?
PR interval prolongation
Indirect Hyperbilirubinemia (leading to jaundice or scleral icterus - referred to as "bananavir")
Rash
Nephrolithiasis (take with 48oz (1.5L) of water may reduce risk
98
Howz Darunavir, DRV (Prezista) dosed in tx-naive?
800mg + 100mg Ritonavir daily
Take with food. Swallow whole
99
SEs of Darunavir, DRV (Prezista)?
Nausea
Diarrhea
Rash (SJS/TEN)
100
Warnings associated with Darunavir, DRV (Prezista) use?
Caution in pts with a sulfa allergy
101
What's the abbreviation and brand name of Atazanavir?
ATV
Reyataz
102
What's the abbreviation and brand name of Darunavir?
DRV
Prezista
103
What's the abbreviation and brand name of Ritonavir?
RTV
Norvir
104
Howz Ritonavir, RTV (Norvir) dosed?
100-400mg/d - booster dose
Take with food
105
Howz solutions, capsules and tablets of Ritonavir, RTV (Norvir) stored?
Ritonavir, RTV (Norvir) solution - don't refrigerate (contains 43% alcohol)
Ritonavir, RTV (Norvir) capsule - refrigerated (30days at room temp)
Ritonavir, RTV (Norvir) tablets - room temp
106
SEs of Ritonavir, RTV (Norvir)?
N/V/D
Pancreatitis
Asthenia
Altered taste
PR prolongation
107
Which PIs is/are preferred in pregnancy?
Atazanavir, ATV (Reyataz)
Lopinavir + Ritonavir, LPV/r (Kaletra)
108
Howz Lopinavir + Ritonavir, LPV/r (Kaletra) dosed in tx-naive HIV+ pts?
800mg Lopinavir/200mg Ritonavir daily or 400mg/200mg BID
Take w/o regard to food, except the oral soln needs to be taken with food
109
Whys Ritonavir used in combo with other PIs?
Ritonavir is a strong inhibitor of 3A4, t4 it's used at low doses to increase, or boost the level of other PIs.
110
MOA of fusion inhibitors? Step in HIV replication cycle?
Block attachment (or fusion) of HIV-1 virus with CD4 cells by blocking the conformational change in gp41 req for membrane fusion and entry into CD4 cells (also known as cell entry inhibitors)
Step 1
111
List agents under Fusion Inhibitors
Enfuvirtide, T20 (Fuzeon)
112
What's the place of Enfuvirtide, T20 (Fuzeon) - fusion inh in therapy?
Salvage therapy (for tx-experienced pts)
113
SEs of Enfuvirtide, T20 (Fuzeon) - Fusion Inh?
Local injection site rxns in almost 100% pts (pain, erythema, induration, nodules and cysts, pruritus, ecchymosis)
Increased risk of bacterial pneumonia
114
MOA of CCR5 antagonists? Step it acts on in HIV replication cycle?
Binds to CCR5 co-receptor on the CD4 cells and prevent the conformation change req for HIV cell entry
Step 1
115
List agents under CCR5 antagonists?
Maraviroc, MVC, (Selzentry)
116
What's the place of Maraviroc, MVC, (Selzentry) in therapy?
For tx-experienced pts
117
Black box warning of Maraviroc, MVC, (Selzentry) - CCR5 antagonist
Hepatotoxicity with allergic type features
118
SEs of Maraviroc, MVC, (Selzentry) - CCR5 antagonist?
Upper respiratory tract inf
Fever
Rash (including SJS)
Musculoskeletal sx
Dizziness
119
Monitoring for Maraviroc, MVC, (Selzentry) - CCR5 antagonist?
Prior to starting therapy, pts must undergo a screening test (Trofile).
120
Why is the screening test, Trofile recommended prior to starting Maraviroc, MVC, (Selzentry) - CCR5 antagonist?
Maraviroc, MVC, (Selzentry) - CCR5 antagonist only works for pts with CCR5-tropic dx
121
MOA of Integrase Strand Transfer Inhibitors (INSTIs)? Place in HIV replication cycle?
Integrase inhibitors block the Integrase enzyme needed for viral DNA to enter the host nucleus
Step 4
122
What's the agents under INSTIs?
RED
Raltegavir, RAL (Isentress)
Elvitegavir, EVG; Cobicistat, COB; Emtricitabine, Tenofovir, (Stribild)
Dolutegravir, DTH, (Tivicay)
123
Howz Raltegavir, RAL (Isentress) dosed?
400mg BID
124
What's the abbreviation and brand name of Raltegavir?
RAL
Isentress
125
Which INSTIs is taken with regards to food?
Elvitegavir, EVG; Cobicistat, COB; Emtricitabine, Tenofovir, (Stribild)
126
Main SE of Elvitegavir, EVG; Cobicistat, COB; Emtricitabine, Tenofovir, (Stribild)?
Proteinuria
127
Which HIV agents are boosters (inhibitors used to increase/ boost the levels of other HIV agents)?
Ritonavir
Cobicistat
128
List the 2-drugs combo HIV pdts
Emtricitabine 200mg + Tenofovir 300mg (Truvada) 1 tab daily
Lamivudine 150mg + Zidovudine 300mg (Combivir) 1 tab BID
Abacavir 600mg + Lamivudine 300mg (Epzicom) 1 tab daily
129
List the 3-drugs combo HIV pdts
Abacavir 300mg + Lamivudine 150mg (Epzicom) + Zidovudine 300mg (Trizivir) 1 tab BID
Emtricitabine 200mg + Tenofovir 300mg + Efavirenz 600mg (Atripla)
1 tab daily on empty stomach
Emtricitabine 200mg + Tenofovir 300mg + Rilpivirine 25mg (Complera)
1 tab daily with food
130
List the 4-drugs combo HIV pdts
Emtricitabine 200mg + Tenofovir 300mg + Elvitegravir 150mg + Cobicistat (Stribild) 1 tab daily with food
131
Which agents used in the 4-drug combo aren't approved as solo agents and only used in combo pdt?
Elvitegravir (INSTIs)
Cobicistat
132
What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg?
Truvada - 1 tab daily
133
What's the brand name and dosing of Lamivudine 150mg + Zidovudine 300mg?
Combivir - 1 tab BID
134
What's the brand name and dosing of Abacavir 600mg + Lamivudine 300mg?
Epzicom - 1 tab daily
135
What's the brand name and dosing of Abacavir 300mg + Lamivudine 150mg + Zidovudine 300mg?
Trizivir - 1 tab BID
136
What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg + Efavirenz 600mg?
Atripla - 1 tab daily on empty stomach
137
What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg + Rilpivirine 25mg?
Complera - 1 tab daily with food
138
What's the brand name and dosing of Emtricitabine 200mg + Tenofovir 300mg + Elvitegravir 150mg + Cobicistat?
Stribild - 1 tab daily with food
139
What's Pre-Exposure Prohylaxis (PrEP)?
New HIV prevention method in which people who don't have HIV take Truvada (Emtricitabine/Tenofovir) to reduce their risk of becoming infected
140
What's the med used in PrEP?
Emtricitabine/Tenofovir (Truvada) 1 tab PO daily
141
What needs to be done before initiating PrEP?
Confirm HIV negative status through HIV antibody test
Confirm CrCl >= 60mL/min
Confirm pt very high risk for acquiring HIV
Screen for Hep B and STDs
142
What needs to be done after initiating PrEP?
HIV test and document -ve result
Provide no more than 90-day supply at a time (renew rx only once HIV negative status is confirmed)
Pregnancy test
Counseling on PrEP adherence and safe sex practices
Q6 months, check SCr and calculate CrCl, and test for bacterial STDs (regardless of sx)
143
List HIV drugs used w/o food?
Atripla
Didanosine
Efavirenz (or small amt of food)
Fosamprenavir (oral suspension)
Indinavir - unboosted
Tenofovir powder (to avoid bitter taste)
144
Nonoccupational Postexposure Prophylaxis (nPEP)?
Nonoccupational exposure is the use of ART prophylaxis after sexual, injection drug use, or some other nonoccupational exposure to HIV
145
What combo is used for nPEP?
NNRTI-based regimens
Efavirenz + (Lamivudine or Emtricitabine) + (Zidovudine or Tenofovir)
PI-based regimens
Lopinavir/Ritonavir + (Lamivudine or Emtricitabine) + Zidovudine
146
What's Occupational Postexposure Prophylaxis Recommendations (PEP)?
Exposure of health care personnel to blood and body fluids that may be potentially be contaminated with HIV
147
What's the preferred tx for Occupational Postexposure Prophylaxis Recommendations (PEP)?
Raltegavir + Truvada (Tenofovir/Emtricitabine) for a 4-wk course (within 72 hrs)
148
Name OTC HIV testing?
Express HIV-1 Test System
OraQuick test
149
How soon after using OraQuick test should test be read?
After 20mins, but no later than 40mins
150
Look at strategies to improve adherence to ART?
Pg 368
151
What's primary prophylaxis of Pnuemocystis pneumonia (PCP)?
TMP/SMX 1DS tab PO daily
Or
1 SS PO daily
152
What's alternative prophylaxis of Pnuemocystis pneumonia (PCP)?
TMP/SMX 1 DS PO TIW
Or
Dapsone 100mg PO daily or 50mg PO BID
Or
Dapsone + Pyrimethamine + Leucovorin) or Aerosolized pentamidine, or Atovaquone
153
What's the indication of Pnuemocystis pneumonia (PCP)?
CD4+ count < 200 cells/mL
Or
Oropharyngeal candidiasis
154
What's criteria for d/c of primary prophylaxis of Pnuemocystis pneumonia (PCP)?
CD4+ count > 200 for 3 months on ART
155
What's indication of Toxoplasma gondii?
Toxoplasma IgG positive pts with CD4+ count < 100 cells/mL
156
What's primary prophylaxis of Toxoplasma gondii?
TMP/SMX 1 DS tab PO daily
157
What's alternative prophylaxis of Toxoplasma gondii?
TMP/SMX 1 DS PO TIW
Or
1 SS PO daily
Or
(Dapsone 50mg PO daily + Pyrimethamine 50mg PO weekly + Leucovorin 25mg PO weekly)
158
What's criteria for d/c primary prophylaxis of Toxoplasma gondii?
CD4+ count > 200 for 3montbs on ART
159
What's indication for Mycobacterium Avium complex (MAC)?
CD4+ count < 50 cells/mL after ruling out active disseminated MAC dx
160
What's primary prophylaxis for Mycobacterium Avium complex (MAC)?
Azithromycin 1,200mg PO weekly
Or
Clarithromycin 500mg PO BID
Or
Azithromycin 600mg PO twice weekly
161
What's criteria for d/c of primary prophylaxis for Mycobacterium Avium complex (MAC)?
CD4+ count >= 100 for 3 months on ART
162
What's 1st-line tx of Cryptococcal meningitis (opportunistic inf)?
Liposomal Amphotericin B + Flucytosine
163
What's alternative tx of Cryptococcal meningitis (opportunistic inf)?
Amphotericin B deoxycholate + Flucytosine/Fluconazole
164
What's secondary prophylaxis of Cryptococcal meningitis (opportunistic inf)?
Fluconazole (low dose)
165
What's 1st-line tx of Cytomegalovirus (CMV) retinitis (opportunistic inf)?
Valganciclovir or Ganciclovir
166
What's alt. tx of Cytomegalovirus (CMV) retinitis (opportunistic inf)?
Foscarnet or Cidofovir
167
What's secondary prophylaxis of Cytomegalovirus (CMV) retinitis (opportunistic inf)?
Continue same agent at reduced at reduced dose (usually Valganciclovir)
168
What's 1st-line tx of Mycobacterium Avium complex (opportunistic inf)?
Clarithromycin or Azithromycin + Ethambutol +/- Rifampicin/Rifabutin
169
What's alt. tx of Mycobacterium Avium complex (opportunistic inf)?
Replace 1 agent with Moxifloxacin
170
What's secondary prophylaxis of Mycobacterium Avium complex (opportunistic inf)?
Same agents at same doses
171
What's 1st line tx of Pneumocystis pneumonia (PCP) (opportunistic inf)?
TMP/SMX +/- corticosteroids
172
What's alt. tx of Pneumocystis pneumonia (PCP) (opportunistic inf)?
Atovaquone or (Clindamycin + Primaquine) or Pentamidine IV or (Dapsone + Trimethoprim)
173
What's secondary prophylaxis of Pneumocystis pneumonia (PCP) (opportunistic inf)?
TMP/SMX or Dapsone or (Dapsone + Pyrimethamine) or Atovaquone or Inhaled Pentamidine
174
What's 1st line tx of Toxoplasmosis meningoencephalitis (opportunistic inf)?
Pyrimethamine + Sulfadiazene
175
What's alt. tx of Toxoplasmosis meningoencephalitis (opportunistic inf)?
TMP/SMX, (Pyrimethadine + Clindamycin or Azithromycin), (Atovaquone or with Sulfadiazine or Primethamine)
176
What's secondary prophylaxis of Toxoplasmosis meningoencephalitis (opportunistic inf)?
Same agents at reduced dose
177
What's imp in all HIV meds counseling?
Don't skip any doses
178
What's imp in Tenofovir counseling?
Use only the dosing scoop to measure the oral powder
Mix oral powders with soft foods that can be swallowed w/o chewing e.g. Applesauce,
Don't mix oral powder with liquid
Give entire dose right away after mixing, to avoid bad taste
179
What's imp in Efavirenz counseling?
Take on an empty stomach, w/o food, usually once daily at bedtime
180
What's considered high risk in HTN?
```
Pts that have DM, CKD, known CAD
Or
CAD equivalent (carotid artery dx, PAD, abdominal aortic aneurysm)
Or
10-yr Framingham risk score > 10%
```
