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HIV Flashcards

1
Q

HIV properties

A

retrovirus
target CD4
serocoversion occurs w/in 4-10wks

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2
Q

stage of HIV

A 
1st infection 
seroconversion 
latent 
early symptom of HIV infection 
AIDS
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3
Q

HIV transmission

A

Sexual
parenteral
perinatal ( immediately before and after birth)

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4
Q

HIV presentation

A 
Wt loss (avg 5kg), painful mucocutaneous ulceration, 
HIV viral load elevated; CD4 count low (normal: 800-1100 cells/mm3, 40-70% total lymphocytes, monitor every 3-6 months in HIV patients), aseptic meningitis
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5
Q

HIV latent phase

A

seroconversion - cell counts and viral load stay in near

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6
Q

HIV reservoirs

A

Infected CD4 cells but not actively producing HIV, can be established early on, continue to survive despite HAART (since they are not marked, they are not destroyed)

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7
Q

HIV early Sx

A

Thrush, STDs, fever or diarrhea >1 month,

+ ELISA and Weastern blot

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8
Q

AIDS

A

CD4 count < 200, HIV+ with AIDs- defining illness, advance aids  CD4 count <50

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9
Q

HIV diagnosis

A

4th generation antigen/antibody assay - 30 min
HIV antibody differentiation assay
HIV RNA testing if acute infection is suspected

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10
Q

HIV labs

A

CD4 count, VL, CBC, Chem 7, LFT, UA, hepatitis screening, FBG and FLP

Co-receptor tropism assays (maraviroc )
HLA-B 5701 (abacavir) renal function

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11
Q

HIV VL

A

indicator for ART therapy: decrease by 30-100 fold in 6 wks
GOAL: undetectable VL
virologic failure: >200 copies

suppression of VL: decrease inflammation and immune activation, prevents selection of drug - resistant mutations, preserves CD4 cell numbers

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12
Q

HIV resistance test

A

Genotype preferred over phenotype
done at baseline and after virologic failure

should be done when viral load >1000

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13
Q

HIV backbone (HAART)

A

2 NRTI + PI/NNRTI/INSTI

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14
Q

HIV complications

A

AIDS
HIV-Associated Nephropathy (HIVAN): occurs almost exclusively in black patients, most common cause of ESRD in HIV patient , more rapid progression of HBV/HCV complications, CVD, non-AIDs defining malignancies, neurologic disease, immune cell activation and inflammation

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15
Q

HAART toxicity

A

Common early toxicities: GI intolerance, anemia, sleep disturbance, hyperbilirubinemia, rash Immediately life-threatening: ABC hypersensitivity, pancreatitis, lactic acidosis, hepatitis, Stevens-Johnson Syndrome Long-term complications: Peripheral nervous system : neuropathy, myopathy Metabolic: Glucose disorders (insulin resistance, hyperglycemia, diabetes), Dyslipidemia (↑TG, ↑Cholesterol, ↓HDL) Cardiovascular: CVD-MI Morphologic: Fat accumulation (abdominal, buffalo hump, gyneocomastia), Fat loss Bone, Renal, Malignancy Nausea counseling: Sx usually decrease over first month, avoid greasy, fried food, eat small frequent snacks or meals, mint and/or simethicone for gas/bloating, consider antiemetics

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16
Q

NRTIs

A

SE: lipoatrophy,
BBW: lactic acidosis, fatty liver

Emtric DID Lift TV ABove Star Zone

Abacavir (ABC), Didanosine (DDI), Emtricitabine (FTC),
Lamivudine (3TC), Stavudine(D4T) Tenofovir(TDF), Zidovudine (AZT,ZDV)

all Require Renal adjustment except Abacavir

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17
Q

Ziagen

A

abacavir
must test for HLA-B 5701 before use
increase LDL & TG

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18
Q

Videx

A

Didanosine
pancreatitis, neuropathy,
No food and alcohol

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19
Q

Emtriva

A

Emtrictabine
M184 V mutation = no
skin discoloration
1st line for HBV co-infection

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20
Q

Epivir

A

Lamivudine
M184V mutation = no
1st line for HBV co-infection

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21
Q

Zerit

A

Stavudine
peripheral neuropathy
pancreatitis
DO NOT TAKE WITH ZIDOVUDINE

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22
Q

Viread

A

Tenofovir
Fanconi syndrome
decrease mineral density
1st line for HBV co- infection

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23
Q

Retrovir

A

Zidovudine
bone marrow suppression
dyslipidemia
not take with stavu

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24
Q

NNRTI

A

SE: rash (NVP> DLV>ETR>efv/rpv), increase LFT, dyslipidemias

Delavirdine (DLV), Rilpivirine (RLP), Efavirenz (EFV), Etravirine(ETR), Nevirapine (NVP)

No use in K103N mutation except etravirine
no renal adjustment needed
higher chance for resistance
a lot DDIs

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25
Rescriptor
Delavirdine avoid antacid CI: alprazolam, midazolam Not recommended as part of initial regimen
26
Edurant
Rilpivirine Take with fatty meal cause depression, insomia, increase LDL, TG Not recommended if baseline VL >100,000
27
Sustiva
``` Efavirenz High potency hangover effect 2-3 weeks false positive THC test avoid high fat meal not for in 1st trimester ```
28
Intelence
Etravirine Rash, nausea take with food
29
viramune
Nevirapine Hepatotoxicity Rash Not recommended if baseline CD4 count >400 in males or >250 in females
30
Complera
(RLP+ TDF+ FTC) take with fatty food good for HBV co-infection Faconi syndrome, decrease bone mineral density
31
Protease Inhibitor
SE: N/V, lipodystrophy, liver toxicity, dyslipidemia, insulin resistance, increase risk of MI, mostly take with food except indinavir low chance for resistance no renal adjustment needed - navir
32
Reyataz
Atazanavir Avoid use of antacids bilirubin, including jaundice and sclearal icterus
33
Prezista
Darunavir sulfa allergy - rash take with food
34
Lexiva
Fosamprenavir | sulfa allergy
35
Crixivan
Indinavir Kidney stone (1.5 L of Water) TAKE 1 HR BEFORE OR 2 HRS AFTER MEALS
36
Kaletra
Lopinavir + Ritonavir Sever diarrhea, nausea, Risk of increase TG DDIs due to Ritonavir GI issues- NV (b/c must be given with higher dose ritonavir [200mg])
37
Viracept
Nelfinavir diarrhea DO NOT USE BOOSTER
38
Invirase
Saquinavir highest pill burden, avoid in arrhythmias Do not use with IDV
39
Aptivus
Tipranavir Fanconi syndrome good for PI resistant
40
Norvir
``` Ritonavir Only used as booster must be refrigerate severe GI and DDI Cross resistance with Indinavir ```
41
Fuzeon
Enfuvirtide Binds to the HIV-1 transmembrane fusion protein gp41 must be reconstituted prior to each injection (site RXn) unknown renal
42
Selzentry
Maraviroc only effective if CCR5 positive BBW: hepatotxity and allergic RXN renal adjustment
43
Integrase inhibitors
- gravir | no renal required
44
Tivicay
Dolutegravir hyperglycemia insomnia, headache
45
Isentress
Raltegravir | increase CPK
46
Atripla
TDF + FTC + EFV 1 NNRTI 2 NRTIs
47
Combivir
ZDV + 3TC | Lamivudine + Zidovudine
48
Epzicom
ABC + 3TC
49
Stribild
Elvitegravir + cobicistat + TDF + FTC (Tenofovir, Emtricitabine) ``` N/D risk for kidney failure DDi with 3A4 due to cobicistat Cobicistat used to boost Elvitegravir level - No antiretroviral activity ```
50
Trizivir
AZT + 3TC + ABC
51
Truvada
TDF + FTC
52
Women in HIV
higher risk for transmission higher risk for SE back up methods for birth control Zidovudine - preventing intrapartum transmission
53
Pregnancy drugs
Lam + zidovudine Abacavir, Tenofovir, Nevirapine: Avoid in starting in ALL women with baseline CD4>250 Lopinavir/r : Avoid once daily dosing Atazanavir/r
54
HIV-2
west Africa longer latent, lower VL, lower mortality rate intrinsically resistant to NNRTI and enfuvirtide resistance commonly develops
55
HIV/ HBV co-infection
TDF + FTC should form backbone of therapy - Lamivudine, entecavir also active Do NOT abruptly discontinue agents with anti-HBV activity All Pt should screen for HCV before ART ART slow progression of liver disease Due to DDIs defer ART if baseline CD4 >500, until HCV treatment is finished Vice versa, if baseline CD4 <200, may defer HCV treatment
56
Prophylaxis
post: 2 NRTIs + PI 4 wks pre: Truvada + safe sex
57
IRIS
Immune Reconstitution Inflammatory Syndrome Extent of immunosuppression before HAART Degree of viral suppression and immune recovery after HAART Corticosteroids or NSAIDs
58
Toxoplasma gondii Encephalitis Prophylaxis
Initiate when CD4 cells 200 for 3 month
59
Toxoplasma gondii Encephalitis treatment
pyrimethamine +sulfadiazine + leucovorin | 6 weeks
60
Fanconi Syndrome
TENOFOVIR Manifested by increases in SCr, and electrolyte and protein wasting via urine Should monitor SCr, UA, electrolytes when taking TDF
61
Elvitegravir
inhibits secretion of creatinine - increase Scr watch for increase Scr >0.4 mg/dl not treat naive Pt with Scr <70 DDIs with 3A4
62
DDIs:
NNRTIs & PIs : NO Sim & lova statin NO MIdazolam, trazolam, alprazolam (zolams) lower antidepression dose increase dose for OC No PIs with Budesonide, Fluticasone, Prednisone
63
Risks and Benefits of Early Initiation of ART
Benefits: Prevention of progressive immune dysfunction Delayed progression to AIDS and prolonged survival Decreased risk of nonAIDS/HIV-related morbidity Decreased risk for ARV toxicities Decreased HIV transmission Decreased emergence of resistance Risks Reduced quality of life Development of drug resistance if adherence is suboptimal Limitation in future choices of ART if drug resistance occurs Long-term drug toxicities Cost

pharmacy (15 decks)

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