HIV

Question 1

Which of the NRTI’s can cause lactic acidosis-hepatic steatosis syndrome?

Answer 1

Didanosine > Stavudine > Zidovudine

Dan Stan Dove

Question 2

Which of the NRTI’s can cause HBV flare (upon discontinuation)?

Answer 2

Lamivudine
Emtricitabine
Tenofovir

(LET’s HBV flare)

Question 3

When is abacavir contraindicated?

Answer 3

HLA-B 5701+ pts (hypersensitivity rxn)

Question 4

Which NNRTI is a/w birth defects most?

When would it be contraindicated?

Answer 4

Efavirenz (EFV)

Contraindicated in 1st trimester pregnancy or women planning to conceive.

Question 5

Either of which 2 drugs can be used w/rifapentin for TB tx along w/the standard 2 NRTIs or alternatives?

Answer 5

Efavirenz (NNRTI) and Raltegravir (INSTI)

(in combination with abacavir/lamivudine or tenofovir/emtricitabine) are recommended w/ rifapentine. Bottom line is that coadministration of rifabutin and ART will require monitoring and dose adjustment

Question 6

Which NNRTI is contraindicated for coadministration w/other NNRTIs and some PI’s?

Answer 6

Etravirine

Question 7

Which NNRTI is a/w severe hepatotoxicity?

Answer 7

Nevirapine (NVP)

Question 8

Besides in pts w/liver disease, when (specifically) else is nevirapine (NNRTI) contraindicated?

Answer 8

HIV drug is contraindicated in women with pretreatment CD4 > 250 cells/mm and men with CD4 > 400 cells/mm

Question 9

Name the NRTIs.

What is the NNRTI that sounds like an NRTI?

Answer 9

Abacavir
Didanosine
Emtricitabine (FTC)
Lamivudine
Stavudine
Tenofovir (TFV)
Zidovudine

“dine”
- NOT Delavirdine (NNRTI)

Question 10

Name the NNRTIs.

Answer 10

Delavirdine
Efavirenz (EFV)
Etravirine
Nevirapine (NVP)
Rilpivirine

Question 11

Name the PI’s.

Answer 11

“navir’s” (Lady Guinevere)

Ritonavir (RTV)
Fosamprenavir
Atazanavir
Indinavir
Nelfinavir
Saquinavir
Tipranavir
Lopinavir
Darunavir

Question 12

What does INSTI stand for?

Name the INSTI’s.

Answer 12

(Integrase Strand Transfer Inhibitors)

Raltegravir
Elvitegravir
Dolutegravir

“gravir’s”
(gravy should not be integrated w/the HIV+ diet)

Question 13

Name the fusion inhibitor.

Answer 13

Enfuvirtide

Question 14

Name the CCR5 antagonist.

Answer 14

Maraviroc

Question 15

How do some statins affect the CYP enzymes?

Which class of drugs affect statin metabolism? How?

Which statins can be used?

Answer 15

They are metabolized by CYP3A4

Levels of some statins decreased w/protease inhibitors.

Pravastatin and fluvastatin may be used.

Question 16

Which PI can cause paresthesias?

Answer 16

Ritonavir (RTV)

Question 17

Which PI is the most potent CYP3A4 inhibitor?

Answer 17

Ritonavir (RTV)

Question 18

Which PI’s are preferred for naive HIV pts?

Answer 18

1. Darunavir
2. Atazanavir
   Lopinavir
   Fosamprenavir

(DALF)

Question 19

Which PI’s can cause metabolic syndrome?

Answer 19

All

Question 20

What is the exact MoA for INSTIs?

Answer 20

Blocks the insertion of reverse-transcribed viral DNA into the host DNA by binding the Mg++ cofactors required for the strand transfer. Mutations that alter orientation of Mg++ ions can be resistant to INSTIs.

Question 21

List the ISNTI’s in order of shortest to longest T1/2

Answer 21

Elvitegravir < Raltegravir < Dolutegravir

Question 22

What are the adverse effects of miraviroc?

Answer 22

Hepatotoxicity and possible hypersensitivity

Question 23

What are the adverse effects of enfuvirtide?

Answer 23

Injection site reaction/inflammation is very common, hypersensitivity

Question 24

Which non-NNRT/PI/NRTI is a CYP substrate?

Answer 24

Miraviroc

Question 25

In general, what are the recommended ART options for tx-naive HIV pts?

Answer 25

Either: 1 INSTI + 2 NRTIs or 1 PI (boosted w/RTV) + 2 NRTIs

Question 26

When giving 1 INSTI (+ 2 NRTIs) for a tx-naive HIV pt, what are the INSTI options?

Answer 26

Raltegravir Elvitegravir Dolutegravir (ie any of them)

Question 27

When giving 1 PI (+ 2 NRTIs) for a tx-naive HIV pt, what are the PI options?

Answer 27

Darunavir (boosted w/ritonavir) Alt: Atazanavir (boosted w/ritonavir or cobicistat)

Question 28

When would you NOT use the alternative PI tx? Alt: Atazanavir (boosted w/ritonavir or cobicistat)

Answer 28

Pts who require high dose PPIs

Question 29

What is the PREFERRED dual NRTI option when treating a tx-naive HIV pt? When can you not use this first-line dual NRTI therapy?

Answer 29

Tenofovir prodrug (TAF or TDF) + emtricitabine Do not use with unboosted atazanavir. Use w/caution w/nevirapine or in pts w/underlying renal insufficiency.

Question 30

What is the ALTERNATIVE dual NRTI option when treating naive HIV pts? When can you not use this alternative dual NRTI therapy?

Answer 30

Abacavir + lamivudine Do not use when positive for HLA-B 5701. Use w/caution w/pts w/ > 100,000 HIV copies/mL or in high risk CV pts.

Question 31

Name 3 regimens that you should NOT use in naive HIV tx.

Answer 31

Monotherapy with NRTI Dual NRTI regimens Triple NRTI regimens

Question 32

Why should you never use mono or dual NRTI regimens without other drugs? What are the exceptions?

Answer 32

1. Rapid resistance development 2. Inferior antiretroviral activity No exceptions

Question 33

Why should you never use triple NRTI regimens without other drugs? What are the exceptions?

Answer 33

High rate of non-response in tx-naive pts Abacavir/zidovudine/lamivudine or tenofovir/zidovudine/lamivudine in pts whom other options are worse.

Question 34

List drugs that should NOT be co-administered w/ | PIs due to CYP-dependent metabolism.

Answer 34

``` Quinidine (substrate) Ergotamine (substrate) Rifampin (inducer) Midazolam (substrate) Phenobarbital (inducer) Warfarin (substrate) St. John's wart (inducer) ```

Question 35

Is Maraviroc effective against CXCR4 virus entry?

Answer 35

No, only CCR5

Question 36

Which of the NNRTIs are CYP3A4 inducers?

Answer 36

Nevirapine | Efavirenz

Question 37

Which NRTI can cause renal toxicity?

Answer 37

Tenofovir (TFV)