HIV Flashcards
Which of the NRTI’s can cause lactic acidosis-hepatic steatosis syndrome?
Didanosine > Stavudine > Zidovudine
Dan Stan Dove
Which of the NRTI’s can cause HBV flare (upon discontinuation)?
Lamivudine
Emtricitabine
Tenofovir
(LET’s HBV flare)
When is abacavir contraindicated?
HLA-B 5701+ pts (hypersensitivity rxn)
Which NNRTI is a/w birth defects most?
When would it be contraindicated?
Efavirenz (EFV)
Contraindicated in 1st trimester pregnancy or women planning to conceive.
Either of which 2 drugs can be used w/rifapentin for TB tx along w/the standard 2 NRTIs or alternatives?
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
Which NNRTI is contraindicated for coadministration w/other NNRTIs and some PI’s?
Etravirine
Which NNRTI is a/w severe hepatotoxicity?
Nevirapine (NVP)
Besides in pts w/liver disease, when (specifically) else is nevirapine (NNRTI) contraindicated?
HIV drug is contraindicated in women with pretreatment CD4 > 250 cells/mm and men with CD4 > 400 cells/mm
Name the NRTIs.
What is the NNRTI that sounds like an NRTI?
Abacavir Didanosine Emtricitabine (FTC) Lamivudine Stavudine Tenofovir (TFV) Zidovudine
“dine”
- NOT Delavirdine (NNRTI)
Name the NNRTIs.
Delavirdine Efavirenz (EFV) Etravirine Nevirapine (NVP) Rilpivirine
Name the PI’s.
“navir’s” (Lady Guinevere)
Ritonavir (RTV) Fosamprenavir Atazanavir Indinavir Nelfinavir Saquinavir Tipranavir Lopinavir Darunavir
What does INSTI stand for?
Name the INSTI’s.
(Integrase Strand Transfer Inhibitors)
Raltegravir
Elvitegravir
Dolutegravir
“gravir’s”
(gravy should not be integrated w/the HIV+ diet)
Name the fusion inhibitor.
Enfuvirtide
Name the CCR5 antagonist.
Maraviroc
How do some statins affect the CYP enzymes?
Which class of drugs affect statin metabolism? How?
Which statins can be used?
They are metabolized by CYP3A4
Levels of some statins decreased w/protease inhibitors.
Pravastatin and fluvastatin may be used.
Which PI can cause paresthesias?
Ritonavir (RTV)
Which PI is the most potent CYP3A4 inhibitor?
Ritonavir (RTV)
Which PI’s are preferred for naive HIV pts?
- Darunavir
- Atazanavir
Lopinavir
Fosamprenavir
(DALF)
Which PI’s can cause metabolic syndrome?
All
What is the exact MoA for INSTIs?
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.
List the ISNTI’s in order of shortest to longest T1/2
Elvitegravir < Raltegravir < Dolutegravir
What are the adverse effects of miraviroc?
Hepatotoxicity and possible hypersensitivity
What are the adverse effects of enfuvirtide?
Injection site reaction/inflammation is very common, hypersensitivity
Which non-NNRT/PI/NRTI is a CYP substrate?
Miraviroc
In general, what are the recommended ART options for tx-naive HIV pts?
Either:
1 INSTI + 2 NRTIs
or
1 PI (boosted w/RTV) + 2 NRTIs
When giving 1 INSTI (+ 2 NRTIs) for a tx-naive HIV pt, what are the INSTI options?
Raltegravir
Elvitegravir
Dolutegravir
(ie any of them)
When giving 1 PI (+ 2 NRTIs) for a tx-naive HIV pt, what are the PI options?
Darunavir (boosted w/ritonavir)
Alt: Atazanavir (boosted w/ritonavir or cobicistat)
When would you NOT use the alternative PI tx?
Alt: Atazanavir (boosted w/ritonavir or cobicistat)
Pts who require high dose PPIs
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?
Tenofovir prodrug (TAF or TDF) + emtricitabine
Do not use with unboosted atazanavir.
Use w/caution w/nevirapine or in pts w/underlying renal insufficiency.
What is the ALTERNATIVE dual NRTI option when treating naive HIV pts?
When can you not use this alternative dual NRTI therapy?
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.
Name 3 regimens that you should NOT use in naive HIV tx.
Monotherapy with NRTI
Dual NRTI regimens
Triple NRTI regimens
Why should you never use mono or dual NRTI regimens without other drugs?
What are the exceptions?
- Rapid resistance development
- Inferior antiretroviral activity
No exceptions
Why should you never use triple NRTI regimens without other drugs?
What are the exceptions?
High rate of non-response in tx-naive pts
Abacavir/zidovudine/lamivudine or tenofovir/zidovudine/lamivudine in pts whom other options are worse.
List drugs that should NOT be co-administered w/
PIs due to CYP-dependent metabolism.
Quinidine (substrate) Ergotamine (substrate) Rifampin (inducer) Midazolam (substrate) Phenobarbital (inducer) Warfarin (substrate) St. John's wart (inducer)
Is Maraviroc effective against CXCR4 virus entry?
No, only CCR5
Which of the NNRTIs are CYP3A4 inducers?
Nevirapine
Efavirenz
Which NRTI can cause renal toxicity?
Tenofovir (TFV)
