HIV

Question 1

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) MOA:

Answer 1

Competitively bind to the the enzyme reverse transcriptase —> block HIV viral RNA-dependent DNA polymerase —> DNA chain termination —> stops further viral DNA synthesis.

Question 2

Abacavir /ABC (Ziagen): renal adjustment required?

Answer 2

No

This is the only NRTI in which no renal adjustment is needed; all other NRTIs require renal adjustment.

Question 3

What is the dose of abacavir/ABC (Ziagen)?

Answer 3

Tablet: 300 mg BID or 600 mg QD

Oral soln: 20mg/mL

Question 4

BW for Abacavir/ABC (Ziagen) consist of?

Answer 4

Screen for HLA-B* 5701 allele before starting - if positive, use is CI due to increase risk of hypersensitivity rxns. Do not re-challenge.

Serious, sometimes fatal, hypersensitivity rxns - fever, rash, fatigue, malaise, GI + respiratory sxs; DC use and do not trial even if HLA-B*5701 is negative.

Question 5

CI to abacavir /ABC (Ziagen):

Answer 5

Previous hypersensitivity to abacavir

Moderate - severe hepatic impairment

Question 6

What warnings does abacavir/ABC (Ziagen) carry?

Answer 6

Caution in CVD due to increase risk of MI

Question 7

SEs of abacavir/ABC (Ziagen) include:

Answer 7

N/V
HA
Rash
Increase LFTs
Hyperlipidemia

Question 8

Monitor for abacavir/ABC (Ziagen):

Answer 8

LFTs

S/sx of hypersensitivity

Question 9

Pearls for abacavir/ABC (Ziagen):

Answer 9

Caution with alcohol (increase abacavir AUC)

ABC/3TC + efavirenz or atazanavir + ritonavir should not be used in patients with pre-treatment HIV VL> 100,000 copies/mL

Question 10

Lamivudine/3TC (Epivir) dosing:

Answer 10

Tablet: 150 mg BID or 300 mg QD

Oral soln: 10 mg/mL

CrCl < 50 ml/min: decrease dose

Question 11

BW for lamivudine/3TC (Epivir) consist of:

Answer 11

Do not use Epivir-HBV for treatment of HIV (contains lower dose of lamivudine); can result in HIV resistance.

Severe acute exacerbation of hep B (HBV) can occur when drug is discontinued in patients with HBV infection.

Question 12

SEs of lamivudine/3TC (Epivir) are:

Answer 12

HA
N/V/D
Fatigue
Insomnia
Myalgias
Increase LFTs

Question 13

Monitor_____ in lamivudine/3TC (Epivir):

Answer 13

LFTs
Renal fxn
HBV status prior

Question 14

Pearls for lamivudine/3TC (Epivir) are:

Answer 14

Avoid combining with FTC; both are cytosine analogs

Has activity against HBV. In HIV/HBC co-infection, must dose 3TC at higher, HIV treatment dose; use correct dosage strength/product (Epivir is not equivalent to Epivir-HBV)

Question 15

Emtricitabine/FTC (Emtriva) dosing:

Answer 15

Capsule: 200 mg QD

Oral soln: 240 mg QD - refrigerate

CrCl < 50: decrease dose or frequency

Question 16

Does emtricitabine/FTC (Emtriva) need to be administer with food?

Answer 16

Can be taken without regards to food.

Question 17

BW for emtricitabine/FTC (Emtriva):

Answer 17

Severe acute exacerbation of hep B can occur when drug is discontinued in patients with HBV infection.

Question 18

SEs of emtricitabine/FTC (Emtriva) are:

Answer 18

N/V/D
Rash
Dizziness
HA
Insomnia
Hyperpigmentation (palms +/- sole, ,mainly in kids)
Increase CPK, LFTs

Question 19

Monitoring for emtricitabine/FTC (Emtriva) consist of:

Answer 19

LFTs
Renal function
HBV status prior

Question 20

Pearls for emtricitabine/FTC (Emtriva):

Answer 20

Avoid combining with 3TC since they are the same analog (cytosine)

Capsule and soln are not bioequivalent

Truvada, Atripla, Complera, Stribild, Descovy, Odefsey, Genvoya: keep in original container (contains desiccant to protect from moisture.

Question 21

Tenofovir disoproxil fumarate/TDF (Viread) dosing:

Answer 21

Tablet: 300 mg QD

Oral powder: 40 mg/g

CrCl < 50: decrease frequency

Question 22

Tenofovir alafenamide (TAF) dosing (only comes in combination products):

Answer 22

Descovy and Odefsey: 25 mg

Genvoya: 10 mg