HIV Flashcards
Most common test used for established HIV infection
-HIV antibody test
Test used for HIV and indeterminate WB
-HIV 1 RNA
4th generation EIA test
-HIV p24 antigen
Who should be screened for HIV
- All patients ages 13 to 64 working in health care
- Pts seeking treatment for STDs
- Patients starting TB treatment
- Pregnant patients
How is HIV transmitted?
- Unprotected sex with an infected partner
- Sharing needles
- From infected mother to child
When is HIV not transmitted
-If patient’s viral load is undetectable
Why is adherence so poor in ART
- Complexity and pill burden
- Unstable housing
- Mental illness
- Lack of patient education
- Fear of adverse rxn
When to start ART
- All HIV infected individuals regardless of CD4 count
- Start therapy ASAP
- Pt should understand that treatment will be indefinite
When should you test for drug resistance?
-BEFORE initiation of ART
If HLA-B*5701 is positive then…
-Pt should NOT receive ABC
HAART guidelines initial regimen
-NRTI Background + Integrase inhibitor
Truvada
-Tenofovir DF + Emtricitabine
Descovy
-Tenovovir AF + Emtricitabine
Triumeq
- Abacavir
- Lamivudine
- Dolutegravir
INSTI Based initial regimens
- BIC/TAF/FTC
- DTG/ABC/3TC
- DTG + TDF/FTC or TAF/FTC
- RAL + TDF/FTC or TAF/FTC
What to use when ABC, TAF, TDF cannot be used
- DRV/r + RAL (if HIV < 100,000 copies/ml and CD4 200
- LPV/r + 3TC
Lab monitoring for Viral load
- HIV viral load 2 to 4 weeks after starting ART
- Repeat at 4 to 8 weeks until undetectable
- Goal is undetectable within 8 to 24 weeks
- Then monitor q3 to 4mo
Lab monitoring for CD4
- Should increase by 50 to 150 during 1st year of ART
- If CD4 is stable (300 to 500) after 2 yrs, measure annually
- CD4 > 500 monitoring = optional
Limitations/ restrictions for ABC/3TC
-Must be HLA-B*5701 negative
-Risk of possible CV events
-Possible inferior if HIV
> 100,000 copies
Pros of TAF/FTC
- Once daily dosing
- High virologic efficacy
- Active against HBV
- Approved for eGFR > 30mL/min
What drugs can you NOT use if CD4 < 200
- RPV based ART
- DRV/r + RAL
What drugs can you NOT use if HIV RNA > 100,000
- RPV based ART
- ABC/3TC + EFV or ATV/r
What drugs can you NOT use if HLA-B*5701 positive
- ABC
- Risk of hypersensitivity
What should you give if resistance is not know yet
- DRV/r or DRV/c + TAF/FTC
- DTG + TAF/FTC
If CKD use which meds
- TAF
- ABC
- LPV/r + 3TC
What drugs can you NOT use if pt has a psychiatric illness
-Avoid EFV and RPV
What drugs can you NOT use if pt has dementia
- Avoid EFV
- Use DRV or DTG based regimen
What drugs can you NOT use if pt is receiving methadone
- Avoid EFV based regimens
- EFV can increase methadone concentrations
Which drugs also have HBV coverage
-TDF or TAF
with
-FTC or 3TC
Adverse effects with NRTIs
- Lactic acidosis
- Lipodystrophy
Emtricitabine (FTC) and Lamivudine (3TC) adverse effects
- Minimal toxicity
- Hyper pigmentation (Emtricitabine)
- Can exacerbate HBV if discontinued
Zidovudine (ZVD) adverse rxn
- Headache
- Bone marrow suppression
- GI intolerance
- Lipoatrophy
Abacavir (ABC) adverse rxn
- Hypersensitivity
- Rash
- Increased risk of MI
TAF and TDF adverse rxns
- Renal impairment (TDF)
- Decreased bone marrow density (TDF)
- Headache
- GI
- TDF helps with lipid profile (GOOD)
Adverse effects of INSTIs
- Hypersensitivity
- Depression/ suicidal ideation
Dolutegravir (DTG) adverse rxn
- Headache
- Insomnia
Elvitegravir/Cobicistat (EVG/c) adverse rxn
- Decreased CrCl
- Nausea/Diarrhea
Raltegravir (RAL) adverse rxn
- Nausea
- Headache
- Diarrhea
- CPK elevation
- Rhabdomyolysis
