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PHRM 865 > HIV and AIDS > Flashcards

HIV and AIDS Flashcards

1
Q

Binding site of HIV cells.

A

Gp120 binds to CD4 receptors on T cells, macrophages, and dendritic cells

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2
Q

What is the primary target cell of HIV?

A

CD4 T helper/inducer lymphocyte

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3
Q

What is the result of HIV binding to CD4 T helper/inducer lymphocytes?

A

Infected CD4 cells are impaired from normal functions, and used for viral replication

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4
Q

What happens to the CD4 T cells after use?

A

Ultimately destroyed by a cytolytic effect

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5
Q

What are the 3 routes of HIV transmission?

A
  1. Exposure of mucous membrane or damaged tissue to infected body fluids
  2. Bloodstream exposure to infected body fluids
  3. Mother-to-child
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6
Q

HIV is not found in which body fluids?

A

Urine, feces, sweat, and tears

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7
Q

What are the methods for HIV diagnosis?

A
  • 4th gen immunoassay for viral detection - 15 day window
  • NAT for viral detection - 10 day window
  • 3rd gen immunoassay for antibody detection - 20-30 day window
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8
Q

What is the process of diagnosing HIV?

A
  1. 4th gen test first
  2. If + result, do 3rd gen test
  3. Most common result is HIV1+
  4. If 3rd gen test comes back negative for HIV1/2 or indeterminate, do HIV1 NAT
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9
Q

Counseling for patients with reactive results after OTC OraQuick test.

A
  • This is a preliminary screen
  • Seek out medical provider for confirmatory testing
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10
Q

Counseling for patients with non-reactive results after OTC OraQuick test.

A
  • Counsel on seroconversion window (3 months for OraQuick)
  • Repeat test if risk event occurred within window period
  • Methods of risk reduction and prevention
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11
Q

What are the 2 important HIV surrogate markers?

A
  • CD4 T lymphocyte cell count
  • HIV RNA PCR (viral load)
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12
Q

What is important about CD4 T lymphocyte cell count?

A
  • Primary marker of immunocompetence
  • Most useful before initiation of therapy
  • Lower levels = more compromised immune system
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13
Q

What is important about HIV RNA PCR?

A
  • Used to assess effectiveness of therapy
  • Most useful after initiation of therapy
  • Higher baseline levels are predictive of faster disease progression
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14
Q

What is the difference between HIV and AIDS?

A

AIDS is HIV stage 3
- CD4 count: <200 or OI diagnosis
- CD4 %: <14

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15
Q

What are the names of NRTIs?

A
  • Abacavir (G)
  • Emtricitabine (C)
  • Lamivudine (C)
  • TDF, TAF (A)
  • Zidovudine (T)
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16
Q

What is the MoA of NRTI class?

A
  • Synthetic purine and pyrimidine analogues
  • Causes elongation termination of growing proviral DNA chain
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17
Q

What are the class AEs of NRTIs?

A

Mitochondrial toxicity, lactic acidosis

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18
Q

AEs of abacavir?

A

Hypersensitivity reaction

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19
Q

What lab test must be completed before initiating abacavir?

A

HLA-B5701 test to prevent hypersensitivity reactions

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20
Q

AEs of TDF?

A

Renal insufficiency, osteomalacia

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21
Q

AEs of Zidovudine?

A

Bone marrow suppression

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22
Q

Do NRTIs require dosage adjustment?

A

Yes, in renal insufficiency (except abacavir)

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23
Q

What are the names of the NNRTIs?

A

The “-vir-“

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24
Q

What is the MoA of NNRTI class?

A

Binds to allosteric site of RT enzyme, reducing functionality

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25
What is the class AE of NNRTI?
Rash
26
AE of efavirenz?
CNS effects (i.e. abnormal dreams, suicidiality)
27
What is the special administration requirement of efavirenz?
Take on empty stomach at bedtime
28
What is the special administration requirement of nevirapine?
Titrate dose over 14 days
29
What is the special administration requirement of etravirine?
Take with food
30
What is the special administration requirement of rilpirivine?
Take with meal (not protein drink)
31
Do NNRTIs require dosage adjustment?
In patients with hepatic impairment
32
What is the precaution associated with the NNRTI class?
High level resistance develops easily and quickly (esp. nevirapine and efavirenz)
33
What are the names of the PI class?
The "-navir"
34
What is the MoA of PI class?
Inhibits viral protease action preventing assembly, maturation, and release of new virions
35
What are the class AEs of the PI class?
GI intolerance, insulin resistance, lipodystrophy
36
AE of atazanavir?
Indirect hyperbilirubinemia
37
AE of ritonavir?
NVD
38
Do PIs require dosage adjustment?
Many not recommended in severe hepatic impairment
39
What is the special administration requirement of atazanavir?
Take with food
40
What is PI boosting?
Using strong CYP3A4 inhibitors cobicistat or ritonavir to increase PI serum concentration
41
AE of cobicistat.
Increased serum creatinine
42
What is the MoA of INSTIs?
Inhibits HIV integrase, preventing proviral DNA integration into host cell genome
43
What are the names of the INSTI class?
"-tegravir"
44
What is the primary AE of the INSTI class?
Weight gain
45
What is the special administration requirement of elvitegravir?
Take with food
46
What is the special administration requirement of cabotegravir?
Lead-in for ≥28 days
47
What are the FDA approved dosages of dolutegravir?
- 50mg daily if INSTI naive - 50mg BID if co-admin. w/ UGT1A/CYP3A inducers such as efavirenz, fosamprenavir/ritonavir, tipranavir/ritonavir, or rifampin
48
What is MoA of attachment inhibitors?
- Fostemsavir is prodrug of temsavir - Temsavir binds to gp120, blocking attachment to CD4 Tcell co-receptor
49
What is the CI of attachment inhibitors?
CI w/ strong CYP3A4 inducers
50
What is the MoA of post-attachment inhibitor?
Binds to domain D2 of CD4 Tcell co-receptor and interrupts post-attachment steps required for HIV entry into cell
51
What is the drug name in the post-attachment inhibitor class?
Ibalizumab
52
What is the special administration requirement of ibalizumab?
Given IV
53
What is the MoA of the chemokine coreceptor 5 (CCR5) antagonist class?
Binds to CCR5 on CD4 cell surface, blocks binding of gp120 and prevents HIV entry into cell
54
What is the drug name in the CCR5 antagonist class?
Maraviroc
55
What lab test must be completed prior to usage of maraviroc?
A tropism assay
56
What is the MoA of the capsid inhibitor class?
- Binds to interface between p24 subunits - Interferes w/ proviral DNA uptake, virus assembly and release, capsid core formation
57
What is the drug name in the capsid inhibitor class?
Lenacapavir
58
What is the special administration requirement for lenacapavir?
Given subq
59
What is the website that houses federally approved HIV/AIDS guidelines?
Clinicalinfo.HIV.gov
60
What are the goals of AR therapy?
1. Maximally and durably suppress HIV RNA below detection (<20-30 copies/assay) 2. Restore and preserve immunologic function 3. Reduce HIV-associated morbidity and prolong the duration and quality of survival 4. Prevent transmission
61
Who is ART recommended to?
All HIV-infected persons, regardless of CD4 count
62
When should ART be initiated?
ASAP after diagnosis Exceptions: cryptococcus and TB meningitis, pregnancy, acute or recent HIV infection
63
What are the recommended initial regimens for most people with HIV with no history of cabotegravir use for HIV prevention?
INSTI + 2 NRTIs: - Biktarvy (bictegravir/TAF/emtricitabine) - Dolutegravir + TAF or TDF + emtricitabine or lamivudine INSTI + 1 NRTI: - Dolutegravir/lamivudine (Dovato)
64
What is the brand name for TDF/emtricitabine?
Truvada
65
What are the brand names for TDF/lamivudine?
Cimduo, Temixys
66
What is the brand name for TAF/emtricitabine?
Descovy
67
When do you NOT use dolutegravir/lamivudine (Dovato)?
- HIV RNA >500,000, - HBV co-infection, or - ART is to be started before HIV genotype resistance or HBV testing results available
68
What is the recommended initial regimen for HIV patients that have used cabotegravir?
PI based regimen: - (Darunavir/cobicistat* or darunavir + ritonavir) + (TAF or TDF)+ (emtricitabine or lamuvidine)** * Prezcobix ** Darunavir/cobicistat/emtricitabine/TAF is Symtuza
69
What are the recommendations due to drug interactions between antiretrovirals and acid reducers?
- Separate antacids from PO INSTI for 6hrs - Never give rategravir w/ Al or Mg - Atazanavir and PO rilpivirine are reduced by acid reducers - Rilpivirine is CI'd w/ PPIs
70
What are the recommendations due to drug interactions between antiretrovirals and benzodiazepines?
W/ PIs and cobicistat, preferred benzos are lorazepam, oxazepam, temazepam (acronym LOT)
71
What are the recommendations due to drug interactions between antiretrovirals and corticosteroids?
W/ PIs and cobicistat, beclomethasone is preferred
72
What are the recommendations due to drug interactions between antiretrovirals and statins?
- W/ PIs and cobicistat, low doses of atorvastatin, rosuvastatin, pitavastatin, or pravastatin preferred - W/ NNRTIs, dose may need increase
73
What are the recommendations due to drug interactions between antiretrovirals and PDE5 inhibitors?
W/ PIs and cobicistat, use very low doses q48-72hrs
74
What are the recommendations due to drug interactions between antiretrovirals and polyvalent cation supplements?
- Space apart by 6hrs with INSTIs - Co-admin. of Ca/Fe w/ dolutegravir or bictegravir is OK if also taken w/ food
75
What is the genetic barrier to resistance of boosted PIs?
Very high; requires 3-4 mutations
76
What is the genetic barrier to resistance of NNRTIs?
Lowest out of all classes; requires 1-2 mutations
77
When is obtaining a resistance test necessary?
- At entry to care - Virologic failure or suboptimal viral response
78
What type of resistance test is necessary if patient is failing 1st or 2nd regimen?
Genotype
79
What type of resistance test is necessary if patient is failing INSTI-based regimen?
Sequence integrase
80
What is the viral load that has the best likelihood of yielding a successful standard resistance test result?
>500 copies/mL
81
What are the CIs for PrEP?
- HIV infection - <77 kg - <60 ml/min for TDF/FTC - <30 ml/min for TAF/FTC - Possible HIV exposure in past 72 hrs (use PEP)
82
PrEP regimens that are oral daily.
- Emtricitabine/TDF 200/300mg PO daily for all risk groups - Emtricitabine/TAF 200/25mg PO daily for men and transgender women who have sex with men
83
PrEP regimen that is oral on demand.
Not FDA approved Emtricitabine/TDF 200/300mg PO for men who have sex with men - 2 tab 2-24hrs prior to sex - 1 tab 24 hours after first 2 tabs - 1 tab 48 hrs after first 2 tabs - 1 tab daily until 48 hours since encounter
84
PrEP regimen that is injection.
Cabotegravir 600mg IM - Initial dose, then - 2nd dose 1 month after 1st dose, then - Every 2months thereafer
85
Lab screening prior to PrEP initiation.
All: - HIV test within 1 wk of starting PrEP - HIV RNA - STI testing If oral PrEP: - Cr, HBV - For TAF/FTC - cholesterol, TGs
86
Monitoring for oral PrEP.
- 1 month, then q3 months: HIV Ag/Ab, HIV RNA, STIs, pregnancy test - q6 months: CrCl for age ≥50 or eCrCl <90 - q12 months: cholesterol, TGs, HCV Ab
87
Monitoring for injection PrEP.
- 1 month: HIV RNA - q2 months: HIV RNA, HIV Ag/Ab - q4 months: HIV RNA, STI testing
88
What is the PEP regimen?
Emtricitabine/TDF 200/300mg PO daily for 28 days + (Raltegravir 400mg PO BID for 28 days or Dolutegravir 50mg PO daily for 28 days)
89
Testing/monitoring timeline for PEP.
- Rapid testing at baseline: if HIV+, start ART, not PEP - Repeat testing at 4-6 wks and at 3 months (use 4th gen assay)
90
What are counseling points for PEP?
- Use precautions, esp. during first 6-12 wks - Possible drug toxicities - Adherence importance - Undergo eval for PrEP if at ongoing risk

PHRM 865 (11 decks)

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