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HIV (last infection disease section) Flashcards

1
Q

OraQuick

A

in-home HIV test, OTC
use after 3 months of exposure… minimum

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2
Q

stage 1: bindin/attachment

A

HIV attaches to a CD4 receptor and CCR5 and/or CXCR4.

CCR5 antagonist: Maraviroc
attachment inhibitor: fostemsavir
post-attachment inhibitor:
ibalizumab-uiyk

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3
Q

stage 2: fusion

A

HIV viral envelope fuses with he CD4 cell membrane. HIV enters the host cell and releases HIV RNA, viral proteins and enzyme needed for replication

Fusion inhibitor: enfuvirtide

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4
Q

stage 3: Reverse Transcription

A

HIV RNA is conveted to the HIV DNA by reverse transcriptase.. HIV DNA can enter the CD4 cell nucleus

nucleoside reverse transcriptase inhibitors (NRTIs): emtricitabine, tenofovir, etc.

non-nucleoside reverse transcriptase inhibitors (NNRTIs): efavirenz, rilpivirine, etc.

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5
Q

stage 4: integration

A

once inside the CD4 cell nucleus integrase is released and used to insert HIV DNA into the host cell DNA

integrase strand transfer inhibitors (INSTIs): bictegravir, dolutegravir, raltegravir

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6
Q

stage 5: replication

A

host ell machinery is used to transcribe and translate HIV DNA into HIV RNA

no med

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7
Q

stage 6: assembly

A

New HIV RNA assembled into a immature HIV

no med

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8
Q

Stage 7: budding and maturation

A

immature HIV pushes out of the CD4 and protease breaks up the long viral protein chain creating mature virus that can infect other cells

protease inhibitors: atazanavir, darunavir

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9
Q

Biktarvy

A

Bictegravir/ Emtricitabine/ Tenofovir alafenamide

one pill daily

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10
Q

Triumeq

A

Dolutegravir/ Abacavir/ Lamivudine

one pill daily

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11
Q

Dovato

A

Dolutegravir/ Lamivudine

one pill daily

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12
Q

Tivicay +
Truvada

A

Dolutegravir +
Emtricitabine/ Tenofovir disoproxil fumarate

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13
Q

Tivicay +
Descovy

A

Dolutegravir +
Emtricitabine/ Tenofovir alafenamide

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14
Q

Most preferred regiments contain

A

2 NRTIs 1 INSTI

Truvada or Descovy make up the NRTI backbone in most regiments

Lamivudine and emtricitabine are interchangeable but should not be used together

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15
Q

Davato (1 NRTI and 1 INSTI)

A

an exception to above
- do not use in tx naive pt if HIV RNA >500,000 copies/ml,
- there is a known hep B co-infection (or status unknown)
- or HIV genotypic test is not yet available

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16
Q

Trimeq contains abacavir

A

extra testing is required

test for HLA-B*5701 allele before using. A positive result indicates a higher risk for a severe hypersensitivity reaction (HSR) and any abacavir- containing product is contraindicted

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17
Q

Fixed- dose

A

combo have less flexibility with renal dosing
Biktarvy, triumeq, dovato, truvada, descovy: do not use if CrCl <30 ml/min

except for biktarvy, individuals components of these drugs can be given separately to allow for more flexible renal dose adjustment

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18
Q

Alternative ART regiments

A

one “base” plus two NRTs to serve as the “backbone”
the “base” can be, PI, an NNRTI, or an INSTI

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19
Q

Alternative ART regiment
PI-based (boosted w/cobicistat or ritonavir)

A

Darunavir or atazanavir

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20
Q

Alternative ART regiments
NNRTI-based

A

Efavirenz or rilpivirine

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21
Q

Alternative ART regiments
INSTI-based

A

Elvitegravir (only available in combo products)
Raltegravir

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22
Q

Alternative ART regiments
NRTI backbone?

A

TDF or TAF or abacavir PLUS
Emtricitabine or lamivudine

TDF= tenofovir disoproxil fumarate
TAF= tenofovir alafenamide

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23
Q

Alternative ART regiments
complete regimen examples

A

Rilpivirine + TDF + emtricitabine
Raltegravir + TAF + emtricitabine

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24
Q

abacavir

A

ziagen
screen for HLA-B*5701
pt must carry med card for HSR
never rechallenge pt w/ history of HSR
consider avoid in CVD pt due to increased risk of MI
all NRTIs except abacavir require renal dose adjustment
- NRTIs

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25
Emtricitabine
Emtriva hyperpigmentation of the palms of the hands and soles of the feet - NRTIs
26
Lamivudine
Epivir - NRTIs
27
Tenofovir alafenamide
TAF only in combo products for HIV; Vemlidy is a single-entity product for HBV renal impairment, dose adjust with other renal toxic drugs, can decrease bone mineral density consider calcium/vitamin D supplement and DEXA scan if at risk monitor lipid if switching from TDF to TAF - NRTIs
28
Zidovudine
Retrovir hematologic toxic: neutropenia and anemia (increased MCV is a sign of adherence) myopathy SE - NRTIs
29
NRTIs general info
warning: lactic acidosis and hepatomegaly with steatosis (fatty liver) SE: nausea, diarrhea, headache, increased LFTs Severe acute HBV exacerbation can occur if emtricitabine, lamivudine, or tenofovir-containing products are D/C (some NRTs tx HBV) do now use epivir-HBV to tx HIV (low dose of lamivudine)
30
Bictegravir
only in combo with Biktarvy renal <30 ml/min do not start Biktarvy or Genvoya increases SCr - INSTIs
31
Dolutegravir
Tivicay increases SCr hypersensitivity reaction (HSR) w/ severe rash and organ dysfunction, including hepatotoxicity small risk of neural tube defects in developing fetus (still preferred drug for HIV tx during prego) increased CPK and myalgia - INSTIs
32
Elvitegravir
only in combo, Genvoya and Stribild CrCl< 70ml/min do not start Stribild CrCl<50ml/min d/c Stribild proteinuria - INSTIs
33
Raltegravir
Isentress, Isentress HD increased CPK, myopathy, and rhabdo - INSTIs
34
All - INSTIs general
headache, insomnia, diarrhea, weight gain, rare risk of depression, and suicidal ideation in pt with pre-existing psychiatric condition (except bictegravir) Take INSTIs 2hrs before or 6hrs after: aluminum, calcium, mag, or iron-containing products Dolutegravir and bictegravir can be taken with oral calcium or iron if taken w/food dose separation with raltegravir may not be effective, avoid polyvalent cations if possible
35
Efavirenz
Sustiva - psychiatric symptoms (depression, suicidal thoughts) - CNS effects (impaired concentration, abnormal dreams, confusion), generally resolve in 2-4 weeks - increases total cholesterol and triglycerides -NNRTIs
36
Rilpivirine
Edurant - depression - increased SCr w/ no effect on GFR - do not use if viral load >100,000 copies/ml and/or CD4 count <200 cells (higher failure rate) DO NOT USE WITH PPIs Separate H2RAs at least 12hrs before or 4hrs after rilpivirine -NNRTIs
37
Doravirine Etravirine Nevirapine
Pifeltro Intelence Viramune XR -NNRTIs
38
NNRTIs general
hepatotoxicity and rash/severe rash, including SJS/TEN: highest risk with nevirapine all NNRTIs major cyp3A4 substrate Rilpivirine and doravirine: do not use with strong cyp3A4 inducer (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifapentine, st. john's wort)
38
Doravirine Etravirine Nevirapine
Pifeltro Intelence Viramune XR NNRTI
39
Atazanavir
Reyataz hyperbilirubinemia (bananavir) requires acid for absorption - antacids 2hrs before or 1hr after - H2RAs avoid or 2hrs before or 10 hrs after - PPIs avoid with unboosted atazanavir, take boosted at least 12hrs after (do not exceed 20mg of omeprazole or equivalent) - PIs
40
Darunavir
Prezista sulfa allergy - PIs
41
Fosamprenavir
Lexiva sulfa allergy - PIs
42
Lopinavir/ritonavir
Kaletra ritonavir is a booster oral solution contains 42% alcohol: can cause disulfiram reaction if taken with metronidazole - PIs
43
Saquinavir
Invirase - PIs
44
Tipranavir
Aptivus sulfa allergy intracranial hemorrhage - PIs
45
PIs general
decrease HDL, increase LDL and TG increase CVD hepatic dysfunction hypersensitivity reaction (SJS/TENS) increase BG insulin resistance abdominal adiposity
46
PIs CYP
cyp3A4 do not use with: - alfuzosin - colchicine - dronedarone - lova and simva (rosuva and atorva preffered) - inducers (carbamazepine, phenytoin, rifampin, st. john's wort - direct-acting antivirals for hep C - hormonal contraceptives - steroids
47
ritonavir
Norvir with food, oral solution contains 43% alcohol strong inhibitor of cyp3A4, cyp2D6, some OAT family and P-gp transporter - boosters
48
cobicistat
tybost with food strong inhibitor of cyp3A4, cyp2D6, some OAT family and P-gp transporter - boosters
49
Maraviroc
Selzentry CCR5 antagonist - Entry and attachment inhibitor
50
Fostemsavir
Rukovia attachment inhibitor - entry and attachment inhibitor
51
ibalizumab-uiyk
trogarzo- IV post-attachment inhibitor - entry and attachment inhibitor
52
Enfuvirtide
Fuzeion fusion inhibitor - entry and attachment inhibitor
53
bictegravir/ emtricitabine/ tenofovir alafenamide
biktarvy - INSTI- based
54
Dolutegravir/ abacavir/ lamivudine
Triumeq - INSTI- based
55
Dolutegravir/ lamivudine
Dovato - INSTI- based
56
Elvitegravir/ clobistat/ emtricitabine/ tenofovir disoproxil fumarate
Stribild - INSTI- based
57
Elvitegravir/ cobicistat/ emtricitabine/ tenofovir alafenamide
Genvoya - INSTI- based
58
Efavirenz/ emtricitabine/ tenofivr disoproxil fumarate
Atripla - NNRTI- based
59
Rilpivirine/ emtricitabine/ tenofovir disoproxil fumarate
Complera - NNRTI- based
60
Rilpivirine/ emtricitabine/ tenofovir alafenamide
Odefsey
61
Abacavir/ lamivudine
Epzicom - NRTI combo
62
Emtricitabine/ tenofovir alafenamide
Descovy - NRTI combo
63
Emtricitabine/ tenofovir disoproxil fumarate
Truvada - NRTI combo
64
Prego NRTI combo
- abacavir/ lamivudine - Tenofovir disoproxil fumarate/ emtricitabine - tenofovir disoproxil fumarate/ lamivudine
65
prego INSTI
- raltegravir - Dolutegravir
66
Boosted PI
- atazanavir+ ritonavir - Darunavir + ritonavir
67
PrEP
before high-risk activity 1 oral drug taken daily, truvada or descovy
68
PEP
after HIV- exposure within 72 hrs taken for 28 days Truvada (if CrCL >60) + Dolutegravir (Tivicay) or Raltegravir (Isentress)
69
prego and HIV
zidovudine to prevent HIV transmission to infant - NRTI

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