HIV medications Flashcards
INSTIs
-Bictegravir
-Daltegravir
-Raltegravir
Which INSTI are preferred in pregnancy?
Daltegravir
Raltegravir
Which NRTI requires testing?
Abacavir (ABC) for HLA-B*5701
What DDIs occur with Inetgarse Inhibitors
-PPIs (Omeprazole & Pantopraxole)
-Cation Antacids (Al, Mg, Ca)
Side effects of Integrase Inhibitors?
GI disturbances
CNS disturbances
Weight gain
Rash (rare)
False creatinine elevation
Which integrase inhibitor(s) have low resistance barrier?
Raltegravir
Which integrase inhibitor(s) are in single-tab regimens?
- Bictegravir
- Daltegravir
NRTIs in Pregnancy
-Emtricitabine (FTC)
-Tenofovir alafenamide (TDF)
-Lamivudine (3TC)
Pregnancy to Potential Pregnancy ART Regimen?
NRTI Backbone + INSTI
OR
NRTI Backbone + Boosted PI
True or False. There are increased clinical outcomes with rapid ART initiation.
True
Single Tablet regimen
INSTI + single NRTI
DTG/3TC
DTG/3TC caveat?
Do not use if HIV1-RNA (viral load) is >500,000
single tablet regimen
INSTI + dual NRTI
DTG/3TC/ABC
DTG/3TC/ABC caveat?
Use only if HLA-B*5701 test is negative
single tablet regimen
NNRTI + single NRTI
RPV/FTC/(TAF or TDF)
RPV/FTC/(TAF or TDF) caveat
Only use if HIV1-RNA (viral load) is <100,000 and CD4 >200 cells
Support for TDF?
generic NRTI combo with 3TC and FTC
Support for TAF?
less impact on markers of renal tubular dysfunction
Support for ABC
Long history and is not renally cleared but requires HLA Testing (grade 1 - 5 threatening rxn)
Entry Inhibitors
-Enfuviritide
-Maraviroc
-Ibalizumab
Use of Entry Inhibitors?
Mainly used in heavily treatment-experienced patients
When to consider Boosted PIs
Starting ART before availability of resistance data
Challenges with Boosted PI use
-DDIs (CYP3A)
-GI Intolerances
-Hyperlipidemia
-Cv risk with some
Striblid or Genvoya
-Elvitegravir
-Cobicistat
-Emtricitabine
-Tenofovir
Striblid or Genvoya. Low fat meal or high fat meal?
High fat meal
Striblid or Genvoya CrCl
> 70 at baseline and not <50
***Slight increase in SCr during therapy
True or False. Oral ART and Long-Acting ART have similar efficacy
True
***Long-Acting - once a month
Striblid or Genvoya Extensive DDIs
-Inhibits 3A, 2D6, pGp
-Induces 2C9
NNRTIs
EFV
RPV
DOR
Primary goals of HIV Treatment
Maximal and durable viral suppression
Restoration and preservation of immune function (CD4 count)
Improved QOL
Reduced HIV-related opportunistic infections
Reduced morbidity and mortality
Recommended regimen for first-line ART
BTC/FTC/TAF
DTG/ABC/3TC
***INSTI + 2NRTIs
