HIV Part 3 Flashcards
What are the 2 drugs in the version of PrEP that is generic and covered by public health (not the new version recently approved in 2020).
TDF 300 mg (Tenofovir disoproxil
fumarate) + FTC 200 mg (Emtricitabine)
new version: (TAF/FTC approved Dec 2020)
How is PrEP dosed?
Dose: 1 tablet daily (TDF/FTC) with or
without food
[alternative dosing strategy
“PrEP on demand”]
What is the CrCL threshold for PreP?
not recommended if crCL < 60 mL/min
IF HIV status is positive or unknwon, should you give PrEP?
no! PrEP not appropriate if unknown or
positive HIV status
how effecitve is prep if adhernet?
> 90%
What is the PrEP Eligibility criteria for:
1) MSM, Trans Women and Gender Diverse
People?
– Condomless anal sex within last 6 months and any
of:
* Infectious syphilis or bacterial STI in past 12 months
* nPEP (post exopsure porphylaxis) more than once
* Ongoing sexual relationship with HIV+ partner with
substantial risk of transmissable HIV (e.g. VL detectable
or HIV status unknown but from higher risk population –
MSM or PWID)
* HIRI-MSM risk score ≥ 11 (see resources)
According to the HIRI-MSM risk assessment toosl, what are the two HIGHEST RISK CATEGORIES?
young age and receptive anal sex in the last 6 months wihtout a condom.
What is the PrEP Eligibility criteria for:
2) Heterosexual persons?
For HIV negative partner in an ongoing
relationship with HIV positive partner involving
condomless vaginal/anal sex where HIV positive
partner has substantial risk of transmissible HIV
(e.g. VL> 40 copies/mL)
OR
HIV status unknown
but they’re from a higher risk population (e.g. MSM, PWID).
What is the PrEP Eligibility criteria for:
3) People who inject drugs
if they shareinjection drug use paraphernalia (e.g.,
needles, syringes, etc)
How does PrEP work?
it prevents HIV from continuing to infect immune cells and getting established early on (i.e. prevents seeding to rest of body).
How long does PREP take to establish protective levels of drug in rectal tissue? vaginal tissue?
– Rectal tissue – 7 days
– Vaginal tissue – 20 days
What are the things to ASSESS FOR ELIGIBILITY FOR PREP?
- Individual is HIV _______ but at ____ risk of _________
- No signs/symptoms of __________ in previous ______
- No documented ____________ to FTC/TDF
- what lab tests/screenings to order? (3)
- Individual is HIV negative (recent test) and is at high risk of acquiring HIV infection
- No signs/symptoms of acute HIV in previous month
- No documented contraindications to FTC/TDF
–> Other laboratory tests:
* Screening for HBV (vaccinate if susceptible), and HCV
* STI screening
* CBC, Scr, urinalysis at baselin
Can anyone prescribe prep?
no! Must be prescribed by a designated prescriber (AB).
How many days duration should the INITAL PRESCRIPTION OF PREP BE?
- for 30 days (NO automatic refills, cuz imp to get follow up blood work done***).
- If runs out of med, see when last had screening done, reach out to doc etc.
What are some counselling points for STARTING PREP?
1) Discuss can take 7 days (or 20 days) to reach ___________
2) Review ___________:
* Common ones?
* Other 2 imp ones?
3) Review if patient taking other drugs that may incr risk of ___ toxicity.
4) Reinforce/discuss strategies for ______.
1) Discuss can take 7 days (or 20 days) to reach protective concentrations
2) Review Adverse events:
* Common – headache, abdominal pain, flatulence
* Other – decreased renal function, decreased BMD
3) Review if patient taking other drugs that may increase risk of TDF renal toxicity
4) Reinforce/discuss strategies for adherence
How often should you be following up PREP pts?
at least q3 months.
–> (follow-up HIV & STI testing every 3 months)
You should Refill a prescription for PREP no more than ___ days
Refill prescription for no more than 90 days
–> Requests for refill extension – discuss with designated prescriber (case by case basis)
What should PREP pts of childbearing potential be continually monitored/tested for?
should have regular pregnancy tests.
What is Post-Exposure Porphylaxis (PEP)?
– Combination antiretroviral therapy (cART) given to someone who may have been exposed to HIV –> usually 2- or 3-drug regimens used to prevent acquisition of HIV infection.
How soon should PEP/cART be given from time of exposure?
ASAP, and within 72 hrs. beyond that, useless and must refer to ED.
What is the preferred regimen for PEP?
- what is the “3rd drug”?
- duration?
-Truvada (tenofovir/emtricitabine) 1 tab daily.
- 3rd drug: Raltegravir 400 mg BID OR Dolutegravir 50 mg daily.
> Duration: x 28 days.
Are occupational and non-occupational HIV exposures covered?
yes. In Alberta, occupational exposures covered by employer (e.g.AHS) and non-occupational exposures covered by Alberta Health
What is the rate of perinatal HIV transmission w/o trx?
25%
80% of perinatal hiv transmission occurs at what point durign prengnacy?
just before or DURING delivery (cuz exchange of blood).
Acquiring HIV when is asociated with the HIGHEST RISK for in-utero transmission?
Acquiring HIV DURING pregnancy is asociated with the HIGHEST RISK for in-utero transmission.
What is the risk of hiv transmission from breastfeeding in untreated mothers?
0.5%.
what is risk of perinatal transmission in ART treated women?
close to 0 if can get VL < 50.
Are Antivirals safe in pregnancy?
yesss
PREVENTING PERINATAL HIV:
- HOw should pregnant women be treated:
- before delivery?
- during Labor nad Delivery?
–> only when should you consider C section? - after delivery?
- What is the baby’s prophylaxis regimen?
- should baby be breastfed?
PREVENTING PERINATAL HIV:
- Pregnant Person:
– Testing (opt-out; rapid HIV testing at delivery where
appropriate)
– BEFORE DELIVERY: should be on Antiretrovirals (ARVs) during pregnancy
(ideally before pregnancy).–> Goal: suppressed viral load.
– DURING L & D: During labour, give IV zidovudine + continue oral ARVs for the mother.
- Consider C-section ONLY if VL> 1000 copies/mL close to delivery.
– AFTER DELIVERY: Mother should Continue ARVs
- Baby:
– shoudl be started on ARV prophylaxis: oral zidovudine x 4-6 wks (start within 6 hours)
– should be FORMULA FED (cuz- risk of
transmission via breastfeeindg < 1% but not zero)
What is the preferred AV drugs in pregnancy (if not previously on trx)?
- what are the 2 options for the third drug?
Preferred Dual NRTI backbone:
▪ Abacavir/lamivudine
▪ Tenofovir DF + emtricitabine or lamivudine
▪ Tenofovir alafenamide/emtricitabine
3rd drug:
▪ INSTI – dolutegravir
▪ PI –darunavir/ritonavir
