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840 > HIV Part II > Flashcards

HIV Part II Flashcards

1
Q

All NRTI AE

A
  • Lactic acidosis
  • Hepatic steatosis
  • Lipodystrophy (fat breakdown)
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2
Q

Zidovudine (ZDV) AE

A
  • Headache
  • Bone marrow suppression
  • GI intolerance
  • Lipoatrophy

Can still be used in preggo (Delivery) and kids

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3
Q

ABC AE

A
  • Hypersensitivity (HLA-B*5701)
  • Rash
  • Possible increased risk of MI
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4
Q

TAF/TDF AE

A
  • Renal impairment (TDF> TAF)
  • Decreased BMD (TDF > TAF)
  • Headache (most common)
  • GI intolerance
  • TAF has no lipid benefits
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5
Q

All INSTI AE

A
  • Rash, hypersensitivity
  • Depression and suicidal ideation

Both VERY rare

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6
Q

Dolutegravir AE

A
  • Headache (lasts about a week)

- Insomnia** (take in morning)

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7
Q

Elvitegravir (EVG/c) AE

A
  • Decreased CrCl
  • Increased risk of TDF-related nephrotoxicity when combined
  • Nausea, diarrhea
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8
Q

Raltegravir AE

A
  • Nausea
  • Headache
  • Diarrhea
  • CPK elevation, myopathy, rhabdomyolysis
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9
Q

ALL PI AE

A
  • Hyperlipidemia
  • Lipodystrophy
  • Hepatotoxicity
  • GI intolerance
  • Possible bleeding risk in hemophiliacs
  • DDI (all PI due to boosters)

More common with older PIs

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10
Q

Atazanavir (ATV) AE

A
  • Hyperbilirubinemia
  • PR Prolongation
  • Nephrolithiasis, cholelithiasis
  • Less likely to cause lipid abnormalities
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11
Q

Darunavir (DRV) AE

A
  • Rash

- Liver Toxicity

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12
Q

Ritonavir AE

A
  • GI intolerance
  • Hyperlipidemia
  • Hyperglycemia
  • Hepatitis
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13
Q

Cobicistat AE

A
  • GI intolerance

- Increased SCr

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14
Q

All NNRTI AE

A
  • Rash (including SJS)
  • Hepatotoxicity (especially with NPV, only used in kids with possible HIV at birth)
  • DDI
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15
Q

EFV AE

A
  • Neuropsychiatric
  • Teratogenic + cases of neural tube defects in human infants (category D)
  • Dyslipidemia
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16
Q

Etravirine (ETR) AE

17
Q

Rilpivirine (RPV) AE

A
  • Depression

- Insomnia

18
Q

Maraviroc AE

A
  • DDI
  • Rash
  • Abdominal pain
  • Upper respiratory tract infection
  • Cough
  • Hepatotoxicity
  • Musculoskeletal symptoms
  • Orthostatic hypotension, esp in renally compromised

(Not HIV specific so large amount of SE)

19
Q

Enfuvirtide AE

A
  • Injection site reactions
  • Hypersensitivity reactions
  • Increased risk of bacterial pneumonia
20
Q

Atazanavir + Acid Requirement

A
  • Separate by 2 hours from antacids
  • Take 2 hours before or 10 hours after H2RAs
  • Don’t use with PPIs, can separate by 12 hours if absolutely needed
21
Q

Rilpivirine + Acid Requirement

A
  • CI with PPI

- Separate H2RAs by 12 hours

22
Q

Lipid Agents + HIV Drugs

A
  • Simvastatin and Lovastatin are CI with PIs or delavirdine
  • Pravastatin and fluvastatin and least likely to interact with ARVs
  • Use atorvastatin at low doses with caution (never go to 80 mg)
  • Rosuvastatin should be started at low doses and increased slowly as drug interactions with PIs are documented
23
Q

Antifungals + HIV Drugs

A
  • Ketoconazole and EFV use is CI
  • Decrease doses of EFV and voriconazole if used together
  • Fluconazole can increase doses of some drugs (ETR, NVP, RPV, and ZDV), monitor while given but adjustment not needed
  • Increase caspofungin with certain HIV drugs
24
Q

Corticosteroids + HIV Drugs

A
  • PK boosters increase levels of steroids and leads to Cushing’s Syndrome
  • Beclomethasone is the only exception
  • NNRTIs can decrease many [steroid]
  • Dexamethasone can decrease concentrations of many HIV meds like NNRTIs, PIs, and cobi-based regimens. CI with rilpivirine
25
Q

M184V Mutation

A
  • Most common NRTI mutation
  • High-level in vitro resistance to 3TC/FTC but not CI
  • Mutation increases TDF, AZT, and d4T susceptibility and decreases viral replication fitness
26
Q

K103N Mutation

A
  • Common NNRTI mutation
  • Resistance to EFV, NVP
  • Most spread from person to person
27
Q

K65R Mutation

A
  • Major mutation to ABC and TDF resistance
  • DDI and decreased susceptibility to 3TC, FTC, and d4T
  • Can’t use a nucleotide backbone anymore
28
Q

HIV Transmission + Pregnancy

A
  • Most occurs close to or during delivery
  • 15-30% risk of transmission without treatment from mother to fetus
  • With ART, C-section, and formula feeding the risk drops to <1%
29
Q

HIV Regimen + Pregnancy

A
  • During pregnancy: ART
  • During labor: ART +/- IV ZDV (if VL > 1000, can consider 50-1000 too), begin when admitted or 3 hours before c-section
  • Post-partum Mothers: Continue ART
  • Newborn: PO ZDV
30
Q

PEP Regimen

A

-TDF/FTC 1 QD
PLUS
-Raltegravir 400 mg BID or Dolutegravir 50 mg daily
-Duration: 4 weeks

31
Q

PrEP

A
  • Truvada 1 PO daily (men and women)
  • Descovy 1 PO daily (men only)
  • Preventing transmission when sexually active with high risk individuals

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