HIV Part II Flashcards
1
Q
All NRTI AE
A
- Lactic acidosis
- Hepatic steatosis
- Lipodystrophy (fat breakdown)
2
Q
Zidovudine (ZDV) AE
A
- Headache
- Bone marrow suppression
- GI intolerance
- Lipoatrophy
Can still be used in preggo (Delivery) and kids
3
Q
ABC AE
A
- Hypersensitivity (HLA-B*5701)
- Rash
- Possible increased risk of MI
4
Q
TAF/TDF AE
A
- Renal impairment (TDF> TAF)
- Decreased BMD (TDF > TAF)
- Headache (most common)
- GI intolerance
- TAF has no lipid benefits
5
Q
All INSTI AE
A
- Rash, hypersensitivity
- Depression and suicidal ideation
Both VERY rare
6
Q
Dolutegravir AE
A
- Headache (lasts about a week)
- Insomnia** (take in morning)
7
Q
Elvitegravir (EVG/c) AE
A
- Decreased CrCl
- Increased risk of TDF-related nephrotoxicity when combined
- Nausea, diarrhea
8
Q
Raltegravir AE
A
- Nausea
- Headache
- Diarrhea
- CPK elevation, myopathy, rhabdomyolysis
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
10
Q
Atazanavir (ATV) AE
A
- Hyperbilirubinemia
- PR Prolongation
- Nephrolithiasis, cholelithiasis
- Less likely to cause lipid abnormalities
11
Q
Darunavir (DRV) AE
A
- Rash
- Liver Toxicity
12
Q
Ritonavir AE
A
- GI intolerance
- Hyperlipidemia
- Hyperglycemia
- Hepatitis
13
Q
Cobicistat AE
A
- GI intolerance
- Increased SCr
14
Q
All NNRTI AE
A
- Rash (including SJS)
- Hepatotoxicity (especially with NPV, only used in kids with possible HIV at birth)
- DDI
15
Q
EFV AE
A
- Neuropsychiatric
- Teratogenic + cases of neural tube defects in human infants (category D)
- Dyslipidemia
16
Q
Etravirine (ETR) AE
A
Nausea
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
M184V Mutation
- 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
K103N Mutation
- Common NNRTI mutation
- Resistance to EFV, NVP
- Most spread from person to person
27
K65R Mutation
- Major mutation to ABC and TDF resistance
- DDI and decreased susceptibility to 3TC, FTC, and d4T
- Can't use a nucleotide backbone anymore
28
HIV Transmission + Pregnancy
- 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
HIV Regimen + Pregnancy
- 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
PEP Regimen
-TDF/FTC 1 QD
PLUS
-Raltegravir 400 mg BID or Dolutegravir 50 mg daily
-Duration: 4 weeks
31
PrEP
- Truvada 1 PO daily (men and women)
- Descovy 1 PO daily (men only)
- Preventing transmission when sexually active with high risk individuals
