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Infectious Disease AB > HIV prophylaxis and treatment AB > Flashcards

HIV prophylaxis and treatment AB Flashcards

1
Q

Pre-exposure prophylaxis - what is the NNT?

A

NNT 13-18

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2
Q

Post-exposure prophylaxis - what is the treatment for low risk?

A

2 NRTI

i.e. Emtricitabine + Tenofovir

or

Lamivudine + Zidovudine

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3
Q

PEP for higher risk?

A

Same as for low risk - 2 NRTI (e.g. Lamivudine + Zidovudine)

PLUS

Raltegravir

Or

Lopinavir + Ritonavir

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4
Q

What is the primary prophylaxis for PCP?

A

Bactrim DS 1 daily

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5
Q

What is the primary prophylaxis for CNS toxoplasma?

A

Bactrim DS 1 daily

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6
Q

What drug is indicated for primary prophylaxis when CD4

A

Azithromycin 1g weekly

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7
Q

When can you cease Bactrim DS as prophylaxis for PCP, CNS toxo, cryptococcus?

A

Once CD4 >200 for 3-6 months, completed induction therapy and asymptomatic

i.e. double the CD4 count you’d be most likely to get the infection at

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8
Q

When can you cease Azithromycin as MAC prophylaxis?

A

CD4 >100 for 3-6 months, completed 12 months of treatment for MAC and asymptomatic

i.e. double the CD4 count you’d be most likely to get the infection at

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9
Q

When can you cease prophylaxis for CMV retinitis?

A

CD4 >100-150 for 6 months

i.e. double (or more) the CD4 count you’d be most likely to get the infection at

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10
Q

Give examples of nucleoside/nucleotide reverse transcriptase inhibitors?

A

Abacavir
Emtricidabine
Lamivudine
Zidovudine

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11
Q

What is a common adverse effect of NRTI?

A

Peripheral neuropathy

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12
Q

Given an example of a non-nucleoside reverse transcriptase inhibitor

A

Efavirenz
Etravirine
Nevirapine

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13
Q

What are common adverse effects of NNRTI?

A

P450 enzyme inducers

Rash

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14
Q

Give examples of protease inhibitors?

A

-navir

Ritonavir, Atazanavir

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15
Q

What are common adverse effects of protease inhibitors?

A

Ritonavir: CYP3A4 inhibitor, p-glycoprotein inhibitor

General: DM, hyperlipidaemia, buffalo hump, central obesity

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16
Q

What are two types of entry inhibitors?

A

Fusion inhibitors - Enfuvirtide

CCR5 inhibitors - Maraviroc

17
Q

Give an example of an integrase inhibitor

A
  • gravir

Raltegravir, Dolutegravir

18
Q

What HLA is associated with Abacavir hypersensitivity?

A

HLA-B5701

19
Q

Which ARV may cause Fanconi syndrome?

A

Tenofovir

20
Q

Which drug doubles the risk of AMI?

A

Abacavir

21
Q

Which drug is associated with CNS toxicity with vivid dreams and sleep change?

A

Efavirenz

22
Q

Which drugs are most strongly associated with lipodystrophy

A

Older retrovirals (NRTI)

23
Q

Which drugs are associated with hyperbilirubinaemia and renal stones?

A

Atazanavir (PI)

Indinavir (PI)

24
Q

Which drugs are contraindicated with the use of Ritonavir?

A

Cisapride - QTc prolongation
Simvastatin - rhabdomyolysis
Midazolam - prolonged sedation

25
Q

Which ART inhibits CYP 3A4?

A

Protease inhibitors - especially Ritonavir

26
Q

Which ART induces CYP 3A4

A

NNRTI (e.g. Nevirapine)

27
Q

Which drugs have little or no p450 activity?

A

Integrase inhibitors (e.g. Raltegravir)

28
Q

Which drug may methadone interact with?

A

Methadone is metabolised by 3A4

Nevirapine results in methadone withdrawal

Cessation of Nevirapine - potential for overdose

29
Q

Which drug do PPIs reduce the absorption of?

A

Atazanavir (protease inhibitor)

30
Q

Which ART cause hepatotoxicity?

A

Nevirapine (NNRTI)

Protease inhibitors

31
Q

Which are the preffered ART drugs to use in pregnancy?

A

Zidovudine
Lamivudine
Lopinavir/Ritonavir

32
Q

Which ART should you use intrapartum if pre-delivery maternal viral suppression inadequate/unknown or late presentation?

A

Zidovudine

33
Q

How effective is ART at reducing the risk of HIV transmission in pregnancy?

A

Risk reduced from 25% to

34
Q

When should you deliver with C-section in HIV?

A

Consider if maternal viral load >50 at 36 weeks

Recommended if viral load >400

35
Q

When should you start neonatal ART?

A

As soon as possible after birth (6-12 hours) and continue for 4 weeks

36
Q

Is breastfeeding advised in pregnancy?

A

No; avoid breastfeeding

Infectious Disease AB (11 decks)

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