HIV prophylaxis and treatment AB Flashcards
Pre-exposure prophylaxis - what is the NNT?
NNT 13-18
Post-exposure prophylaxis - what is the treatment for low risk?
2 NRTI
i.e. Emtricitabine + Tenofovir
or
Lamivudine + Zidovudine
PEP for higher risk?
Same as for low risk - 2 NRTI (e.g. Lamivudine + Zidovudine)
PLUS
Raltegravir
Or
Lopinavir + Ritonavir
What is the primary prophylaxis for PCP?
Bactrim DS 1 daily
What is the primary prophylaxis for CNS toxoplasma?
Bactrim DS 1 daily
What drug is indicated for primary prophylaxis when CD4
Azithromycin 1g weekly
When can you cease Bactrim DS as prophylaxis for PCP, CNS toxo, cryptococcus?
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
When can you cease Azithromycin as MAC prophylaxis?
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
When can you cease prophylaxis for CMV retinitis?
CD4 >100-150 for 6 months
i.e. double (or more) the CD4 count you’d be most likely to get the infection at
Give examples of nucleoside/nucleotide reverse transcriptase inhibitors?
Abacavir
Emtricidabine
Lamivudine
Zidovudine
What is a common adverse effect of NRTI?
Peripheral neuropathy
Given an example of a non-nucleoside reverse transcriptase inhibitor
Efavirenz
Etravirine
Nevirapine
What are common adverse effects of NNRTI?
P450 enzyme inducers
Rash
Give examples of protease inhibitors?
-navir
Ritonavir, Atazanavir
What are common adverse effects of protease inhibitors?
Ritonavir: CYP3A4 inhibitor, p-glycoprotein inhibitor
General: DM, hyperlipidaemia, buffalo hump, central obesity
What are two types of entry inhibitors?
Fusion inhibitors - Enfuvirtide
CCR5 inhibitors - Maraviroc
Give an example of an integrase inhibitor
- gravir
Raltegravir, Dolutegravir
What HLA is associated with Abacavir hypersensitivity?
HLA-B5701
Which ARV may cause Fanconi syndrome?
Tenofovir
Which drug doubles the risk of AMI?
Abacavir
Which drug is associated with CNS toxicity with vivid dreams and sleep change?
Efavirenz
Which drugs are most strongly associated with lipodystrophy
Older retrovirals (NRTI)
Which drugs are associated with hyperbilirubinaemia and renal stones?
Atazanavir (PI)
Indinavir (PI)
Which drugs are contraindicated with the use of Ritonavir?
Cisapride - QTc prolongation
Simvastatin - rhabdomyolysis
Midazolam - prolonged sedation
Which ART inhibits CYP 3A4?
Protease inhibitors - especially Ritonavir
Which ART induces CYP 3A4
NNRTI (e.g. Nevirapine)
Which drugs have little or no p450 activity?
Integrase inhibitors (e.g. Raltegravir)
Which drug may methadone interact with?
Methadone is metabolised by 3A4
Nevirapine results in methadone withdrawal
Cessation of Nevirapine - potential for overdose
Which drug do PPIs reduce the absorption of?
Atazanavir (protease inhibitor)
Which ART cause hepatotoxicity?
Nevirapine (NNRTI)
Protease inhibitors
Which are the preffered ART drugs to use in pregnancy?
Zidovudine
Lamivudine
Lopinavir/Ritonavir
Which ART should you use intrapartum if pre-delivery maternal viral suppression inadequate/unknown or late presentation?
Zidovudine
How effective is ART at reducing the risk of HIV transmission in pregnancy?
Risk reduced from 25% to
When should you deliver with C-section in HIV?
Consider if maternal viral load >50 at 36 weeks
Recommended if viral load >400
When should you start neonatal ART?
As soon as possible after birth (6-12 hours) and continue for 4 weeks
Is breastfeeding advised in pregnancy?
No; avoid breastfeeding
