hiv review from quiz Flashcards
HIV Testing
As HIV progresses
- CD4 count( goes down )
- Viral load (Increase) is indicator of how well drug is working, as it should go down with drug therapy. HIV tx regimen reduce viral load to undetectable
- **gentic resistance testing **(means mutation or changes to genetic struct of HIV has occurred making virus resistant to certain med. mutation cause virus to replicated despite pt being on drug therapy
cd4 count of 192 with no allergy, what reccomendation you can make for prevention of opportunistic infection
Bactrim DS PO qd
opportunist infection
PCP
pneumocytosis pneumonia-
- CD4 <200
- DOC: Bactrim DS PO QD
- sulfa allergy: Dapsone, pentamidine or atovaquone (Mepron)
atovaquone
Mepron
opportunist infection
Toxoplasmosis
CD4< 100
DOC : Bactrim DS PO QD
Sufla:
-dapsone with pyrimethamine/Leucovorin
- Atovaquone
opportunist infection
Macobacterium Tuberculosid
CD4<50
Prophylaxis for Mac not recommended in pts with HIV on ART
- Only prevention given if they are not on ART and CD4<50
DOC:
- Azithromycin 1200mg once weekly
- Clarithromycin 500mg BID
Propylaxis agaoint toxoplasma only performed if in high endemic area
if
pt with cd4 45 and not on anteretroviral therapy. Pt does not live in high endemic area pt. is not seropositive for any opportunistic infection
Propylaxis against toxoplasma only performed if in
- high endemic area
- if pt. is seropositive
seropositve mean
- having or being a positive serum reaction especially in a test for the presence of an antibody.
- endemic: regularly occurring within an area or community.
Pneumocytosi jiroveci (PCP)
causes
PPX
TX
causes: fever, dry cough, sob, nighsweats
PPX: Bactrim DS PO QD
**Tx: Bactrim+ prednisone X 21 days **
Toxoplasmosis
PPX
TX
PPX: bactrim DS PO QD
sulfa allergy:
- atovaquone or
- dapsone + pyrimethamine/leucovorin
Treatment:
- sulfadiazine + pyrimethamine + leucovorin
leucovorin to protech against vit b def from pyrimethmine
Sulfadiazine
CMV TX
Ganciclovir (Cytovene)-
- IV , renal, seizure
Valganciclovir (prodrug of ganciclovir)
- Oral, renal
**Cifodovir **(vistide):
- IV, renal, neutropeia
**Foscarnet **(Foscavir):
- iV, seizrue, nephrotox
entry inhibitors
**cd4 receptor **
CCR5 or Cxcr4 co-receptor
NRTI
NNRTI
reverse transcriptaste Inhib
ZALES- DT
Intergrase Inhib
gravir
Protease Inhib
“navir”
lanD FirsT
B- D O G
A- T C S
Truvada: et - emtricitabine +TDF
Complera: ret- Rilviprine+ emtricita+ TDF
Stripla: ceet: colbi+emtricit+eletgravir+TDF
Atripla: et- Emtricit+ TDF + efavirenz
Descovy: et- emtricitabine + TAF
Odefsey: ret- Rilpiv +emtricit+ TAF
Genvoya: ceet: Colb+emtric+eltegrav+ TAF
Biktary: et- Emtricit+ TAF+ bictegravir
Symtuza: et- emtrict+TDF+ colb+ darunavir
efavirenz (sustiva)
rilpivrine ( edurant)
B- D O G
A- T C S
truvada : crcl< 30
complera: Crcl < 50
Strbild Crcl< 70
DOG crcl< 30
Atripla: empty stoma (efavirenz)
Odefsey: with food
Symtuza: with food
stribild: with food
Genvoya : with food
Julaca
dolutegravir + rilpivrine
- with food
- stepdown therapy
dovato
2 drug regimen
- dolutegravir + lamivudine
Cabenuva
Cabotegravir+ rilpivirne
- IM once monthly
- gluteal admin
- 2 inj : 1 cabotegravir+ 1 rilpivrine
Epzicom
Triumeq
Trizivir
Epzicom-Abacavir + lamivudine
triumeq: abacavir+lamivudine+dolutegrav
Trizivir: abacavir+lamivudine+ zidovudine
combivir
zidovudine + lamivudine
bactrim
- can be give to rena dysf pt but dose ajust
- cuase BMS (myelosupression)
NRTI SE
LHR
- L : lactic acidosis
- H: Hepatic steatosis (fat in liver)
- R: renal
Zidovudine
- causes myopahty
- cause myelosupression ( anemia and neutropenia) give epogen, darasnep for anemia and filgrastim, pegfigrastim for Neutropenia
- IV
- LHR
- take with food to dec nausea
- Pregnancy : doc
*
efavirenz
sustiva
- vivid dreams
- false cannaboid tes
- empty stomach
- Preg Cat D
- CY3A4 Inducer
Note: if women who present with 1st trimester already with efavirenz and who has adeq viral supression efavirenz may be continued, changing regimen may lead to loss of viral control & risk of perineateal transmission
rilpivrine
edurant
PrEP ( pre exposure ppx)
Truvada Crcl <60 don’t use
Descovy Crcl <30 don’t use
**Cabotegravir **( Apretude) IM once every 2 months
- consider using when Crcl <30
PEP
Post- exposure prophylaxis
start ASAP
Regiment includes
- Truvada +
- Raltegravir or Dolutegravir
evotaz
darunavir + colbicstat
NNRTI SE
Hepatoxicity, Rash
- rilpivrine (edurant)
- efavirenz (sustiva)
- etravirine (Intelence)
NRTI
zales- DT
zidovudine ( Retrovir) ZDV, AZT
abacavir (ziagen) ABC
Lamivudine ( epivir- epivr HBV)- 3TC
Emtricitabine (emtriva): FTC
Stavudine ( Zerit): d4T ; cap, PO sol
Didanosine (videx): ddI
Tenfovir (TDF -viread) TAF: vemildy
abacavir : HSR , HLA 5701
tenOFovir
TDF: viread - HIV
TAF- Vemildy- HBV**
Side Effect
- Fanconi sx
- osteoperosis
Maviroc
selzentry
- work on CCR5 on human CD4 cell.
- oral
- Hepatoxicity: BBW
- 150mg bid if on cyp3a4 inhi
- 600mg BID if on cyp3a4 inducer
- St. john wart not recommended to take with selzentry
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Enfuvritide
binds to gp41 inhibiting fusion
- monitor for sign/sx of pnemoia and infection
- sub Q injection
ELISA VS WESTERN BLOT
ELISA: hiv screening
western blot: confirming HIV diagnosis
vaccination for HIV pt
- influenza (not flumist which is live)
- Tdap
- HPV (papilloma virus)
- Pneumococcal vaccination
- hep B vaccine (if no immune)
- MMR ok if cd4 > or equal to 200. if cd4 <200 (AIDS) no MMR in AIDS pt.
- varicella ok in HIV not in AIDS
**
Raltegravir is metabolized by
UGT (1A1)
- does not inhibit, induce nor substrate of CYp1a2, cyp2d6, cyp3a4
what HIV med can be take on empty stomach?
- efaviren (sustiva)
- didanosine
- Indinavir (crixiban)
HIV med take once daily
truvada
complera
Atripla
Stribild
Dolutegravir
Eltegravir
Raltegravir (isentress ) taken BID
