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PT3 ID 1 (HIV) > HIV therapeutics > Flashcards

HIV therapeutics Flashcards

1
Q

significance of HIV-1 and HIV-2 strains

A
  • HIV-1 more common in the west

- some ARVs are not active against HIV-2

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2
Q

how long does it take 4th gen Ab/Ag HIV test to detect invection

A

within 4 weeks of infection

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3
Q

what to do if you get a negative Ab/Ag test result

A

test second time 3 months after the first test to confirm

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4
Q

main tests to do in HIV positive patients

A

viral load
CD4 T cell count
resistance testing (genotypic assays)

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5
Q

viral load looks at what

A

current level of virus in the blood

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6
Q

when to do viral load in untreated patients

A

at baseline

monitoring is optional

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7
Q

when to do viral load in treated patients

A
  • immediately before starting ART
  • 2-4 weeks after start or change in ART, then q4-8 weeks until suppressed
  • every 3-4 months when stable, may consider 6 months
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8
Q

goal of therapy in terms of viral load measurements

A
  • 0.5-1 log drop

- undetectable amounts of virus within 12-24 weeks

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9
Q

when to do CD4 in untreated patients

A
  • baseline

- then every 3-6 months

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10
Q

when to do CD4 after initiating or modifying ART

A

every 3-6 months during first 2 years or if CD4 is still under 300

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11
Q

when to do CD4 after 2 years of ART with suppressed viral load

A
  • if 300-500 then every 12 months

- if over 500 then its optional

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12
Q

what constitutes an adequate response to ART in terms of CD4 test

A
  • 30% change in absolute count

- 50-150 increase in 1st year, 50-100 per year afterwards

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13
Q

drug class HIV is most resistant to

A

NNRTI’s

single mutation can be enough for resistance

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14
Q

signs and symptoms of HIV infection

A
  • mononucleosis like illness of non-specific signs and symptoms that present 1-4 weeks after exposure
  • 40-90% are symptomatic
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15
Q

opportunistic infections that can appear when CD4 count is 200-500

A

kaposi sarcoma

oropharyngeal candidiasis

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16
Q

opportunistic infections that can appear when CD4 count is <200

A

pneumocystis jiroveci pneumonia
disseminated histoplasmosis
coccidioidomycosis

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17
Q

opportunistic infections that can appear when CD4 count is <100

A

toxoplasmosis
cryptococcosis
cryptosporidiosis
esophageal candidiasis

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18
Q

opportunistic infections that can appear when CD4 count is <50

A

cytomegalovirus (eye infections)

mycobacterium avium complex

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19
Q

most common opportunistic infection in HIV

A

pneumocystis jiroveci pneumonia

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20
Q

surprising benefits of ART

A
  • decrease in transmission to sexual partners

- decrease in perinatal transmission

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21
Q

who should be on ART

A

all HIV infected individuals regardless of CD4 count

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22
Q

things to treat before starting ART if possible

A

substance abuse

psychiatric disorders

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23
Q

immune reconstitution inflammatory syndrome (IRIS)

A

-exacerbation of an opportunistic infection that occurs as a result of ART initiation

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24
Q

when does IRIS usually occur

A

within 4-8 weeks of initiating ART

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25
Q

how do we manage IRIS that occurs

A

NSAIDS

corticosteroids

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26
Q

prophylaxis for mycobacterium avium complex

A

CD4 <50

clarithromycin or azithromycin

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27
Q

prophylaxis for pneumocystis jiroveci pneumonia

A

CD4 <200

Bactrim DS

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28
Q

prophylaxis for toxoplasmosis

A

CD4 <100 and Toxo is IgG positive

Bactrim DS

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29
Q

adverse effects of TDF

A
  • nausea/gas
  • renal insufficiency
  • osteomalacia
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30
Q

adverse effects of TAF

A
  • nausea/gas

- low renal/bone toxicities

31
Q

adverse effects of Abacavir

A

hypersensitivity reactions

MI

32
Q

how renal toxicity in TDF occurs

A

TDF can’t exit through MRP2/4 and accumulates in the proximal tubule

33
Q

tenofovir relationship with active hep B virus

A

if tenofovir is stopped acute exacerbation of hepatitis may occur

34
Q

screening that needs to be done before starting abacavir

A

HLA-B*5701

35
Q

drug that comes with a warning card

A

abacavir

36
Q

adverse effects of emtricitabine

A
  • hyperpigmentation of palms and soles

- acute exacerbation of hepatitis if active HBV and you discontinue

37
Q

adverse effects lamivudine

A
  • well tolerated

- acute exacerbation of hepatitis if discontinued

38
Q

risk factors for lactic acidosis with hepatic steatosis

A

women
obesity
pregnancy
prolonged use of NRTIs

39
Q

dietary restrictions of NRTIs

A

take with or without food

40
Q

backbone drugs for all regimens in treatment-naive patients

A

NRTIs

41
Q

adverse effects of protease inhibitors

A 
N/V/D
insulin resistance
rash (sulfa)
hepatotoxicity
fat maldistribution on waist and neck
42
Q

protease inhibitors to know

A

darunavir

ritonavir

43
Q

adverse effects of dolutegravir

A

rash
insomnia
headaches

44
Q

adverse effects of elvitegravir/cobicistat

A

N/D

increase in SCr w/COBI

45
Q

adverse effects of raltegravir

A

N/D
headache
CPK elevation (potential muscle injury)

46
Q

special warning for integrase inhibitors

A

all may cause depression or suicidal thoughts

47
Q

integrase inhibitor that needs to be taken with food

A

elvitegravir/cobicistat

48
Q

ritonavir use in HIV

A

boosts other drugs by inhibiting 3A4

49
Q

ritonavir adverse effects

A

N/V/D
metabolic complications
hepatitis

50
Q

drug that causes circumoral paresthesias

A

ritonavir

51
Q

cobicistat use in HIV

A

boosts other drugs by inhibiting 3A4, 2D6, and others

52
Q

cobicistat adverse effects

A
  • may elevate creatinine clearance and alter eGFR

- N/D

53
Q

when starting ART in naive patients how many drugs are needed

A

at least 3

usually 2 NRTIs and one from one of the other 4 classes

54
Q

regimens with dolutegravir as anchor

A
  • TDF/emtracitabine (2 tabs qd)
  • TAF/emtracitabine (2 tabs qd)
  • abacavir/lamivudine (triumeq, 1 tab qd)
55
Q

regimens with elvitegravir/COBI as anchor

A
  • TDF/emtracitabine (stribild, 1 tab qd)

- TAF/emtracitabine (genvoya, 1 tab qd)

56
Q

regimens with raltegravir as anchor

A
  • TDF/emtracitabine (3 tabs qd)

- TAF/emtracitabine (3 tabs qd)

57
Q

regimens with darunavir/ritonavir as anchor

A
  • TDF/emtracitabine (3 tabs qd)

- TAF/emtracitabine (3 tabs qd)

58
Q

integrase inhibitors that are susceptible to viral mutations

A

eltegravir/COBI

raltegravir

59
Q

the NRTI that isn’t renally excreted

A

abacavir

60
Q

avoid what class of drugs with PIs and COBI

A

corticosteroids

61
Q

dose adjustments for PIs and COBI and steroids

A

beclomethasone - none

prednisone - AUC is increased, use with caution

62
Q

what class of drugs needs consideration with polyvalent cations

A

integrase inhibitors

63
Q

what class of drugs has increased risk of myalgias when used with statins

A

PIs and COBI

simvastatin contraindicated, others use with caution

64
Q

supplements to avoid with PIs, NNRTIs, and integrase inhibitors

A

st john’s wort
garlic
ginkgo

65
Q

counseling points for patients on ARVs

A
  • pick up all meds at same time
  • do not start any medications/supplements without consulting with provider/pharmacist
  • use reminders
  • do not stop taking w/o talking to provider
66
Q

PrEP

A

preexposure prophylaxis

67
Q

who is PrEP recommended for

A
  • MSM with HIV partner, or many partners
  • hetero with HIV or many partners
  • injection drug uses w/ HIV positive partner
68
Q

clinical eligibility for starting PrEP

A
  • negative HIV test
  • normal renal function
  • HBV status/vaccines
69
Q

PrEP drug(s)

A

TDF

emtracitabine

70
Q

monitoring PrEP

A
  • every 3 months need HIV test
  • every 6 months need STI test
  • every 3-6 months renal function
  • every 12 months reevaluate need
71
Q

drugs that can cotreat HBV

A

TDF/TAF
with
emtricitabine or lamivudine

72
Q

drugs that have adverse effects on lipids

A
  • darunavir/ritonavir

- elvitegravir/cobicistat

73
Q

drug that has beneficial effect on lipids

A

TDF

PT3 ID 1 (HIV) (5 decks)

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