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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
how do we manage IRIS that occurs
NSAIDS | corticosteroids
26
prophylaxis for mycobacterium avium complex
CD4 <50 | clarithromycin or azithromycin
27
prophylaxis for pneumocystis jiroveci pneumonia
CD4 <200 | Bactrim DS
28
prophylaxis for toxoplasmosis
CD4 <100 and Toxo is IgG positive | Bactrim DS
29
adverse effects of TDF
- nausea/gas - renal insufficiency - osteomalacia
30
adverse effects of TAF
- nausea/gas | - low renal/bone toxicities
31
adverse effects of Abacavir
hypersensitivity reactions | MI
32
how renal toxicity in TDF occurs
TDF can't exit through MRP2/4 and accumulates in the proximal tubule
33
tenofovir relationship with active hep B virus
if tenofovir is stopped acute exacerbation of hepatitis may occur
34
screening that needs to be done before starting abacavir
HLA-B*5701
35
drug that comes with a warning card
abacavir
36
adverse effects of emtricitabine
- hyperpigmentation of palms and soles | - acute exacerbation of hepatitis if active HBV and you discontinue
37
adverse effects lamivudine
- well tolerated | - acute exacerbation of hepatitis if discontinued
38
risk factors for lactic acidosis with hepatic steatosis
women obesity pregnancy prolonged use of NRTIs
39
dietary restrictions of NRTIs
take with or without food
40
backbone drugs for all regimens in treatment-naive patients
NRTIs
41
adverse effects of protease inhibitors
``` N/V/D insulin resistance rash (sulfa) hepatotoxicity fat maldistribution on waist and neck ```
42
protease inhibitors to know
darunavir | ritonavir
43
adverse effects of dolutegravir
rash insomnia headaches
44
adverse effects of elvitegravir/cobicistat
N/D | increase in SCr w/COBI
45
adverse effects of raltegravir
N/D headache CPK elevation (potential muscle injury)
46
special warning for integrase inhibitors
all may cause depression or suicidal thoughts
47
integrase inhibitor that needs to be taken with food
elvitegravir/cobicistat
48
ritonavir use in HIV
boosts other drugs by inhibiting 3A4
49
ritonavir adverse effects
N/V/D metabolic complications hepatitis
50
drug that causes circumoral paresthesias
ritonavir
51
cobicistat use in HIV
boosts other drugs by inhibiting 3A4, 2D6, and others
52
cobicistat adverse effects
- may elevate creatinine clearance and alter eGFR | - N/D
53
when starting ART in naive patients how many drugs are needed
at least 3 | usually 2 NRTIs and one from one of the other 4 classes
54
regimens with dolutegravir as anchor
- TDF/emtracitabine (2 tabs qd) - TAF/emtracitabine (2 tabs qd) - abacavir/lamivudine (triumeq, 1 tab qd)
55
regimens with elvitegravir/COBI as anchor
- TDF/emtracitabine (stribild, 1 tab qd) | - TAF/emtracitabine (genvoya, 1 tab qd)
56
regimens with raltegravir as anchor
- TDF/emtracitabine (3 tabs qd) | - TAF/emtracitabine (3 tabs qd)
57
regimens with darunavir/ritonavir as anchor
- TDF/emtracitabine (3 tabs qd) | - TAF/emtracitabine (3 tabs qd)
58
integrase inhibitors that are susceptible to viral mutations
eltegravir/COBI | raltegravir
59
the NRTI that isn't renally excreted
abacavir
60
avoid what class of drugs with PIs and COBI
corticosteroids
61
dose adjustments for PIs and COBI and steroids
beclomethasone - none | prednisone - AUC is increased, use with caution
62
what class of drugs needs consideration with polyvalent cations
integrase inhibitors
63
what class of drugs has increased risk of myalgias when used with statins
PIs and COBI | simvastatin contraindicated, others use with caution
64
supplements to avoid with PIs, NNRTIs, and integrase inhibitors
st john's wort garlic ginkgo
65
counseling points for patients on ARVs
- 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
PrEP
preexposure prophylaxis
67
who is PrEP recommended for
- MSM with HIV partner, or many partners - hetero with HIV or many partners - injection drug uses w/ HIV positive partner
68
clinical eligibility for starting PrEP
- negative HIV test - normal renal function - HBV status/vaccines
69
PrEP drug(s)
TDF | emtracitabine
70
monitoring PrEP
- every 3 months need HIV test - every 6 months need STI test - every 3-6 months renal function - every 12 months reevaluate need
71
drugs that can cotreat HBV
TDF/TAF with emtricitabine or lamivudine
72
drugs that have adverse effects on lipids
- darunavir/ritonavir | - elvitegravir/cobicistat
73
drug that has beneficial effect on lipids
TDF

PT3 ID 1 (HIV) (5 decks)

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