HIV Therapy Flashcards

1
Q

Does ART cure HIV?

A

NO - it only keeps the viral load low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the major target cell of HIV?

A

CD4+ T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the normal CD4 T cell count?

A

800-1500 cells/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

At what level of CD4 cells are patients at increased risk for infections?

A

Less than 500 cells/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is used to determine the viral load in HIV?

A

PCR-based load assessment testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When do you start ART?

A

ART is recommended for all HIV-infected individuals, regardless of CD4 T lymphocyte cell count, to reduce the morbidity and mortality associated with HIV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where is HIV-2 endemic?

A

West Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What class are these drugs?

  1. Abacavir
  2. Didanosine
  3. Emtricitabine
  4. Lamivudine
  5. Stavudine
  6. Tenofovir
  7. Zidovudine
A

Nucleoside/Nucleotide RT Inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NRTI MOA

A

They are nucleotide or nucleoside analogs that will compete for incorporation into viral genome and when they are they terminate the DNA strand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are naive patients?

A

Patients not previously treated with ART are considered to be “naïve”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NRTI SE

A

Inhibit DNA polymerase γ, blocking production of mtDNA and inhibiting oxydative phosphorylation complexes. This promotes production of cytosolic lactate, and may induce lactic acidosis-hepatic steatosis syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which of the NRTIs can cause lactic-acidosis-hepatic steatosis syndrome?

A
  • Didanosine
  • Stavudine
  • Zidovudine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main DNA polymerase in humans?

A

DNA polymerase α

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can be a complication of NRTI discontinuation?

A

Discontinuation of agents that have anti-HBV

activity is associated with increase in HBV titer - HBV flare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Abacavir Contraindications

A

HLA-B 5701+ patients - can cause hypersensitivity that can be lethal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Zidovudine Contraindications

A

Stavudine antagonistic - not for co-administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which NRTIs are preferred for naive patients?

A
  • Emtractitabine

- Tenofovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are NNRTIs?

A

Nonnucleotide RT Inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drug class are these?

  1. Delavirdine
  2. Efavirenz
  3. Etravirine
  4. Nevirapine
  5. Rilpivirine
A

NNRTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NNRTI MOA

A

Noncompetitive inhibitors bind to RT and induce a conformational change that greatly reduces enzyme activity

21
Q

Are NRTIs and NNRTIs used as mono therapies?

22
Q

NNRTI SE

A

CYP450 interaction

23
Q

Efavirenz Contraindications

A

1st trimester pregnancy or in women planning to conceive

24
Q

Nevirapine SE

A

Severe hepatotoxicity

25
Nevirapine Contraindications
Women with pretreatment CD4 greater than 250 cells/mm and men with CD4 greater than 400 cells/mm
26
What drug class do the following drugs belong to? 1. Ritonavir 2. Fosamprenavir 3. Atazanavir 4. Indinavir 5. Nelfinavir 6. Saquinavir 7. Tipranavir 8. Darunavir
Protease Inhibitors
27
Protease Inhibitor MOA
PIs inhibit HIV aspartyl protease, block | processing of viral proteins required to produce a mature viral particle.
28
How effective are protease inhibitors?
Highly effective in the majority of patients when used in combination therapy.
29
What are some drugs that should not be administered alongside protein inhibitors due to CYP metabolism?
- Quinidine - Rifampin - Warfarin - St. John's Wart
30
Ritonavir SE
Paresthesia - not well tolerated at high doses that are effective
31
Why is ritonavir used in ART even though it cannot be tolerated at the needed doses?
Ritonavir is a potent CYP inhibitor that enhances the half life of other protease inhibitors and allows for reduced dose and frequency
32
What can PIs induce?
Metabolic Syndrome
33
What are the features of metabolic syndrome?
- Hyperlipidemia - Diabetes - Central Obesity - Atherosclerosis
34
What dyslipidemia drugs should be avoided in patients on protease inhibitors?
Statins that are CYP3A4 substrates like pravastatin and fluvastatin
35
Integrase Inhibitor MOA
Inhibits integrase enzyme of HIV that leads to the integration of viral DNA into the host DNA
36
Raltegravir MOA
Blocks the insertion of reverse-transcribed | viral DNA into the host DNA by binding the Mg++ cofactors required for the strand transfer - integrate inhibitor
37
What drug class are: - elvitegravir - dolutegravir
Integrase Inhibitor
38
Enfuvirtide MOA
This peptide binds to HIV surface glycoprotein | gp41 to block conformation required for membrane fusion with host cell - fusion inhibitor
39
What is the route of administration of enfurvitide?
Injection
40
Maraviroc MOA
Small molecule slowly-reversible antagonist of | the CCR5 interaction with gp120, blocks CCR5-tropic HIV-1 entry
41
What is the problem of rifampin co-administered with ART?
Rifampin induces CYP enzymes and reduces exposure to PIs and NNRTIs
42
What is the general recommendation for starting ART?
1. 1 NNRTI + 2 NRTI OR 2. 1 PI + 2 NRTI
43
What is the preferred NNRTI?
Efavirenz
44
What is the preferred PI combination?
Atazanavir + Rifonavir
45
Virology Suppression Failure
The inability to achieve or maintain suppression of viral replication to levels below the limit of detection
46
Immunologic Failure
The inability to achieve and maintain an adequate CD4 T-cell response despite virologic suppression
47
Should ART ever be mono therapy?
NO
48
A 29 year-old male was previously diagnosed with M. tuberculosis infection and rifampin treatment was initiated. In a follow up exam, lab results reveal the patient to be infected with HIV, and lab results are as follows: CD4+ count = 460 cells/mm3 viral load = 41,000 copies/ml resistance testing = HIV1 Which of the following treatment regimens would be a recommended option, if any? A. efavirenz, tenofovir, and emtricitabine B. Nevirapine, tenofovir, and emtricitabine C. Atazanavir, darunavir, and tipranavir D. Didanosine, abacavir, and lamivudine E. None of the above
A. efavirenz, tenofovir, and emtricitabine