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Year 4: Sexual Health & HIV > HIV Treatment > Flashcards

HIV Treatment Flashcards

1
Q

As a general rule, HIV regimens consist of [+]

What is the BHIVA recommendation drug regimens to start for HIV tx? [4]

A

As a general rule, regimens consist of:

Two nucleoside reverse transcriptase inhibitors (NRTIs)

A third agent, typically one of:
- Ritonavir-boosted protease inhibitor (PI/r)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Integrase inhibitor (INI) - RECOMENDED

OR
- Dolutegravir + Lamivudine

This is the list of BHIVA preffered drug regimens to start

In theory; any of above can be used; but BHIVA slide is the.

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2
Q

Why would you not use abacavir/lamivudine/dolutegravir for first line treatment of HIV? [1]

A

If 10 year risk of CVD more than 10%

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3
Q

Which

A
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4
Q

Entry inhibitors aim to prevent HIV from entering host cells.

Name two classes and drug examples of entry inhibitors used for HIV Tx

A

CCR5 inhibitors (CCR5 is a co-receptor for CD4 allowing the entry of HIV into target cells)
- E.g. Maraviroc

Fusion inhibitors:
- block glycoprotein-41
- Enfuvirtide

NB: not really used

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5
Q

Describe the MoA of NRTIs and NNRTIs [2]

A

NRTIs:
- inhibiting the action of reverse transcriptase

NNRTIs
- preventing the action of reverse transcriptase.

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6
Q

Name examples for NRTIs [4] and NNRTIs [2]

A

NRTIs:
* Tenofovir disoproxil fumarate
* Abacavir
* Emtricitabine
* Lamivudine

NNRTIs:
- Efavirenz
- Nevirapine

As NRTIs are the backbone - don’t want to be LATE with starting treatment Lamivudine, Abacavir TDF Emtricitabine

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7
Q

Describe the MoA of PIs [1]

A

Protease inhibitors (PIs) inhibit the action of protease preventing the cleavage of Gag-Pol polyproteins.

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8
Q

PIs are given alongside which drug [1] as they boost the action of the drug

Name two examples of PIs

A

They are given alongside ritonavir - referred to as a boosted PI - which increase the action of the drug.

PIs:
* Atazanavir
* Darunavir
* Lopinavir

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9
Q

Post-attachment inhibitors prevent envelope protein [] engaging with co-receptors.

Name an example [1]

A

Post-attachment inhibitors prevent envelope protein glycoprotein-120 engaging with co-receptors.

There is currently one medication in this class, the monoclonal antibody Ibalizumab. It is given as an IV infusion once every two weeks.

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10
Q
A

Tenofovir disoproxil fumarate is associated with renal failure and osteoporosis. Lamivudine has been shown to cause pancreatitis, whilst abacavir is avoided in patients with cardiovascular disease. Emtricitabine may cause hyperpigmentation of the palms of hands and soles of feet.

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11
Q

[] tend to have a high barrier to resistance and therefore may be preferred in patients where there are concerns regarding adherence

NRTIs
NNRTIS
PIs
II
EI

A

[] tend to have a high barrier to resistance and therefore may be preferred in patients where there are concerns regarding adherence

NRTIs
NNRTIS
PIs
II
EI

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12
Q

Which drugs are contained in PEP? [2]
For how long is the course? [1]

A

Once a day of:
* Tenofovir disoproxil fumerate
* Two Raltegravir

for 28 days

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13
Q

State 3 side effects of protease inhibitors [3]

A

There are many adverse effects including lipodystrophy, hyperlipidaemia, insulin resistance and hepatotoxicity.

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14
Q

Which drugs are used in PrEP? [1]

A

Tenofovir-df/emtricitabine

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15
Q

How do you measure safety and toxicity of ARTs? [3]

A
  • Renal and liver test
  • Lipids and metabolic tests
  • FBCs
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16
Q

What is the most common cause of HIV VL rebounding? [1]

A

Intermittent adherence (but alsocould be low drug levels / bad luck)

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17
Q

Which ART causes a risk of hypersensitivty? [1]

Which drug class does it belong to? [1]

A

Abacavir: hypersensitivity
- NRTI

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18
Q

Which ART causes a risk of hepatotoxicity? [1]

Which drug class does it belong to? [1]

A

Nevirapine NNRTI

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19
Q

Which ART can cause this reaction? [1]

Which drug class? [1]

A

Darunavir
- PI

NB: Reaction = SJS

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20
Q

Efavirenz can cause which side effects? [3]

A

Neuropsychotic / CNS side effects:
- impaired concentration
- mood swings
- sleep disturbance

21
Q

Renal disease is caused by long term use of which ART? [1]

22
Q

Which ART might cause this reaction

Abacavir
Efavirenz
Tenofovir
Darunavir
Nevirapine

A

Which ART might cause this reaction

Abacavir - get HLAB5701 screen

Efavirenz
Tenofovir
Darunavir
Nevirapine

23
Q

Which two drugs make up long-acting drugs for HIV treatment? [2]

A

II and NNRTI

24
Q

Name two side effects of Tenofovir DF long term use [2]

A

Tenofovir DF:
- Tubular toxicity (prevents re-ab of certain solutes at PCT - risk of kidney failure
- Reduction in bone mineral density

25
Q

Name a side effect of abacavir long term use [1]

A

Dyslipidaemia / atherosclerosis

Avoid in ptx with high risk CVD

26
Q

Name two side effects of boosted PIs long term use [1]

A

Dyslipidaemia / atherosclerosis

and increased other drug dose

27
Q

Boosted PIs may cause which other metabolic effects? [1]

A

Insulin resistance and diabetes

28
Q

Dolutegravir is which drug class? [1]

A

Integrase inhibitor

29
Q

Which drug class is associated with Cushingoid appearances? [1]

A

AZT / old medications

30
Q

Which drug is most likely to cause vivid dreams, and somnolence

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause vivid dreams, and somnolence

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir

31
Q

Which drug is most likely to cause diarrhoea, nausea
Hyperlipidaemia

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause diarrhoea, nausea
Hyperlipidaemia

Lopinavir (PI)

32
Q

Which drug is most likely to cause elevation in bilirubin (unconjugated)

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause elevation in bilirubin (unconjugated)

Atazanavir (PI)

33
Q

Which drug is most likely to cause a severe reaction at the injection site

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause a severe reaction at the injection site

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir

34
Q

Which drug is most likely to cause mood / sleep disturbance and is an II?

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause **mood / sleep disturbance and is an II?*

Dolutegravir

35
Q

Which drug is most likely to cause SJS

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause SJS

Nevirapine

36
Q

Which drug is most likely to cause renal dysfunction

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

37
Q

Which drug is most likely to cause reduced bone minderal density

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

38
Q

Which drug is most likely to cause an increased risk of CVD

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

A

Which drug is most likely to cause an increased risk of CVD

Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine

39
Q

Which antiretroviral is most likely to be responsible for jaundice?

Abacavir
Atazanavir
Darunavir
Efavirenz
Emtricitabine/FTC
Lamivudine/3TC
Lopinavir
Nevirapine
Raltegravir
Ritonavir
Tenofovir

TMS

A

Atazanavir

40
Q

Generalised itchy rash with raised liver enzymes 2-4 weeks into treatment is most likely? [1]

A

Nevirapine

41
Q

Risk of weight gain seems to be higher with some ART agents:
- Tenofovir [] is associated with more weight gain than Tenofovir [], which may
be protective

A

Risk of weight gain seems to be higher with some ART agents:
- Tenofovir alafenamide (TAF) is associated with more weight gain than Tenofovir (TDF), which may
be protective

TAF –> FAT

42
Q

[Drug class] are associated with more weight gain than other ART: Raltegravir >

A

Integrase Inhibitors are associated with more weight gain than other ART: Raltegravir >

43
Q

[] tend to exacerbate the cytopenic effects of chemotherapy.

NNTRIS
NRTIs
IIs
PIs
FI

A

NRTIs tend to exacerbate the cytopenic effects of chemotherapy.

44
Q

[] are potent liver enzyme inducers and may lower the levels of other drugs

NNTRIS
NRTIs
IIs
PIs
FI

A

[] are potent liver enzyme inducers and may lower the levels of other drugs

NNTRIS
NRTIs
IIs
PIs
FI

45
Q

How should you manage infants born to HIV infected mothers? [1]

A

Most infants should be given AZT monotherapy for 4 weeks

46
Q

When should an elective caesarean section should be planned for 38 weeks? [2]

A

Women on combination therapy with detectable viraemia
Women with HIV / HCV co-infection

47
Q

For ART to be
successful, adherence rates must be in the range of []-[]%

A

For ART to be
successful, adherence rates must be in the range of 90-95%

Year 4: Sexual Health & HIV (19 decks)

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