Human Immunodeficiency Virus Flashcards
AIDS diagnosed when…
CD4 count > 200 or patient has an AIDs-defining condition
HIV transmission
Direct contact with blood, semen, vaginal or rectal secretions or ingestion of breast milk.
High risk indicators for HIV are….
Sharing drug injection equipment
High risk sexual behavior: MSM, multiple partners, hx of STIs
Hx of hepatitis or TB infection
HIV antibody testing
can be detected in people 4-12 weeks after getting disease, but can take up to 6 months
OraQuick Test
OTC test that tells you instantly
have to get follow up test with HCP
should be used > 3 months after exposure, if sooner can be false negative
Which drug is CCR5 antagonist
Maraviroc
CCR5 co-receptor on CD4 cell that HIV stages to
Which drug is attachment inhibitor
fostemsavir
Which drug is a post-attachment inhibitor
ibalizumab-uiyk
Which drug is a fusion inhibitor
enfuvirtide
Which drugs are nucleoside reverse transcriptase inhibitors (NRTIs)
emtricitabine
tenofovir
Which drugs are non-nucleoside reverse transcriptase inhibitors (NNRTIs)
efavirenz
rilpivirine
Which drugs are Integrase strand Transfer inhibitors (INSTIs)
Bictegravir
Dolutegravir
Raltegravir
Which drugs are protease inhibitors (PIs)
Atazanavir
Darunavir
Which allele do you test for if considering using abacavir?
HLA-B*5701
Which assay do you perform if considering using maraviroc?
Tropism assay
Preferred initial ART treatment
Biktarvy, Triumeq, Dovato = 1 single pill
Tivicay + Descovy/Truvada = 2 pills once daily
Triumeq should not be taken if test for….
HLA-B*5701
contains abacavir
Which HIV meds should not be used if CrCl < 30
Biktarvy, Triumeq, Dovato, Truvada and Descovy
Which HIV medication is given IV to mother to protect baby?
Zidovudine
in patients with unknown HIV RNA lvl or > 1,000
list of NRTIs
Abacavir
Emtricitabine
Lamivudine
TDF
TAF
Zidovudine
Warnings for All NRTIs
lactic acidosis and hepatomegaly with fatty liver
all can cause N/D/HA inc LFTs
Emtricitabine side effecrts
hyperpigmentation of palms of hands or soles of feet
TDF has higher risk for….
renal impairment
dec bone mineral density
Abacavir boxed warnings
boxed warning for hypersensitivity reaction
Avoid with CVD due to inc risk of MI
List of INSTIs
BRED
Bictegravir (in Biktarvy combo)
Raltegravir (Isentress)
Elvitegravir (In Genvoya/Stribild combo)
Dolutegravir (Tivicay)
CrCl cut off for Stribild?
< 70 dont start
< 50 d/c
CrCl cut off for Biktarvy and Genvoya
Dont start < 30
Cabotegravir IM injection indicated for…
PrEP
Cabotegravir PO is only used for….
lead in treatment before starting combo injection w/ rilpivirine
Which drug is preferred in pregnancy for HIV treatment?
Dolutegravir
INSTI and cations should be separated by…..
2hra before or after aluminum, calcium, magnesium and iron containing products
Dolutegravir/Bictegravir can be taken with calcium/iron if taken with food also**
List of NNRTIs
REDEN
Rilpivirine
Efavirenz
Doravirine
Etravirine
Nevirapine
Rilpivirine additional info
req acidic environment, dont sue with PPI, and separate from H2RA/antacids
Take w/ meal and water
Efavirenz additional info
food inc bioavailability and risk of CNS effect, take on empty stomach at bedtime
Best way to remember PIs
End in -navir
Info about all PIs
take with a booster (ritonavir or cobicistat)
no renal dose adjust
take w/ food to dec GI upset
Atazanavir requires a XXXX gut for absorption
acidic
Drug interactions with PI
too many to remember
Which PI can be used as boosters
Ritonavir
Cobicistat - products containing this should be taken with food
dont use together, not interchangeable and have many drug interactions
When can you use Maraviroc
When of tropism assay and if HIV strain only binds to CCR5 co-receptor.
If binds CXCR4 or CXCR4/CCR5 then cant use
Fostemsavir is indicated in….
combination with other ARTs in heavily treatment-experienced patients who are failing current therapy
Cabenuva has to be preceded by 1 month of….
cabotegravir to asses tolerability
Stribild and Genvoya should be taken with….
food
TDF contain treatments shouldn’t be started in CrCl below what?
< 50
TAF contain treatments should be started in CrCl below what?
< 30
Which NNRTI based therapy should be taken with food?
Complera and Odefsey
Which NNRTI based therapy should be taken on empty stomach?
Atripla, Symfi, Symfi Lo
Which ART require HLA-B testing?
Epzicom
Trizivir
AIDs defining conditions?
Opportunistic infections
Kaposi’s sarcoma
HIV wasting syndrome - can use dronabinol and megestrol to stim appetite
Immune reconstitution inflammatory syndrome
IRIS
unexpected worsening of underlying condition once starting ART or changing to more effective therapy regimen
symptoms can range from mild-severe but self limiting and ART should be continued
If breastfeeding with HIV, you should….
replace with formula to not pass on HIV to child
PrEP treatment options
90 day supply of Truvada or Descovy
Cabotegravir (Apretude) monthly for 2 doses, then every 2 months
What to know before starting PrEP
confirm person is HIV negative
CrCl > 60 for Truvada or > 30 for Descovy
screen Hep B n STI
have to have HIV test before each refill
oPEP
occupational post-exposure prophylaxis
usually HCP needle stick
Start within 72hrs, take for 28 days
HIV test at 4-6wk, 3 months and 6 months after exposure
