ic18 HIV

Question 1

How can HIV be diagnosed? (2 points)

Answer 1

Antibody detection
HIV RNA detection (PCR) aka Viral load

Question 2

CD4 level for AIDs

Answer 2

<200 / mm3

Question 3

Role of CD4 in patient? (4 points)
What does it indicate, predict

Answer 3

1. Indicates immune function
2. Predicts subsequent disease progression and survival
3. Assess response to antiretroviral therapy
4. Need for initiating or discontinuing prophylaxis for opportunistic infections

Question 4

Role of Viral load in HIV?

Answer 4

indicator of response to antiretroviral therapy

Question 5

Benefits of early ART (5 points)

Answer 5

Maintain higher CD4 count

Prevent potentially irreversible damage to immune system

Decrease risk for HIV associated complications
Tuberculosis
Lymphoma
Cognitive impairment

Decrease risk of non-opportunistic conditions
CVD
Renal disease
Liver disease
non-AIDS associated malignancies

Decrease risk of HIV transmission to others

Question 6

2 types of ART regimes

Answer 6

1) 2 NRTIs + 1 INSTI (TEB, TED, LAD)
Tenofovir + Emtricitabine + Bictegravir
Tenofovir + Emtricitabine + Dolutegravir
Abacavir + Lamivudine + Dolutegravir (3-in-1, Triumeq®)

2) 1 NRTI + 1 INSTI (ED)
Emtricitabine + Dolutegravir

Question 7

Who is 1NRTI + 1INSTI not suitable for? (3 points)

Answer 7

Not suitable for patients with
High viral load (HIV RNA > 500,000 copies/ml)
HBV (Hep B) coinfection
Before genotyping resistance testing of HIV and HBV

Question 8

What does NRTI stand for?
Name 5 NRTIs

Answer 8

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
TEALZ
Tenofovir
Emtricitabine
Abacavir
Lamivudine
Zidovudine

Question 9

Adverse effects of NRTI + Need look out for?

Answer 9

1. Mitochondrial toxicity (Lactic acidosis, lipoatrophy, zidovidine worst)
2. Need renal impairment (except Abavcavir)

Question 10

Adverse effect of
Tenofovir
Abacavir
Zidovudine

Answer 10

Tenofovir: Decrease in bone mineral density
Abacavir: Hypersensitivity, need to do genotype testing
Zidovudine: Mitochondrial toxicity, bone marrow suppression

Question 11

2 types of Tenofovir
Which can cause more osteopenia / osteoporosis

Answer 11

Tenofovir Alafenamide (TAF) less than Tenofovir Disoproxil Fumarate (TDF)

Question 12

What does INSTI stand for?
Name 2 INSTI

Answer 12

INtegrase Strand Transfer Inhibitor (INSTI)

BD
Bictegravir
Dolutegravir

Question 13

What does NNRTI stand for
Name 2 NNRTI

Answer 13

Non-nucleoside Reverse Transcriptase Inhibitors
Efavirenz, Rilpivirine

Question 14

Side effect of Efavirenz

Answer 14

Neuropsychiatric SE (dizziness, depression, insomnia, abnormal dreams, hallucination)

Question 15

What is PI
Name 1 PI

Name 1 ADR

Answer 15

Protease Inhibitor
Ritonavir

metabolic complications (dyslipidemia, insulin resistance)

Question 16

Which drug is associated with lipohypertrophy and which is associated with lipoatrophy?

Answer 16

hyper -> Ritonavir
atrophy -> NRTI (zidovudine)

PIs also associated with insulin resistance, take insulin can cause lipohypertrophy

Question 17

Example of fusion inhibitor

name 1 ADR

Answer 17

Enfuvirtide

Injection site reaction

Question 18

Example of CCR5 antagonist

What is the MOA?

Answer 18

Maraviroc

CCR5 is a receptor used by HIV to enter CD4 cells, need to do assay and check if the strain of HIV uses CCR5

Question 19

CYP3A4 substrates (3 points)

Hence they can interact with?

Answer 19

NNRTI (Efavirenz, Rilpivirine)
INSTI (Bictegravir, Dulotegravir)
CCR5 antagonist (Maraviroc)

Can interact with Ritonavir (CYP3A4 inhibitor)