Lecture 6 - HIV Infection 3 Flashcards
PrEP
given prior to exposure to prevent establishment of infection
PEP
given after exposure to prevent infection
oPEP = occupational
nPEP = non-occupational
Preferred regimen for pregnant people, ARV naive
Dolutegravir**
Raltegravir = must be used twice
Atazanavir + ritonavir**
Darunavir + ritonavir = must be used twice
2 NRTI backbone for pregnant people, ARV naive
Emtricitabine/tenofovir
Lamivudine/tenofovir
Intrapartum care
expedited HIV testing + viral load, continue ART therapy
Give IV zidovudine until delivery w/ VL > 1,000 or unknown…continuous infusion
C.section at 38 weeks if VL high
IV Zidovudine not req for people receiving ART w/ VL < 50 copies and no adherence concerns
benefit»_space; risk so just give IV honestly
Infant ARV prophylaxis suppressed mother
4 week zidovudine if virally suppressed mother….6/12hrs after birth
start regardless of zidovudine resistance history
Infant ARV prophylaxis non suppressed mother
6 week zidovudine + 2-6 weeks Lamivudine + nevirapine/raltegravir
do NAAT at birth, if neg then you can shorten the Lamivudine/neviraine/raltegravir
what bodily fluid not considered infectious unless visibly bloody?
the shit you excrete
Poop, boogies, salvia, sweat, vomit, pee etc
Factors associated with increased risk HIV transmission
Visible contaminated device
needle in vein or artery
deep injury
high viral load
Timing and duration of oPEP
start within 72hrs
duration ~ 4 weeks
Preferred oPEP regimen
Raltegravir 400 BiD + TDF/FTC (Truvada) 1 QD
Dolutegravir used in practice
oPEP monitoring and followup?
use contraceptives and avoid donating blood, breast-feeding during 6-12 weeks after exposure
follow up testing BL, 6,3-4 months
CBC, renal/hepatic function at BL and 2 weeks
nPEP is recommended when….
source of body fluids is known to be HIV positive and reported exposure present substantial risk for transmission
nPEP is not recommended when….
reported exposure present no substantial risk of HIV transmission OR care is sought > 72hrs after potential exposure
nPEP regimens
28 day course of 3 drugs
preferred: TDF/FTC + Raltegravir BID or dolutegravir QD
Alternative: TDF/FTC + darunavir + ritonavir
PrEP options for MSM/ Transwomen
TDF/FTC
TAF/FTC
Cabotegravir = Q8 weeks…possible use in high risk
Studies showed you could do daily or on demand
PrEP options for Heterosexual w/ 1 partner having HIV and other doesn’t
cabotegravir found superior in cis women, so its an option
PrEP for people who inject drugs
BANGKOK study
indications for PrEP use by MSM?
adult man
without acute or established HIV infections
Any male partners in past 6 months
not monogamous with recently tested, HIV negative man
1 of following…anal w/o condom in past 6 month, STI in past 6 month, relationship with HIV positive male
indications for PrEP by straight men/women
adult
w/o acute or established HIV infection
Any sex with opposite sex in past 6 months
non-monogamous w/ recently tested HIV neg partner
1 of following…man who is bi, infrequent condom use with 1+ partner with unknown status, sexual relationship with HIV positive partner
indications for PrEP by people who inject drugs
adult
w/o acute or established HIV infection
injection drug use in last 6 months
1 of following….sharing injection equip, in detox, risk of sexual acquisition
FDA approved PrEP regimens
TDF/FTC = QD
TAF/FTC = QD except cisgender women…vag sex no data
CAB = approved Q 2 months
Can you do PrEP as expedited partner therapy?
nah
PrEP education
adverse effects uncommon, mostly headache, nausea,farting during 1st month
adherence V important
PrEP monitoring
Every 3 months….HIV, refill no more than 90-DS, STI testing
Every 6 months….Estimated CrCl, STI if lower risk
Every 12 months….eval if further need PrEP
Discontinuing PrEP?
getting HIV
personal choice
changed life situations
intolerable toxicities
chronic non-adherence
