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HIV Diploma > National ART Guidelines 2023 > Flashcards

National ART Guidelines 2023 Flashcards

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1
Q

TLD 1 vs TLD 2

A

TLD 1 = DTG regimen who have never failed any other regimen
TLD 2 = DTG regimen who have failed an earlier regimen

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2
Q

What is the new TDF weight eligibility?

A

30kg

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3
Q

What is the dose of DTG dispersible tablets?

A

10mg

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4
Q

When is AZT reserved for use?

A

Renal failure AND hypersensitivity

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5
Q

What is the definition of virological failure?

A

> 2 VLs >1000 >2 years of DTG/PI containing regimen with >80% adherence

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6
Q

When can DTG-containing regimen be changed?

A

Must be confirmed with a resistance test

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7
Q

What is the preferred 1st line regimen in adults?

A

TLD

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8
Q

What is the preferred 1st line regimen in children?

A

ALD

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9
Q

When should ART be initiated in a patient with CD4< 50 and DS-TB at a non-neurological site?

A

Within 2 weeks

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10
Q

When should ART be initiated in a patient with CD4>50 and DS-TB at a non-neurological site?

A

Within 8 weeks

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11
Q

When should ART be initiated in a pregnant patient with DS-TB at a non-neurological site?

A

Within 2 weeks

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12
Q

When should ART be initiated in a patient with DR-TB at a non-neurological site?

A

Within 2 weeks

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13
Q

When should ART be initiated in a patient with TB at a neurological site?

A

4-8w after TB treatment initiation

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14
Q

When should ART be initiated in a patient with positive serum CrAg but negative CSF CrAg without symptoms?

A

Immediately

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15
Q

When should ART be initiated in a patient with cryptococcal meningitis?

A

4-6w after antifungal treatment initiation

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16
Q

When should ART be initiated in a patient with PCP or bacterial pneumonia?

A

Within 1-2 weeks

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17
Q

When should ART be initiated in a patient with clinical symptoms/sign of liver disease?

A

Investigate first

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18
Q

How do we test for TB in an HIV positive patient at initiation?

A

Symptom screen
GXP

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19
Q

When should a U-LAM be done?

A

Any hospitalised HIV patient
OR
Outpatient with CD4 < 200, AHD or current serious illness

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20
Q

What are the baseline tests at ART intiation?

A

CD4
Renal function (TDF)
Hb (AZT)
GXP
Cervical cancer screening HBsAg

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21
Q

How should eGFR be calculated in adults >16yo

A

MDRD equation

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22
Q

What are indications for CPT in a HIV positive child <1yo?

A

All children regardless of CD4 or clinical stage

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23
Q

What are indications for CPT in a HIV positive child 1-5yo?

A

CD4% <25%
WHO stage 2, 3, 4

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24
Q

What are indications for CPT in a HIV positive child <5yo with PJP infection?

A

Start CPT after PJP treatment is complete

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25
Q

What are indications for CPT in a HIV positive child >5yo

A

CD4 <200
WHO stage 2, 3, 4

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26
Q

When can CTP be stopped in a HIV positive child 1-5yo?

A

CD4 >25% regardless of clinical stage

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27
Q

When can CTP be stopped in an HIV positive child >5yo?

A

CD4>200 regardless of clinical stage

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28
Q

When can CTP be stopped in a HIV positive child <5yo with PJP infection?

A

Continue until 5yo and then stop once CD4>200

29
Q

What is the criteria for TPT in adults >15yo?

A

Exclude active liver disease, alcohol abuse or INH sensitivity
Any CD4

30
Q

What is the dose for TPT in adults >15yo?

A

INH 300mg po dy x 12 months + pyridoxine 25mg dy

31
Q

What is the criteria for TPT in children with HIV <15yo

A

HIV child with positive TB contact

32
Q

What is the criteria for TPT in children <5yo?

A

ANY child with positive TB contact

33
Q

What is the dose for TPT in children <15yo?

A

INH 10mg/kg/d for 6 months (max 300mg)

34
Q

What is the criteria for TPT in pregnant women?

A

Exclude active liver disease, alcohol abuse or INH sensitivity
Any CD4

35
Q

What is 50mg of film coated DTG tablet equivalent to in dispersible DTG tablets?

A

30mg

36
Q

When should antacids be taken in relation to TLD?

A

2 hours AFTER
6 hours BEFORE

37
Q

Which anticonvulsants are contraindicated with DTG?

A

Carbamazepine
Phenobarbital
Phenytoin

38
Q

Which anticonvulsants are not contraindicated with DTG?

A

Valproate (C/I in pregnancy)
Lamotrigine
Levetiracetam
Topiramate

39
Q

If alternative anticonvulsant cannot be used, how do you proceed with DTG-regimen?

A

Double DTG dose to 50mg bd

40
Q

What is first line ART for neonates 2-3kg and <4 weeks old?

A

AZT + 3TC + NVP

41
Q

What is first line ART for infants >3kg and >4 weeks old?

A

ALD

42
Q

What is first line ART for children >30kg and >10yo?

A

TLD

43
Q

How do you initiate ART in an adult diagnosed during labour?

A

Stat dose TLD and stat dose NVP

44
Q

How do you re-initiate ART in a non-pregnant client with interrupted treatment?

A

<28d missed - continue routine care and routine VL monitoring
>28d missed - assess clinically

Clinically well, missed appointment <90d - continue ART
Clinically well, missed appointment >90d - Restart ART and do CD4
Clinically unwell - Restart ART and do CD4
For all above, repeat VL after 3 months

45
Q

How long should ART boosting regimen continue after stopping rifampicin?

A

2 weeks

46
Q

Which ARVs interact with TB treatment?

A

DTG
NVP
LPV/r
Atazanavir
Darunavir

47
Q

How do you adjust LPV/r in TB treatment?

A

a) double dose 800/200 bd
OR
b) superboost 400/100 bd PLUS 300mg ritonavir bd

48
Q

Can you double dose LPV/r syrup?

A

NO! Only tablets
Superboosting can be done with tablets and syrup

49
Q

At what age and weight can EFV be used?

A

> 10kg and >3yo

50
Q

Can you crush LPV or ritonavir tablets?

A

NO!

51
Q

What is the criteria for a switch from a LPV/r or ATV/r regimen to a DTG-regimen to be non VL-dependent?

A

Must have been on the regimen <2y

52
Q

What is the criteria for switching to a DTG-regimen from a LPV/ATV/r regimen with >2 VL >1000 2 years after starting the regimen?

A

Adults:
Adherence <80% - do not do resistance test, same day switch
Adherence >80% - do resistance test, do not same-day switch

OR

Children
Adherence <80% with solution/pellets - change to 4 in 1 capsules to improve adherence and repeat VL in 3 months
Adherence <80% with tablets - change to ALD
Adherence >80% - discuss with HIV expert and do resistance test

53
Q

How can you measure good adherence?

A
  1. Pharmacy refills >80% in last 6-12 months
  2. Attendance >80% in last 6-12 months
  3. ARV detection in blood or urine
54
Q

If you change from an NNRTI based regimen to an InSTI-based regimen in adults do you need to do resistance testing?

A

No

55
Q

If you change from an InSTI based regimen to an PI-based regimen in adults do you need to do resistance testing?

A

Yes

56
Q

What is the visit schedule for all patients >5yo on ART?

A

Initiation - baseline eGFR, CD4
Month 1 - review results
Month 3 - VL, eGFR
Month 4 - review results
Month 7 - collect medicine
Month 10 - VL, eGFR, CD4
Month 11 - review then begin annual monitoring

57
Q

When do you repeat CD4?

A
  1. Every 6 months until CD4 >200
  2. Every 6 months until VL<1000
  3. New WHO stage 3/4 condition
  4. Treatment interruption >90d
58
Q

When do you check for dyslipidemia on a PI-based regimen?

A

Month 3

59
Q

When do you repeat FBC on an AZT-based regimen?

A

Month 1, month 3 and if clinically indicated

60
Q

What is the schedule for TB screen at follow up visits?

A

At every f/u, symptom screen
Every 12 months, GXP
Hospitalisation, U-LAM
Outpatient CD4<200, AHD or serious illness, U-LAM

61
Q

How often should VL be monitored in BF women?

A

Every 6 months from start of breastfeeding

62
Q

What are the ABCDEs of elevated VL?

A

Adherence
Bugs
Correct dose
Drug interactions
REsistance

63
Q

What do you do for a patient on TLD1 with confirmed virological failure?

A

Repeat VL in 6 months

64
Q

When do you do resistance testing in TLD confirmed virological failure?

A

Patients on TLD2 - discuss with HIV expert

65
Q

Which special circumstances warrant a resistance test on TLD1?

A

Perinatally affected adolescents
Existence of drug interactions

66
Q

When do you repeat TB smear?

A

Week 7
Week 23

67
Q

What is the ART regimen in neonates 2kg >35w GA?

A

AZT + 3TC + NVP

68
Q

What is the ART regimen in infants >3kg and >4w?

A

ABC + 3TC + DTG

69
Q
A

HIV Diploma (3 decks)

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