Day 3- HIV Flashcards
Which group increased and stayed the same or declined among HIV incidence?
Which NRTI’s affect adenosine and which affect cytidine?
What is your FDA approved PrEP regimen for everyone(including MSM) vs Non MSM?
Increased by 12% among MSM and stablized or declined with IDU and heterosexuals.
Tenofovir Disoproxil Fumarate and Didanosine. Lamuvidine and Emtrictabine.
Truvada. Tenofovir.
Which clinical trials supported evidence for MSM?
What about Heterosexual trials and IDU trial?
Which trials lead to Truvada use?
iPrEX trial and US MSM trial.
Partners PrEP. IDS is BTS.
iPrEx and Partners PrEP.
What were the results of the US MSM safety trial?
What were the effects vs placebo in the Partners PrEP trial?
What did the Bangkok Tenofovir Study show?
No HIV infections occurred while participants were given TDF. 3 occurred in placebo and 3 occurred in delayed TDF. 1 occurred in a man who was assigned placebo but then discovered he had acute HIV.
67% TDF and 75% TDF/FTC.
48.9% reduction in HIV incidence. No virus with mutations associated with TDF resistance were identified.
When is deferral common?
Is viral load suppression completely protective against HIV transmission to a heterosexual?
What are the indications for PrEP for MSM?
providers of primary care, STI care, and HIV care.
NO!
Adult man w/o HIV who has had sex with a man in the last 6 months who isn’t in a monogamous partenrship with an HIV negative man who also has one of : any anal sex in last 6 months w/o condoms, any STI diagnosed or reported in last 6 months, is in an ongoing sexual relationship with an HIV positive partner.
What are indications for PrEP for heterosexuals?
What about for IDU’s?
What are your 3 baseline labwork recommendations for PrEP?
Same as above except list is : man who is bisexual, infrequently using condoms during sex and HIV status is unknown in one of the partners, in an ongoing sexual relationship with an HIV positive partner.
Any sharing of injection stuff in last 6 months, been in a treatment program in last 6 months, risk of sexual acquisition.
Oral rapid tests should not be used due to less sensitivity, patient should not accept patient reported or anonymous test results. Any patient with eCrCl <60 should not receive TDF/FTC.
How should you assess hepatitis risk in PrEP evaluation?
Which drugs do you monitor for dose-related renal toxicities?
Is their a medication assistance program available and how long should your initial prescription be?
HBV and HCF should be checked for by serology prior to TDF/FTC administration.Patients(esp IDU and MSM) should be vaccinated.
Acyclovir, Valacyclovir, Cidofovir, Ganciclovir, Valganciclovir, Aminoglycosides, high dose or multiple NSAIDS.
Gilead sciences offers one. No more than 90 days.
Is a rise in SCr a reason to withhold if eCrCl remains >60?
What are the trials associated with Cabotegravir?
How is HIV transmitted?
NO.
HPTN 83 and HPTN 084.
Blood, Semen, Pre-seminal fluid, rectal and vaginal fluids, breast milk.
What are the HIV lifecycle steps?
What are reasons to begin HIV therapy immediately?
What are reasons for delaying HIV therapy?
Binding and fusion(CD4), Reverse transcription, Transcription, Assembly, Budding.
Pregnancy, AIDS-defining condition, Acute OI, Rapid decline in CD4, HBV or HCV coinfection, HIVAN.
Adherence concerns, acceptance, structural barriers.
What did the START trial show and how are goals of therapy accomplished?
What should your CD4 count be to being prophylaxis and what is your goal response to therapy?
What is your goal for HIV RNA testing?
Starting at 500 CD4 is better than 350 CD4. Selecting appropriate ARV therapy, maximizing adherence, and performing pretreatment resistant training.
PCP and Toxoplasmosis: <200 Smx/TMP SS once daily or DS TIW. MAC <50 cells/uL–> Zpak 1200 mg once weekly. 50-150 cell increase per year.
<2o-75 copies/mL.
What is special about genotype testing for HIV patients?
What are your pharmacoenhancers and what special things should you know about them?
What are your NTRI’s?
Recommend for all of them prior to pregnancy and initiation of therapy. If virologic failure repeat while patient is on ART or within 4 weeks.
Cobicistat and Ritonavir. Cobi is no ARV acitivity, little effect on lipid profile, causes increased in SCr. Rito is opposite.
Lamivudine or Emtrictibine. Abacavir, Tenofovir, Zaduvidine.
What are your NNTRI’s and what are the initial therapy recommendations for HIV?
When should you use INSTI based vs protease?
What is the primary meaning of case 103?
Anything with VIR in the middle. 2 NRTI’s + integrase inhibitor, 2 NRTI’s + NNRTI, 2 NRTI’s + protease inhibitor and the 2 NRTI’s should include lamivudine or emtricitibine.
INSTI only if HLA-B 5701 negative. EVG/COBI/TDF/FTC if pre-ART CrCl >70.
No treatment difference between people when using HIV-1 RNA level.
What is Stribild and what special things to know about it?
What is Stribild’s black box warning?
What is Triumeq?
EVG/c/3TC/TDF. 1 tablet taken once daily with food, seperate antacid use by at least 2 hours, Don’t use in hepatic or renal impairment(no initiation in below 70 and stop in <50).
Lactic Acidosis and Severe Hepatomegaly with Steaotosis and Post treatment acute exacerbation of HEP B.
ABC/DTG/3TC.
What is Trizivir?
What is Odefsey?
What is Atripla?
ABC/3TC/ZDV.
FTC/RPV/TAF.
Efavirenz, Emtrictibine, TDF
What is different between TDF and TAF?
What is your CCR5 antagonist and what are your integrase inhibitors?
What is your fusion inhibitor?
TAF has smaller bone mineral density decrease, smaller decrease in eGFR, less proteinuria.
Maraviroc. Gra in name(Dolutegravir,Elvitegravir,Raltegravir).
Enfuvirtide.
What is the key to find your Protease inhibitors?
NAVI in the middle
