Drugs

Question 1

PPI

Answer 1

Contraindicated with atazanavir and rilpiverine as both require low gastric pH

Antacids and H2 blockers ok but take at different time - less long lasting effect

Question 2

Antacids

Answer 2

Need to be timed away from integrases due to chelation of II

Question 3

Dabigatran

Answer 3

Coadministration with ritonivir and cobicistat increases dabigatran exposure and therefore increases bleeding risk
can give with ritonivir with close monitoring
Cannot give with cobicistat

Question 4

Metformim

Answer 4

Increased exposure with DTG
Risk is lactic acidosis
Close monitor and consider adjusting dose with DTG. Close monitoring with BIC only if renal impairment.

Question 5

IM carbotegravir/rilpivirine

Answer 5

Exposure reduced by strong enzyme inducers eg rifampicin

Avoids other DDI eg. Antacids

Question 6

Corticosteroids

Answer 6

Avoid with boosters
Risk of Cushing syndrome increased even if not taking steroid orally

Beclometasone safest

Question 7

Clopidogrel

Answer 7

Not with boosters - 44% HIV patients not achieving platelet inhibition

Prasugel is ok

If must have clopidogrel change ARVs

Question 8

Injectable?

Answer 8

Carbotegravir with rilpivirine
Aqueous particle suspension
Monthly use
Cabenuva
ATLAS and FLAIR trial

Question 9

Micro needle patch

Answer 9

7 days exposure achieved from 1 patch with rilpivirine

Question 10

Apixaban

Answer 10

Induced by ETR

EDOXABAN SAFER

Question 11

DOACs

Answer 11

Not with PIs - increase exposure
Not with NNRTI - decrease exposure (Doravirine safe)

INSTI safe