ARTs & ADRs

Question 1

Statins & ARVS

Answer 1

Ritonavir - inhibits Cytochrome P450

Increased rosuvastatin levels

Question 2

Ritonavir interactions

Answer 2

1. Statins - increases statin levels
2. Quetipine - reduce to 1/6th dose
3. Dexamethasone - increases steroid levels
4. Rifampicin
5. Dabigatran - caution recommended

Question 3

INSTI interactions

Answer 3

1. Antacids - administered at different times due to reduced absorption of INSTI

Question 4

Rilpivirine interactions

Answer 4

1. Pantoprazole & omeprazole reduces absorption of RIL
2. Carbamazepine & phenytoin reduce ril levels
3. Rifampicin & rifabutin reduce ril levels
4. Dexamethasone reduces ril levels
5. St John’s wort reduces ril levels
6. Macrolide INCREASES ril
7. Methadone levels reduced BY ril

Question 5

Cobisistat interactions

Answer 5

1. Dabigatran CI
2. Rifampicin

Question 6

CVD risk criteria HIV

Answer 6

1. Established CVD
2. Familial DLP
3. Albuminuria or eGFR < 60
4. QRISK > 10%
5. Age>40 + Diabetes

Question 7

ART problematic in CVD

Answer 7

Abacavir increases MACE

PIs & Efavirenz increase lipids

Question 8

Benign inhibition of creatinine secretion & eGFR reduction

Answer 8

Does not cause damage!!

10ml/min decrease
RIL
RAL
RIT
DOR

10-20 mL/min
COB
DOL

BHIVA recommends using alternative estimation of eGFR - nystatin C or nuclear medicine based

Question 9

TDF & Bone CIs

Answer 9

Osteoporosis
Fragility fracture
FRAX > 10%