Chapter 26: HIV Flashcards
(188 cards)
1
Q
What type of virus is HIV?
A
HIV is a single-stranded RNA retrovirus.
2
Q
What cells does HIV use to replicate?
A
HIV uses CD4 T-helper cells (T cells) to replicate.
3
Q
What happens to the viral load and CD4 count if HIV replicates continuously?
A
The viral load increases and the CD4 count decreases.
4
Q
What is the critical CD4 count threshold for the immune system’s efficacy?
A
The critical threshold is below 200 cells/mm³.
5
Q
What specific malignancy is related to AIDS?
A
Kaposi’s sarcoma.
6
Q
How is HIV transmitted?
A
By direct contact between infected body fluids and mucus membranes or open wounds.
7
Q
What are common ways HIV infection is caused?
A
Unprotected vaginal or rectal sex, sharing injection drug equipment, including needles.
8
Q
What is vertical transmission of HIV?
A
Transmission from a woman with HIV to her child during pregnancy, childbirth, or breastfeeding.
9
Q
Fill in the blank: HIV infection is spread by direct contact between infected body fluids such as _______.
A
blood, semen, vaginal or rectal secretions, or breast milk.
10
Q
What is the CDC’s recommendation for routine HIV screening?
A
Routine HIV screening at least once for all patients who are 13 - 64 years old.
Annual testing is recommended for high-risk individuals.
11
Q
Who should undergo annual HIV testing according to CDC recommendations?
A
Patients with a history of other sexually transmitted infections, hepatitis, TB and those who engage in high-risk activities, such as:
* Sex with multiple partners
* Men who have sex with men
* Anal or vaginal sex with someone infected with HIV
* Sharing drug injection equipment
12
Q
What are common symptoms of acute HIV infection?
A
Flu-like symptoms such as:
* Fever
* Myalgia
* Headache
* Lymphadenopathy
* Pharyngitis
* Rash
Symptoms can last from a few days to several weeks.
13
Q
What signifies the progression from HIV to AIDS?
A
AIDS is diagnosed when the CD4 count is < 200 cells/mm’ or an AIDS-defining condition is present such as opportunistic infections, certain cancers and HIV wasting syndrome.
14
Q
What is HIV wasting syndrome?
A
A debilitating condition with loss of fat tissue, muscle mass, appetite, and diarrhea.
15
Q
What are treatment options for HIV. wasting syndrome?
A
Treatment options to stimulate appetite include the cannabis-related drug Dronabinol and Megestrol.
16
Q
What does diagnostic testing for HIV typically involve?
A
Initial screening for HIV antibodies and/or antigens, followed by a confirmatory test.
A nucleic acid test may also be used to detect HIV RNA.
17
Q
How long can it take for antibodies to be detected after HIV infection?
A
Antibodies can be detected in most people approximately 4 - 12 weeks after infection, but may take up to 6 months in some cases.
Repeat testing may be needed if initial tests are negative.
18
Q
Fill in the blank: AIDS is diagnosed when the CD4 count is _______ cells/mm’.
A
< 200
19
Q
What does the OraQuick In-Home HIV Test detect?
A
The presence of HIV antibodies
It provides immediate results unlike other OTC test kits.
20
Q
What must individuals do after receiving a positive result from the OraQuick test?
A
Follow up with a confirmatory laboratory test
21
Q
What can happen if testing is done sooner than 3 months after exposure?
A
It can lead to a false negative due to the lag in antibody production
22
Q
What receptor does HIV attach to on the host CD4 T cell?
A
CD4 receptor and a co-receptor (CCR5 and/or CXCR4)
This attachment is the first step in the HIV infection process.
23
Q
Which drug class(s) effect the binding and attachement stage of HIV?
A
- CCR5 antagonist: maraviroc
- attachment inhibitor: fostemsavir
- Post-attachment inhibitor: ibalizumab-uiyk
24
Q
What happens during the fusion stage of HIV infection?
A
HIV viral envelope fuses with the cell membrane, releasing its inner capsid containing HIV RNA and viral enzymes.
25
What drug/drug class(s) works on fusion stage of HIV?
Fusion inhibitor: enfuvirtide
26
What role does reverse transcriptase play in HIV infection?
Converts HIV RNA to HIV DNA
## Footnote
It is an enzyme specific to HIV.
27
Name a CCR5 antagonist used in HIV treatment.
Maraviroc
## Footnote
This drug blocks the CCR5 co-receptor.
28
What is the function of enfuvirtide in HIV treatment?
Fusion inhibitor
29
Which drug classes work on reverse trascription stage of HIV?
* NRTI: nucleoside reverse transcriptase inhibitors.
* NNRT: non-nucleoside reverse transcriptase inhibitors
30
What is the process of nuclear import in HIV infection?
Transport of the HIV capsid into the cell nucleus through a nuclear pore
## Footnote
This is essential for HIV DNA integration.
31
Where is HIV replication does capsid inhibitors wrok?
Lenacapavir works on
1. Nuclear import
2. Assembly
3. Budding and maturation
32
What is the role of integrase in HIV infection?
Inserts HIV DNA into the host cell DNA
## Footnote
This step is crucial for viral replication.
33
What class of drugs work on integration stage of HIV replication?
INSTIs
(Integrase strand transfer inhibitor)
34
What are the components produced during transcription and translation of HIV DNA?
HIV RNA and long-chain proteins
## Footnote
These are the building blocks for new HIV particles.
35
What occurs during the assembly stage of HIV infection?
New HIV RNA, proteins, and enzymes assemble at the cell surface
## Footnote
This prepares the virus for budding.
36
What is the final step of the HIV life cycle?
Budding and maturation
## Footnote
An immature virus pinches off from the host cell.
37
Which enzyme breaks up long viral protein chains to form the mature virus?
Protease
## Footnote
This enzyme is crucial for the maturation of the virus.
38
What type of inhibitor is lenacapavir?
Capsid inhibitor
## Footnote
It interferes with the viral capsid formation.
39
Fill in the blank: HIV RNA is converted to HIV DNA by _______.
reverse transcriptase
40
Why is adherence to ART important?
To prevent resistance to ART
## Footnote
Resistance can develop quickly in patients who miss doses or do not follow recommended regimens.
41
What is the major indicator of immune function in HIV patients?
CD4 count
## Footnote
The CD4 count determines the need for OI prophylaxis and increases with ART.
42
What does the HIV viral load indicate?
The amount of HIV RNA in the blood, It is the most important indicator of ART response and should decrease after starting ART.
43
What can a high viral load after starting ART indicate?
Medication non-adherence or drug resistance
## Footnote
It is crucial to monitor viral load to assess treatment effectiveness.
44
List some routine lab tests performed during the initial evaluation of HIV patients.
* Comprehensive metabolic panel (includes SCr and LFTs)
* CBC with differential
* Random or fasting lipid panel
* Random or fasting blood glucose level
* Urinalysis
* **Hepatitis B and C** screening
* **Pregnancy** test (if of child-bearing potential)
* **HLA-B*5701** allele (if considering abacavir)
* **Tropism assay** (if considering maraviroc)
## Footnote
These tests help in monitoring the patient's health and treatment response.
45
When should ART be initiated in HIV-infected individuals?
As soon as possible
## Footnote
Early initiation of ART is crucial for effective management of HIV.
46
What are the treatment goals of ART?
* Achieving and maintaining an undetectable viral load
* Restoring and preserving immune function
* Reducing HIV-associated morbidity and mortality
* Preventing transmission
## Footnote
These goals are essential for the long-term health of HIV patients.
47
What are the preferred initial ART regimens for treatment-naïve adults?
One-Pill, Once Daily (Single Tablet Regimens): Biktarvy, Triumeq, Dovato.
## Footnote
Biktarvy: Bictegravir / Emtricitabine / Tenofovir alafenamide; Triumeq: Dolutegravir / Abacavir / Lamivudine; Dovato: Dolutegravir / Lamivudine.
48
What are the two-pills, once daily ART regimens?
Tivicay + Truvada, Tivicay + Descovy.
## Footnote
Tivicay: Dolutegravir; Truvada: Emtricitabine / Tenofovir disoproxil fumarate; Descovy: Emtricitabine / Tenofovir alafenamide.
49
What is the NRTI backbone in most preferred regimens?
Emtricitabine/tenofovir disoproxil fumarate (Truvada) or emtricitabine/tenofovir alafenamide (Descovy).
50
What is a key consideration when using Lamivudine and Emtricitabine?
They are interchangeable but should not be used together due to antagonistic effects.
51
What is the exception for Dovato in treatment-naïve patients?
Dovato (1 NRTI + 1 INSTI) should not be used if HIV RNA > 500,000 copies/mL, there is HBV coinfection, or HIV genotypic testing is not performed.
52
What is required when using Triumeq?
Extra testing is required due to the presence of abacavir, which indicates a higher risk for severe hypersensitivity reactions.
53
What is a limitation of fixed-dose combinations?
They have less flexibility with renal dosing and should not be used if CrCl < 30 mL/min.
54
What can be done for renal dose adjustments with individual components?
Except for Biktarvy, the individual components can be given separately.
55
Why are alternative ART regimens less ideal?
Less ideal due to lower barriers for resistance, lower tolerability, higher potential for drug interactions, and/or lower efficacy.
## Footnote
Combination Antiretroviral Products are referenced as part of the alternative ART regimens.
56
What is the backbone of a complete HIV ART regimen?
One 'base' plus two NRTIs.
## Footnote
The 'base' can be a PI, an NNRT, or an INSTI.
57
List the types of bases in a complete HIV ART regimen.
* PI-based (boosted with cobicistat or ritonavir)
* NNRTI-based
* INSTI-based
58
Provide examples of PI-based drugs.
* Darunavir
* Atazanavir
## Footnote
Both can be combined with TDF, TAF, or abacavir along with emtricitabine or lamivudine.
59
What are the two examples of complete regimens?
* Rilpivirine + TDF + emtricitabine
* Raltegravir + TAF + emtricitabine
60
What is the risk associated with breastfeeding for HIV-positive mothers?
Increased risk of HIV transmission to the infant.
## Footnote
Replacement feeding with formula or banked pasteurized milk may be preferred.
61
What is recommended for treatment-naïve pregnant patients?
Start a regimen consisting of two NRTIs plus either an INSTI or boosted PI as soon as possible.
62
What drugs are preferred for treatment-naïve pregnant patients?
* Abacavir/lamivudine or tenofovir alafenamide/emtricitabine
* Dolutegravir (preferred INSTI) or darunavir (preferred boosted PI)
63
What is administered to prevent perinatal HIV transmission?
IV zidovudine is administered to the mother and the newborn.
64
What is Immune Reconstitution Inflammatory Syndrome (IRIS)?
A paradoxical worsening of a known condition or an unidentified condition after ART is started or changed.
65
What types of conditions can be unmasked by IRIS?
* **Common opportunistic infections** (OIs)
* Hepatitis B and C
* Herpes simplex virus (HSV)
* Varicella zoster virus (VZV)
* **Autoimmune conditions**
* **Some cancers (e.g., Kaposi's sarcoma)**
66
How should IRIS be managed?
Continue ART and treat the unmasked condition.
67
True or False: Most HIV medications are considered unsafe to use during pregnancy.
False.
68
Fill in the blank: A complete HIV ART regimen consists of one 'base' plus _______.
two NRTIs.
69
What drugs are in Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)class?
**Z-LATTE**
* Abacavir,
* Emtricitabine,
* Lamivudine,
* Zidovudine
* Tenofovir disoproxil fumarate TDF
* Tenofovir alafenamide TAF
70
What is the mechanism of action of NRTIs?
Competitively inhibit reverse transcriptase enzyme
## Footnote
This action prevents the conversion of HIV RNA to HIV DNA.
71
Which NRTI is contraindicated if the patient tests positive for the HLA-B*5701 allele?
Abacavir
## Footnote
Positive HLA-B*5701 increases the risk for hypersensitivity reactions.
72
What are common side effects of NRTIs?
Nausea, diarrhea
## Footnote
All NRTIs share these common side effects.
73
What boxed warning is associated with Zidovudine?
Lactic acidosis and hepatomegaly with steatosis
## Footnote
Zidovudine has a specific boxed warning due to these risks.
74
What should be monitored when switching from TDF to TAF?
Lipids
## Footnote
TAF is associated with lipid abnormalities, requiring monitoring.
75
Fill in the blank: NRTIs have a low barrier to _______.
resistance
## Footnote
Resistance develops easily with NRTIs.
76
What is a key safety issue associated with Tenofovir formulations?
Renal impairment, including acute renal failure and Fanconi syndrome
## Footnote
TDF has a higher risk compared to TAF.
77
What is the dosing frequency for Tenofovir both formulations?
Once daily
78
What is a sign of adherence when taking Zidovudine?
Macrocytosis (high MCV)
## Footnote
This hematologic toxicity can indicate proper medication use.
79
What should patients carry if they are prescribed Abacavir?
A medication card indicating hypersensitivity reaction (HSR)
## Footnote
This card is crucial for emergency situations.
80
What condition can occur if emtricitabine, lamivudine, or tenofovir-containing products are discontinued?
Severe acute HBV exacerbation
## Footnote
This is a significant risk for patients co-infected with HBV and HIV.
81
What is the dosing frequency for Zidovudine?
Twice daily
## Footnote
This is the standard dosing for Zidovudine.
82
What specific side effect is associated with Emtricitabine?
Hyperpigmentation of the palms of the hands or soles of the feet
## Footnote
This is a unique side effect noted with Emtricitabine.
83
What is a key feature of NRTIs regarding dosage adjustment?
Adjust dose in renal impairment
## Footnote
This applies to all NRTIs except abacavir.
84
What is the MOA of Integrase Strand Transfer Inhibitors (INSTIs)?
They block the integrase enzyme, preventing HIV DNA from inserting into the host cell DNA.
85
Name all of INSTIs.
* Bictegravir
* Dolutegravir
* Cabotegravir
* Elvitegravir
* Raltegravir
## Footnote
B-CRED
86
What is the brand name for Bictegravir?
Only in the combination drug Biktarvy.
87
What are the brand names for Cabotegravir?
* Vocabria
* Apretude
* Also a component of Cabenuva
88
What are the brand names for Dolutegravir?
* Tivicay
* Also a component of Triumea, Dovato, and Juluca.
89
What are the brand names for Elvitegravir?
* Genvoya
* Stribild
90
What are the brand names for Raltegravir?
* Isentress
* Isentress HD
91
How do Bictegravir and Dolutegravir compare to NRTIs and NNRTIs in terms of resistance?
They have a higher barrier to resistance.
92
Which INSTIs can be taken once daily?
* Biktarvy
* Stribild
* Genvoya
* Isentress HD
* Tivicay
* Triumea
* Dovato
93
Which INSTI should be taken twice daily?
Isentress
94
What is the recommendation for Stribild in patients with CrCl < 70 mL/min?
Do not start Stribild.
95
What is the recommendation for Stribild in patients with CrCl < 50 mL/min?
Discontinue Stribild.
96
What is the recommendation for Biktarvy or Genvoya in patients with CrCl < 30 mL/min?
Do not start Biktarvy or Genvoya.
97
What is Cabotegravir extended-release intramuscular injection (Apretude) indicated for?
Only for pre-exposure prophylaxis (PrEP).
98
What are common side effects of all INSTIs?
* Weight gain
* Insomnia
* Rare risk of depression and suicidal ideation
99
What specific side effect is associated with Bictegravir and Dolutegravir?
Increased serum creatinine without effect on GFR.
100
What are potential serious side effects of Raltegravir and Dolutegravir?
* Increased CPK
* Myopathy
* Rhabdomyolysis
101
What specific risk is associated with Dolutegravir?
Hepatotoxicity, especially if co-infected with hepatitis B or C.
102
What is the recommended timing for taking INSTIs relative to products containing Al, Ca, Mg, or Fe?
Take INSTI 2 hours before or 6 hours after.
103
True or False: Dolutegravir and Bictegravir can be taken with calcium- or iron-containing supplements if taken with food.
True
104
Name all of NNRTIs
* Efavirenz
* Rilpivirine
* Doravirine
* Etravirine
* Nevirapine
105
Name a drug in the NNRTI class that is a component of the combination product Cabenuva.
Rilpivirine
## Footnote
Rilpivirine is also part of Complera and Odefsey
106
What is the mechanism of action of NNRTIs?
Non-competitively inhibit the reverse transcriptase enzyme
## Footnote
This prevents the conversion of HIV RNA to HIV DNA
107
Which NNRTI requires an acidic environment for absorption?
Rilpivirine
## Footnote
Do not use with PPIs and separate from H2RAs and antacids
108
What are the key safety issues associated with all NNRTIs?
Hepatotoxicity and rash/severe rash, including SJS/TEN
## Footnote
Nevirapine has the highest risk of these side effects
109
What psychiatric symptoms are associated with Efavirenz?
Depression and suicidal thoughts
## Footnote
CNS effects include impaired concentration, abnormal dreams, and confusion
110
What should patients be advised regarding food intake with Efavirenz?
Take on an empty stomach to minimize CNS effects
## Footnote
Food increases the bioavailability and risk for CNS effects
111
Fill in the blank: Rilpivirine should not be used with strong _______ inducers.
CYP3A4
## Footnote
Examples of strong inducers include phenytoin and rifampin
112
True or False: All NNRTIs are major CYP3A4 substrates.
True
## Footnote
Some NNRTIs are also substrates of other CYP enzymes
113
What specific laboratory values should be monitored when using Rilpivirine?
Increase SCr with no effect on GFR
## Footnote
Monitor for renal function but Rilpivirine does not affect GFR
114
What is the recommended dosing strategy for H2RAs when taking Rilpivirine?
Take H2RAs at least 12 hours before or 4 hours after Rilpivirine
## Footnote
This ensures adequate absorption of Rilpivirine
115
Which NNRTI is known for causing significant CNS effects?
Efavirenz
## Footnote
Effects generally resolve in 2-4 weeks in most patients
116
What should be avoided when administering Rilpivirine?
PPIs, strong CYP3A4 inducers, and antacids
## Footnote
Antacids should be taken at least 2 hours before or 4 hours after
117
Name 2 drug that are a Protease Inhibitor.
Atazanavir (Reyataz)
Darunavir (Prezista)
118
What is the mechanism of action of Protease Inhibitors?
They inhibit the HIV protease enzyme, preventing long viral protein chains from being broken down into smaller chains needed to produce mature virus.
119
What is a key feature of Darunavir?
It has a high barrier to resistance.
120
How should Protease Inhibitors generally be taken?
Recommended to take with a booster (ritonavir or cobicistat)
121
What is a unique requirement for Atazanavir absorption?
It needs an acidic gut for absorption.
122
What is Ritonavir used for in the context of Protease Inhibitors?
Used at low doses for pharmacokinetic boosting.
123
What are some metabolic abnormalities associated with all Protease Inhibitors?
* Hyperglycemia/insulin resistance
* Dyslipidemia (increased LDL and triglycerides)
* Increased body fat and lipodystrophy
124
What are common side effects of Protease Inhibitors?
* Diarrhea
* Nausea
125
What is a significant risk factor associated with Protease Inhibitors?
Increased cardiovascular disease (CVD) risk.
126
What should be monitored due to potential hepatic dysfunction from Protease Inhibitors?
Liver function tests (LFTs) for signs of hepatitis or exacerbation of preexisting hepatic disease.
127
What are some hypersensitivity reactions that can occur with Protease Inhibitors?
* Rash (including SJS/TEN)
* Angioedema
* Bronchospasm
* Anaphylaxis
128
True or False: All Protease Inhibitors are major CYP3A4 substrates.
True
129
What caution should be taken with Darunavir, Fosamprenavir, and Tipranavir?
Caution with sulfa allergy.
130
What is a specific interaction concern with Lopinavir/Ritonavir (Kaletra)?
The oral solution contains 42% alcohol, which can cause a disulfiram reaction if taken with metronidazole.
131
What is a common issue with Atazanavir related to bilirubin?
It can cause hyperbilirubinemia (jaundice or scleral icterus), which is reversible and does not require discontinuation.
132
Fill in the blank: All Protease Inhibitors are recommended to take with a _______.
booster (ritonavir or cobicistat)
133
What is Ritonavir (Norvir)?
A pharmacokinetic booster used in combination with other antiretroviral drugs
## Footnote
Ritonavir is an oral powder and tablet form and is a component of Kaletra and Paxlovid.
134
What is Cobicistat (Tybost)?
A pharmacokinetic booster that enhances the effect of certain antiretroviral drugs
## Footnote
Cobicistat is a component of Genvoya, Stribild, Symtuza, Prezcobix, and Evotaz.
135
What is the recommended dosage for Ritonavir?
100 to 200 mg PO once or twice daily with the boosted drug and with food
136
What is the recommended dosage for Cobicistat?
150 mg PO daily with the boosted drug and with food
137
What is the main function of Ritonavir and Cobicistat?
Inhibitors of CYP3A4 that increase antiretroviral therapy levels
## Footnote
They inhibit ART metabolism, boosting therapeutic effects.
138
Why is Ritonavir used only as a booster?
It is not well tolerated at higher doses needed for antiretroviral activity
139
Are Ritonavir and Cobicistat interchangeable?
No, they are not interchangeable and should not be used together
140
Name the drug/drug class that are contraindicated with boosted protease inhibitors.
1. Alpha-1A blockers (alfuzosin, silodosin, and tamsulosin.)
2. Amiodarone, dronedarone
3. DOACs and antiplatlets
4. Azole antifungals
5. Hep C PIs
6. Loastatin and simvastatin
7. PDE 5i
8. Anytype of steroid except beclomethasone
9. Strong CYP3A4 inducers
141
What is the mechanism of action of Maraviroc (Selzentry)?
Blocks HIV from binding to and entering CD4 cells using the CCR5 co-receptor
142
What is the mechanism of action of Fostemsavir (Rukobia)?
Inhibits the interaction between HIV and the CD4 host cell by binding to gp 120 subunit
143
What boxed warning is associated with Maraviroc?
Hepatotoxicity and hypersensitivity reactions
144
What baseline test is required before starting Maraviroc?
Tropism assay results
145
What is the significance of the tropism assay for Maraviroc?
Determines if the HIV strain can bind to the CCR5 co-receptor
146
What should be maintained in patients coinfected with HBV when using Maraviroc?
Effective HBV treatment
147
Fill in the blank: Ritonavir and Cobicistat are inhibitors of _______.
CYP3A4
148
What safety issues are associated with Enfuvirtide (Fuzeon)?
Risk of bacterial pneumonia, hypersensitivity reactions, local injection site reactions
## Footnote
Local reactions include pain, erythema, nodules, cysts, ecchymosis, nausea, diarrhea, and fatigue
149
What is the benefit of combination antiretroviral products?
Lower the pill burden and improve adherence
## Footnote
Includes commonly used combination drugs
150
What is the brand name of the combination product containing Bictegravir, emtricitabine, and tenofovir alafenamide?
Biktarvy
| BETA
151
What is the recommended administration frequency for Cabenuva?
Administered IM once monthly by a healthcare professional
## Footnote
May be preceded by lead-in treatment with oral cabotegravir to assess tolerability
152
What is a key consideration for starting tenofovir disoproxil fumarate-containing products?
Do not start if CrCl < 50 mL/min
## Footnote
< 70 mL/min for Stribild
153
What is a key consideration for starting tenofovir alafenamide-containing products?
Do not start if CrCl < 30 mL/min
154
Which combination products are considered first line?
Biktarvy, Triumeq, Dovato
## Footnote
Cabenuva and Juluca are only indicated to replace a stable ART regimen
155
What should be noted about the administration of Stribild and Genvoya?
Take with food due to cobicistat component
156
What are the components of Biktarvy?
Bictagravir
Emtricitabine
TAF
157
158
What are the components of Cabenuva?
Cabotegravir
Rilpivirine
159
What are the components of Triumeq?
Dolutegravir
Abacavir
Lamivudine
160
What are the components of Dovato?
Dolutegravir
Lamivudine
161
What are the components of Stribild?
Elvitegravir
Cobicistat
Emtricitabine
TDF
162
What are the components of Genvoya?
Elvitegravir
Cobicistat
Emtricitabine
TAF
163
What are the components of Complera?
Rilpivirne
Emtricitabine
TDF
164
What are the components of Odefsey?
Rilpivirne
Emtricitabine
TAF
165
What are the components of Symtuza?
Darunavir
Cobicistat
Emtricitabine
TAF
166
What are the components of Descovy?
Emtricitabine
TAF
167
What are the components of Truvada?
Emtricitabine
TDF
168
What is Treatment as Prevention in the context of HIV?
Treatment of HIV with current ART regimens can achieve a viral load low enough to prevent infecting others.
169
What are PrEP and PEP?
PrEP (Pre-Exposure Prophylaxis) and PEP (Post-Exposure Prophylaxis) are strategies to reduce HIV infection risk before or after exposure.
170
What does PrEP stand for?
Pre-Exposure Prophylaxis.
171
What is the primary purpose of PrEP?
To prescribe ART to prevent HIV infection in patients who engage in high-risk activities.
172
What are the oral regimen options for PrEP?
* Truvada
* Descovy
173
How often should the oral PrEP regimen be taken?
Daily, with no more than a 90-day supply provided at a time.
174
What is the long-acting injection option for PrEP?
Cabotegravir (Apretude) administered IM monthly for 2 doses, then every 2 months.
175
What must be confirmed before starting PrEP?
* Patient is HIV-negative
* Recent symptoms indicating HIV infection
* CrCl ≥ 60 mL/min (Truvada) or ≥ 30 mL/min (Descovy)
* Screen for hepatitis B and STIs
176
What is the CrCl cutoff for Truvada when used for PrEP?
≥ 60 mL/min.
177
What is the CrCl cutoff for Descovy when used for PrEP?
≥ 30 mL/min.
178
What screening is recommended if using oral PrEP?
Screen for hepatitis B and sexually transmitted infections (STIs).
179
What should be tested for at each PrEP follow-up visit?
HIV and confirm a negative result
## Footnote
This is necessary before refilling or administering PrEP treatment.
180
What is the recommended frequency for testing when using Truvada or Descovy?
Every 3 months
## Footnote
This is for refilling or administering PrEP treatment.
181
What is the recommended frequency for testing when using Cabotegravir?
1 month after the first injection, then every 2 months
## Footnote
This is for refilling or administering PrEP treatment.
182
What additional screenings are recommended during PrEP follow-up visits?
STIs, renal function, drug adverse effects
## Footnote
Suggested frequency varies between treatment strategies.
183
What is Post-Exposure Prophylaxis (PEP)?
Emergency treatment after potential HIV exposure
## Footnote
It is for non-infected persons exposed to potentially infectious body fluids.
184
What are the two types of PEP?
* Nonoccupational (nPEP)
* Occupational (OPEP)
## Footnote
These types cater to different exposure scenarios.
185
When should PEP be started after exposure?
As soon as possible within 72 hours
## Footnote
Treatment should be continued for 28 days.
186
What is the follow-up testing schedule after receiving PEP?
Baseline test, then at 4-6 weeks, 3 months, and 6 months
## Footnote
This is to monitor HIV status after exposure.
187
What is the administration schedule for Cabotegravir?
Monthly for 2 doses, then every 2 months
## Footnote
Cabotegravir is an IM drug used in PrEP.
188
What combination of drugs may be used for PEP if Truvada is indicated?
Truvada (if CrCl ≥ 60) + Dolutegravir (Tivicay) or Raltegravir (Isentress)
## Footnote
This combination is part of the treatment regimen for PEP.
