Day 3 HIV questions continued Flashcards
HIV houses which 3 enzymes responsible for HIV replication?
What are the first 4 steps of HIV replication?
What are the last 4 steps of HIV replication?
Reverse transcriptase, Protease, Integrase.
1: HIV attaches to a CD4 receptor on the cell membrane of the host cell. 2:HIV fuses with the cell membrane and goes in. 3: HIV’s protein coat degrades and HIV’s RNA and reverse transcriptase are released into the cytoplasm. 4: Reverse transcriptase rewrites HIV RNA into HIV DNA.
5: HIV’s DNA enters the host cells nucleus and is then inserted into the DNA of a host cell chromosome. 6: Many copies of single stranded HIV RNA are made. They direct the synthesis of HIV proteins. 7: HIV proteins and RNA gather at the cell membrane and leave as an immature virus. 8: HIV RNA and proteins are reassmbled to make a mature virus.
What does START stand for and what did it show?
What are the 4 goals of HIV therapy and how is this accomplishted?
How do you improve adherence for HIV?
Strategic Timing of Antiretroviral Therapy. Showed it is better to start Antiretroviral therapy when CD4 >500 vs CD4 >350.
Restore and/or preserve immunologic function. Suppress HIV viral load. Reduce HIV related morbidity; prolong duration and quality of survival. Prevent HIV transmission. Selecting appropriate regimen, maximizing adherence, performing pretreatment resistant testing.
Ongoing education and reminders, Adherence counseling, simplified dosing regimen, minimal side effects, Trust in healthcare providers.
What 7 tests/labs should be included in a baseline evaluation?
What is considered to be the best indicator of immune function and goal response to therapy?
What is prophylaxis against PCP and Toxoplasmosis and when do you initiate it?
CD4 count, HIV RNA(VL), Genotype test, Adherence counseling and psych evaluation, HLA-B5701(+ result could mean hypersensitivity to abacavir), CBC/BMP, Lipid profile.
CD4 cell count, 5-150 cell increase per year.
SMX/TMP SS once daily or DS TIW. <200 cells
What is prophylaxis against MAC and when do you start it?
What is the goal HIV RNA level?
Should we do HIV genotype testing and when do we retest in virologic failure?
<50 cells and Azithromycin 1200mg once weekly.
<20-75 copies/mL.
always do it especially pregnant ladies and repeat while patient is taking ART or within 4 weeks after discontinuing therapy.
What are all the NRTI’s and how do they work?
What are the NNRTI’s and what is the key to finding them?
What is the key to finding the integrase inihibitors?
Abacavir, Didanosine, Stavudine,Lamuvidine, Emtrictabine, Tenofovir, Zidovudine. They block the function of reverse transcriptase.
DelaVIRdine, EfaVIRenz, EtraVIRine, NeVIRapine, RilpiVIRine. Look for the VIR in the middle. Work same as NNRTI’s.
DoluteGRAVIR, ElviteGRAVIR, RalteGRAVIR. Gravir in the name.
What are the protease inhibitors?
What is your CCR5 antagonist?
What do Ritonavir and Cobicistat do and what are the main differences between the 2?
Have NAVI in the name(DaruNAVIr, LopiNAVIr, etc.).
Maraviroc
Enhance the effects of the HIV medicines. Ritonavir is a CYP3A4 inhibitor, has ARV activity, Negative effects on lipids.
What are your 3 combinations of HIV therapy and the initial regimen should at least include what 2 drugs?
Which ARV therapy combinations are not recommended when VL >100,000 due to risk of virologic failure?
Which NRTI’s has an increased risk of decreased bone mineral density and renal toxicity?
2 NRTI’s + an integrase inhibitor, protease inhibitor, or NNRTI. Lamuvadine or Emtrictabine.
Abacavir + Lamuvidine or Efavirenze + Atazanvir/Ritonavir. Darunavir/Ritoanvir + Raltegravir.
Tenofovir Disoproxil.
Which ARV therapy combinations are not recommended when CD4<200 due to risk of virologic failure?
Which NNRTI should be taken on an empty stomach and can cause increased risk of suicidal ideation?
Which combination medicines should be taken with food?
Rilpivirine based ART or Darunavir/Ritonavir + Raltegravir.
Efavirenz.
Stribild, Odefsey, Descovy?
Which class of ARVs has an adverse effects on lipids?
STUDY 103 compares which 2 drug combinations?
When do you recheck CD4 and VL?
Protease inhibitors.
EVG/COBI/FTC/TDF vs ATV/r/FTC/TDF.
3-6 months after initiation for CD4 and 2-4 weeks after start for VL then every 4-8 weeks until VL suppression <50.
