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Spring 2025 Therapeutics V > Exam 5: HIV/AIDS > Flashcards

Exam 5: HIV/AIDS Flashcards

(115 cards)

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1
Q

What is the website where you can get information about HIV therapy?

A

http://clinialinffo.hiv.goc

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2
Q

How does HIV infect the host cell?

A

Uses Glycoprotein 120 (gp120) on its surface to bind to CD4 receptors on T cells, macrophages, and dendritic cells

*Primary target of HIV is the CD4 T helper/inducer lymphocyte

-CD4 cells cannot carry out normal functions (cell-mediated immunity, protection against viruses, bacteria, and cancers)

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3
Q

What is the primary target of HIV?

A

CD4 T helper/inducer lymphocytes

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4
Q

What is the ultimate effect on CD4 cells by HIV?

A

Ultimately get destroyed by a cytolytic effect

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5
Q

What are the 3 routes of HIV transmission?

A

Exposure of mucous membrane or damaged tissue to infected body fluids* (ex: sexual contact)

Blood stream exposure to infected body fluids

Mother-to-child

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6
Q

Which body fluid gets infected by HIV but not HepB?

A

Breast milk

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7
Q

Why is it important to know which nucleosides the HIV drugs mimic?

A

Because if we use 2 drugs that mimic the same nucleoside together, they will compete for the same active site

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8
Q

What is the most common method of HIV transmission?

A

Sexual transmission

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9
Q

What are the stages of HIV infection?

A

Acute Retroviral Syndrome

Chronic HIV Infection (asymptomatic)

Acquired Immunodeficiency Syndrome (AIDS) (symptomatic)

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10
Q

What are the qualities of the Acute Retroviral Syndrome stage of HIV?

A

Occurs after initial exposure

Viral load is greater than the upper limit of infection by commercial assays

HIV virus is creating a viral reservoir around the body
“seeding”

Infected T cells can become latent, not replicating, which is why HIV is not curable

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11
Q

What are the qualities of the Chronic HIV Infection stage of HIV?

A

Asymptomatic

Antibodies against HIV have been developed but are normally not enough to keep it undetectable

Initial decline with progressive loss of cells each year

*Enter Stage 3 when CD4 < 200

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12
Q

What are the qualities of the Acquired Immunodeficiency Syndrome (AIDS) stage of HIV?

A

Symptomatic

CD4 < 200

This is the stage where opportunistic infections are most likely to occur

Used to be the main cause of death

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13
Q

Who should be screened for HIV?

A

Patients age 13-64 in any health-care setting
-repeat annually in high-risk groups

All pregnant women as soon as possible

All patients initiating TB treatment

All patients attending STD clinics
-during each visit for a new complaint

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14
Q

HIV testing should be what?

A

“opt-out”

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15
Q

How long after exposure to HIV does it take before we are able to test for it?

A

10 days with a nucleic acid screen

-the seroconversion window depends on the type of test used
-it takes time for viral replication to occur

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16
Q

What is the first detectable biomarker of HIV?

A

RNA

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17
Q

What is the second detectable biomarker of HIV to appear?

A

P24 antigen

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18
Q

What is the P24 antigen?

A

A core protein of the HIV virus

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19
Q

What type of HIV infection is the P24 antigen mainly used to detect and why?

A

It is bound by antibodies and when they develop this marker goes down in the body

-mostly used to detect acute infections because of this

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20
Q

What are the methods for diagnosing HIV?

A

Positive results from a multitest algorithm
(initial and supplemental tests must be different)

Positive virologic test

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21
Q

What are the 2 things that a Virologic Test for HIV tests for?

A

Viral load

Qualitative HIV NAT

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22
Q

What are the 3 initial things we test patients for when trying to diagnose HIV?

A

HIV-1 antibodies
HIV-2 antibodies
p24 Ag

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23
Q

If the first 3 biomarkers for HIV come back negative, what else should we test to check for an HIV infection

A

HIV-1 NAT

(HIV RNA)

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24
Q

If a patient is negative for HIV-1 and HIV-2 antibodies but positive for HIV-1 NAT, what does this mean?

A

They have an acute HIV-1 infection

-because RNA appears faster than antibodies

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25
What OTC HIV test is available?
OraQuick
26
How does OraQuick work?
Uses oral fluids Two lines= positive **Cannot give a definitive diagnosis, patient needs to meet with a doctor **Patients need to have a 3 month seroconversion window before using (need to wait until 3 months after exposure to use)
27
If patients have a negative result on an OraQuick test how should we counsel them?
-Counsel on 3 month seroconversion window -Repeat the test if the risk event occurred within this window -Counsel on methods of risk reduction and prevention
28
What are the 2 surrogate markers used to assess the progress of an HIV infection and the effectiveness of ART?
CD4 T Lymphocyte count *most useful before therapy initiation *low levels indicate more compromised immune system HIV RNA PCR (viral load) *primarily used to assess effectiveness of therapy *most useful after therapy initiation *higher levels are predictive of faster disease progression
29
What CD4 count indicates Stage 1 HIV Infection (acute)?
>/=500
30
What CD4 count indicates Stage 2 HIV infection (chronic)?
200-499
31
*What CD4 count indicates Stage 3 HIV infection (AIDS)?
<200 OR diagnosis of an Opportunistic Infection
32
What drugs are Nucleotide Reverse Transcriptase Inhibitors?
Abacavir Emtricitabine Lamivudine Tenofovir disoproxil fumarate Tenofovir alafenamide Zidovudine
33
What is the MOA of the Nucleotide Reverse Transcriptase Inhibitors?
Synthetic purine and pyrimidine analogs -Result in elongation termination of the growing proviral DNA chain
34
What are the 2 main adverse events seen with the Nucleotide Reverse Transcriptase Inhibitors?
Mitochondrial Toxicity Lactic Acidosis
35
Which Nucleotide Reverse Transcriptase Inhibitors have less frequent adverse effects (less mitochondrial toxicity and lactic acidosis)?
Tenofovir Emtricitabine Abacavir Lamivudine "TEAL"
36
What is the only Nucleoside Reverse Transcriptase Inhibitor that does not require renal dose adjustment?
Abacavir
37
What is the main adverse effect to know with Abacavir?
Hypersensitivity reaction
38
What are the main adverse effects to know with tenofovir disoproxil fumarate?
Renal insufficiency Osteomalacia
39
What is the main side effect to know with Zidovudine?
Bone marrow suppression
40
What are the 1st line Nucleoside Reverse Transcriptase Inhibitors?
Emtricitabine Lamivudine Tenofovir Disoproxil Fumarate Tenofovir Alafenamide
41
Which Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are G analogs?
Abacavir
42
Which Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are C analogs?
Emtricitabine Lamivudine
43
Which Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are A analogs?
Tenofovir disoproxil fumarate Tenofovir alafenamide
44
Which Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are T analogs?
Zidovudine
45
Which drugs are the Non-Nucleoside Revere Transcriptase Inhibitors?
"vir" Efavirenz Nevirapine Etravirine Rilpivirine
46
What is the MOA of the Non-Nucleoside Reverse Transcriptase Inhibitors?
Bind to an allosteric site of the reverse transcriptase enzyme -reduces functionality
47
What the common adverse effect of Non-Nucleoside Reverse Transcriptase Inhibitors?
Rash
48
What is an important counseling point for Efavirenz?
Take on empty stomach at bedtime
49
What is the main adverse effect of Efavirenz?
CNS side effects
50
What is an important counseling point for Nevirapine?
Titrate dose over 14 days
51
What is an important counseling point for Etavirine?
Take with food
52
What is an important counseling point for Rilpivirine?
Take with meal (not a protein drink)
53
What are the 2 main Protease Inhibitors (PI) to know?
Atazanavir Ritonavir
54
What is the MOA of the Protease Inhibitors?
Inhibit the action of the viral protease -prevents the assembly, maturation, and release of new virions
55
What are the adverse effects of the Protease Inhibitors?
GI intolerance Insulin resistance Lipodystrophy
56
When should Protease Inhibitors be avoided?
Severe hepatic impairment
57
What is a downside to using Protease Inhibitors?
High pill burden
58
What is an important counseling point for Atazanavir?
Take with food
59
What is the main side effect of Atazanavir?
Indirect hyperbilirubinemia
60
What are the main side effects of Ritonavir?
Nausea Vomiting Diarrhea
61
What are our 2 "boosting agents"?
Ritonavir Cobicistat
62
How do the boosting agents work?
Potent inhibitors of CYP3A4 -used to boost the concentrations of other ARTs
63
What is the main difference in efficacy between ritonavir and cobicistat?
Ritonavir has boosting and anti-HIV activity Cobicistat only has boosting activity, it has no anti-HIV activity
64
What is the main side effect of Cobicistat?
Increases serum creatinine
65
What are the Integrase Strand Transfer Inhibitor drugs (INSTIs)?
Raltegravir Elvitegravir Dolutegravir Bictegravir Cabotegravir
66
What are the first-line Integrase Strand Transfer Inhibitors?
Dolutegravir Bictegravir
67
What is the MOA of the Integrase Strand Transfer Inhibitors?
Inhibit HIV integrase -prevents proviral DNA integration into the host cell genome
68
What is the class adverse effect of the Integrase Strand Transfer Inhibitors (INSTIs)?
Weight gain
69
What is the main side effect of raltegravir?
CK elevation
70
What is are important clinical pearls for Elvitegravir?
Take with food Only available in co-formulation
71
What is the dosing of Dolutegravir?
INSTI-naive patient: 50 mg daily INSTI-experienced patient or mutation: 50 mg BID
72
What drug is an Attachment Inhibitor?
Fostemsavir -prodrug of Temsavir
73
What is the MOA of the Attachment Inhibitor?
Binds to gp120 on the surface of HIV -blocks attachment to the CD4 T-cell co-receptor
74
What drug is a Post-Attachment Inhibitor?
Ibalizumab
75
How is Ibalizumab administered?
IV
76
What is the MOA of Ibalizumab?
Binds to domain D2 of the CD4 T-cell co-receptor and interrupts the post-attachment steps required for entry of HIV into the host cell
77
Which drug is a Chemokine Coreceptor 5 Antagonist?
Maraviroc
78
What is the MOA of the Chemokine Coreceptor 5 Antagonist?
Binds to CCR5 on the CD4 cell surface -blocks the binding of gp120 -prevents entry of HIV into the host cell
79
Before starting maraviroc, what must occur?
A tropism assay must be performed
80
Maraviroc is only active against what strains of HIV?
CCR5-tropic strains
81
What drug is a capsid inhibitor?
Lenacapavir
82
What is the MOA of the capsid inhibitor?
Binds to the interface between capsid protein p24 subunits
83
Lenacapavir is used in what patients?
Patients with multidrug resistant infection who are failing their ART regimens *only approved for this
84
What are the goals of HIV therapy?
-Suppress plasma HIV RNA to below the lower level of detection of the assay (undetectable) -Restore and preserve immunologic function -Reduce HIV-associated morbidity and prolong the duration and quality of survival -Prevent transmission
85
What are the benefits of HIV therapy?
Reduces morbidity and mortality Reduces transmission of HIV Suppresses viremia
86
Who should receive ART?
All HIV patients regardless of CD4 count
87
How long does HIV therapy last?
Lifelong
88
When do we start ART?
Initiate immediately after diagnosis or as soon as possible
89
What 2 conditions would we wait to start ART? Why do we wait and for how long?
Meningitis from TB Cryptococcus -wait 2 weeks or so because of IRIS
90
How many drugs are standardly used in ART therapy?
3 -we never use monotherapy -dual therapy is rarely used
91
What drug classes generally make up our ART regimen?
2 NRTIs 1 other class from one of the following: -INSTI* -NNRTI -PI boosted with enhancer
92
What 2-drug regimen for HIV has some data to support its use?
Dolutegravir + Lamivudine
93
What are the 2 recommended treatment regimens for most people with HIV (no history of long-acting cabotegravir use)?
1: Biktarvy: -Bictegravir -Tenofovir alafenamide -Emtricitabine 2: -Dolutegravir -Tenofovir alafenamide OR Tenofovir disoproxil fumarate -Emtricitabine OR Lamivudine
94
If a patient is HLA-B*5701 Negative, what HIV regimens can we give them?
Dolutegravir + Abacavir +Lamivudine Darunavir + Cobicistat OR Darunavir + Ritonavir +Abacavir +Lamivudine
95
If a patient has HIV RNA <100,000 and CD4 >200, what therapy regimen do we give them?
Rilpivirine + Tenofovir alafenamide + Emtricitabine
96
What website can be used to check for HIC drug interactions?
www.hiv-druginteractions.org
97
What is the drug interaction that occurs with acid reducers?
Need to separate antacids from po INSTIs by 6 hrs Never give raltegravir with Al or Mg Rilpivirine is contraindicated with PPIs
98
What is the drug interaction that occurs with Benzodiazepines?
Occurs with protease inhibitors and cobicistat -Preferred benzodiazepines include: Lorazepam, Oxazepam, Temazepam (LOT)
99
What is the drug interaction that occurs with Corticosteroids?
Interacts with protease inhibitors and Cobicistat *Beclomethasone preferred
100
What is the drug interaction that occurs with statins?
Interacts with Protease Inhibitors and Cobicistat Low doses of statins preferred
101
What is the drug interaction that occurs with biguanide?
Dolutegravir increases metformin -may need a dose decrease of the metformin
102
What is a polymorphic mutation?
A naturally occurring variant in the absence of therapy
103
When should resistance testing in HIV be done?
At baseline If virologic failure or suboptimal response occurs
104
A specimen should contain how many copies/mL for the best likelihood of yielding a successful resistance test result?
>500 copies/mL
105
What is the definition of virologic failure?
Inability to achieve or maintain suppression of viral replication to a viral load <200 copies/mL
106
If resistance is detected, how do we adjust the HIV therapy regimen?
Add two or three fully active drugs including: -Dolutegravir -Boosted darunavir *Never add a single drug to a failing regimen*
107
If we want to switch an HIV therapy regimen, when should we do it?
When they are virologically suppressed -will not jeopardize future treatment options
108
What is our goal HIV RNA plasma level to be considered untransmittable?
<200 copies/mL *must have stayed at this level for 6 months to be considered untransmittable
109
What is PrEP?
Uses antiretroviral agents as prevention for people who do not currently have HIV but who are at risk *Not a lifelong therapy
110
What are the 2 possible PrEP regimens?
Emtricitabine + Tenofovir disoproxil fumarate Emtricitabine + Tenofovir alafenamide *for men and transgender women Cabotegravir IM gluteal injection
111
What is the main problem with Cabotegravir for PrEP?
It remains in the systemic circulation for long periods of time (up to 12 months or longer) -if an HIV infection occurs during this time it can lead to CAB resistance
112
What screening should be done before starting PrEP?
HIV test HIV RNA STI test
113
If a person is planning on stopping PrEP, what timing should they follow for stopping it?
Continue for 28 days after last potential HIV exposure
114
What is PEP?
Post-Exposure Prophylaxis for HIV
115
What is the drug regimen for PEP?
Emtricitabine + Tenofovir disoproxil fumarate + Raltegravir OR Dalutegravir

Spring 2025 Therapeutics V (41 decks)

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