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HIV Flashcards

(56 cards)

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1
Q

Primary goals of ART

A
  • Maximal and durable viral suppression
  • Restoration and preservation of immune function (CD4 count)
  • Improved quality of life
  • Reduced HIV-related opportunistic infections
  • Reduced morbidity and mortality
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2
Q

First-line ART (recommended for most people)

A

INSTI + 2 NRTIs
or
INSTI + 1 NRTI

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3
Q

Single tablet regimens available for initial ART

A
  • INSTI
    • BIC/FTC,TAF(weight gain)
    • DTG/3TC (do not use is viral load is >500,000, with HBV coinfection, or w/o resistance testing results
    • DTG/3TC/ABC (only use if HLA-B*5701 negative)
  • NNRTI
    • RPV/FTC/(TAF or TDF) (only is HIV-1 RNA < 100,000 and CD4+ cell count >200
  • Boosted PI
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4
Q

INSTI

A
  • BIC/FTC/TAF
  • DTG/3TC
  • DTG/3TC/ABC
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5
Q

DTG/3TC (INSTI + 1 NRTI) caveat

A

Do not use if HIV-1 RNA > 500,000 c/mL, HBV coinfection, or without resistance testing results

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6
Q

DTG/3TC/ABC (INSTI + 2 NRTI) caveat

A

Only use if HLA-B*5701 negative

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7
Q

Bictegravir (INSTI) advantages

A
  • Single tablet regimen daily with FTC/TAF
  • Few drug/food interactions
  • High barrier to resistance
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8
Q

Bictegravir (INSTI) disadvantages

A
  • Least amount of data (new drug)
  • Only available as single tablet regimen
  • Limited safety data in pregnancy
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9
Q

Dolutegravir (INSTI) advantages

A
  • Single tablet regimen once daily with 3TC or 3TC/ABC
  • Available as single agent
  • Few drug/food interactions
  • Higher barrier to resistance
  • A preferred agent for pregnant women in every trimester
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10
Q

Dolutegravir (INSTI) disadvantages

A
  • ABC coformulation requires HLA-B*5701 testing
  • Increases metformin levels
  • Limited data at conception
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11
Q

Raltegravir (INSTI) advantages

A
  • Longest experience
  • Few drug or food interactions
  • A preferred option for pregnant women
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12
Q

Raltegravir (INSTI) disadvantages

A
  • Multiple pills (no STR)
  • Lower barrier to resistance than BIC or DTG
  • Limited safety data at conception
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13
Q

INSTI AE

A
  • GI distress
  • CNS disturbances (Most with Dolutegravir)
  • Rash (less with Bictegravir)
  • False elevation in creatinine
  • Weight gain
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14
Q

INSTI DDI

A

-Cations (acid reducers), Metformin

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15
Q

Interaction of INSTI with acid reducers

A

Decreases absorption, so wait at least 2 hours before taking antacids or take INSTI 6 hours or more after supplement.

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16
Q

Rilpivirine (NNRTI) Contraindication

A

Acid reducers

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17
Q

DTG + 3TC

A

cost effective compared to 3 drug regimen

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18
Q

DTG + 3TC

A

Rates of genital HIV-1 RNA shedding decreases with treatment

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19
Q

Preferred ART in pregnant women or women trying to conceive

A

Dual NRTI backbone plus INSTI or boosted PI
ex:
-3TC/ABC + DTG or ATV/RTV

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20
Q

Alternative ART in pregnant women or women trying to conceive

A

Dual NRTI backbone plus NNRTI
ex:
FTC/TAF + EFV

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21
Q

Raltegravir (RAL) pregnancy outcomes

A

No Neural tube defects after RAL exposure at conception/during 1st trimester

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22
Q

Rapid ART initiation

A

Improves clinical outcomes. Same day ART increased patient retention and viral suppression at 12 months.

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23
Q

NNRTI AE (except doravarine)

Study These Flashcards
A
  • liver toxicity
  • rash usually six weeks
  • hyperglycemia
  • hyperlipidemia
  • Efavirenz (dose QHS) and Rilpivirine cause neuropsychiatric effects
24
Q

NNRTI DDI (except doravarine)

Study These Flashcards
A
  • Efavirenz, Nevirapine, and Etravirine are CYP3A4 inhibitors
  • Rilpivirine is a substrate of CYP3A4
25
Supporting TDF
- Longer experience with greater number of patients with TDF VS TAF - Coformulations with many regimens - Lipid decreases of uncertain clinical significance seen with use of TDF - Weight gain signal with TAF - Preferred NRTI in pregnancy - Available with generic NRTI combinations with 3TC and FTC
26
Supporting TAF
- Has less impact on bone mineral density | - Less impact on markers of renal tubular dysfunction
27
BIC
Bictegravir
28
FTC
Emtricitabine
29
TAF
Tenofovir Alafenamide
30
DTG
Dolutegravir
31
ABC
Abacavir
32
3TC
Lamivudine
33
TDF
Tenofovir Disoproxil Fumarate
34
Supporting ABC
- coformulated with DTG in first line regimen - long history of use - not renally cleared
35
Opposing ABC
- HLA-B*5701 test required before use - grade 1 to 5 threatening reaction - Continuing evidence of association of ABC with increased risk of MI
36
Entry/fusion inhibitors
- Enfuvirtide - Maraviroc - Ibalizumab - well tolerated, manly used for heavily treatment experienced patients
37
Supporting Boosted PI
- Starting ART before availability of resistance data - If high risk for poor adherence - Highest known genetic barrier to resistance
38
Opposing Boosted PI
- DDI - GI intolerance - Hyperlipidemia - CV risk with some PIs - Metabolic syndromes - Multiple daily dosing for some
39
Stribild/Genvoya (Elvitegravir/cobicistat/emtricitabine/tenofovir)
- STR - Meal restrictions (must take with food, high fat meal is good for absorption) - Renal dysfunction (CrCl must be > 70 ml/min at baseline and not fall below 50 ml/min) - Expect SrCr elevations during therapy - Reasonable option for pregnancy
40
Cobicistat
- inhibits CYP enzymes 3A, 2D6, p-gp - induces 2C9 - drug interactions are overwhelming - Contraindicated with corticosteroids
41
Emtricitabine/Tenofovir
Black box warnings: - lactic acidosis/severe hepatomegaly - Hepatitis B coinfection (severe exacerbations of Hep B)
42
FTC/TAF
Has improved safety and tolerability over FTC/TDF and ABC/3TC, but appears to be associated with greater weight gain
43
Potential drawbacks with INSTIs
Weight gain, CNS AEs, drug interactions with antacids
44
MSM risk factors for HIV
- HIV + sex partner - Recent bacterial STI - High number of sex partners - History of inconsistent/no condom use - commercial sex work
45
Heterosexual women/men risk factors for HIV
- HIV + sex partner - Recent bacterial STI - High number of sex partners - History of inconsistent/no condom use - commercial sex work - in high HIV prevalence are/network
46
PWID risk factors for HIV
- HIV + injecting partner | - sharing injection equipment
47
PrEP eligibility criteria
- Documented negative HIV test result - No signs/symptoms of acute HIV - normal renal function - no contraindicated comedications - documented HBV infection/vaccination status
48
PrEP prescription
Daily, continued, oral FTC/TDF, = 90 day supply
49
Other services for PrEP
Follow-up visits at least every 3 months for: HIV test, medication adherence counseling, behavioral risk reduction support, adverse event assessment, STI symptom assessment
50
Recommended indications for PrEP use by MSM
Have to meet all criteria: - adult male or adolescent weighing >35 kg - no acute or established HIV infection - any male sex partner in previous 6 months - Not in monogamous relationship w/ recently tested, HIV negative man and 1 or more of these criteria: - any anal sex w/o a condom in previous 6 months - bacterial STI in previous 6 months
51
Recommended indications for PrEP use by heterosexuals
Have to meet all criteria: - adult male or adolescent weighing >35 kg - no acute or established HIV infection - any male sex partner in previous 6 months - Not in monogamous relationship w/ recently tested, HIV negative man and 1 or more of these criteria: - is a male who is bisexual - infrequent condom use with 1 or more partners with unknown HIV status at substantial risk of HIV infection (PWID or bisexual male) - is in ongoing relationship with HIV + partner - bacterial STI in previous 6 months
52
Recommended indications for PrEP use by people who inject drugs
Have to meet all criteria: - adult male or adolescent weighing >35 kg - no acute or established HIV infection - any injection of drugs not prescribed by a clinician in the previous 6 months and 1 or more of these criteria: -any sharing of injection or drug prescription equipment in the past 6 months
53
NRTI
FTC, 3TC, AZT/ZDV, TDF, ABC
54
NNRTI
RPV, ETV, EFV, NVP
55
PI
LPV, FPV, DRV, ATV, NFV
56
INSTI
RAL, DTG

ID Therapeutics (11 decks)

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