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HIV Flashcards

1
Q

how is HIV transmitted?

A

Bodily fluid

High risk: blood, semen, vaginal & cervical secretion, breast milk

Medium risk: amniotic, cerebrospinal, peritoneal, pericardial, synovial, pleural

Low risk: saliva, tears, sweat, urine, feces, bite, sharing sex toes

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2
Q

Clinical presentation

A

acute infection–> clinical latency–> AIDs, OI CD4 < 200cells/mm^3

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3
Q

Clinical Presentation
acute retrovirus syndrome

A

flu like/mononucleosis
onset:2-4 wks after exposure
duration <
test + or - or indeterminate

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4
Q

Clinical presentation seroconversion

A

onset: up to 6 months
test positive after ab production

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5
Q

clinical presentation
clinical latency

A

asymptomatic

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6
Q

HIV Testing

A

-one time testing for 13-64 yo + sexually activ e
-opt out testing
no speerate consent for HIV
-pretest counseling not required
-repeat HIV testing left to discretion of provider

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7
Q

when to screen annually

A

unprotected sex
>1 sex partner since last test
STI,TB, or hepatitis
IVDU
exchange $ or drug for sex
partner HIV + or with any of these criteria

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8
Q

diagnosis for HIV

A

CD4/CD4%
-tells immune function

Nucleic Acid Test**
-confirmatory test
-detects HIV RNA (aka viral)

4th Gen HIV p24 Ag+ EIA**
-detects the presence of infection early on

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9
Q

Monitoring parameters for HIV

A

surrogate markers
-CD4 (as high as possible, >200)
-Viral load (goal = undetected)

Resistance testing
-genotype: baseline and failure
-phenotype: failure; similar to MICs and not routine

Adherence
-decrease morbidity and mortality

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10
Q

treatment naive antiretroviral initiation

A

-ART for ALL patients with HIV/AIDS
-Treat and treat

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11
Q

Classes of HIV Medications

A

NRTI
NNRTI
Protease Inhibitors
Fusion Inhibitor
Entry Inhibitor
Integrase Inhibitors
Post attachment Inhibitor

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12
Q

NRTI
Co-formulations

A

Abacacvir/lamivudine (epzicome)

Tenofovir disoproxil fumarate/ emtriocitabine (Truvada)

Tenofovir alafenamide/emtricitabine (descovy)

Lamiudine/ Tenofovir disoproxil fumarate (Cimduo)

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13
Q

Possible NRTI adverse effects class effect

A

pancreatitis and lactic acidosis

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14
Q

lamiviudine (NRTI) elimination and side effect

A

elimination: renal

minimal toxicity

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15
Q

abacavir (NRTI) elimination and side effects

A

hepatic

hypersensitivity reaction
check HLAB*5701

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16
Q

Tenofovir disoproxil fumarate (NRTI) elimination and side effect

A

renal

renal insufficiency (increased Scr), decreased BMD, Fanconi syndrome, HA, N/V/D

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17
Q

Emtricitabine (NRTI) elimination and side effect

A

renal

Minimal toxicity, palmar-plantar hyperpigmentation

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18
Q

Tenofovir alafenamide (NRTI)
elimination and side effects

A

carboxyl-esterses; Pgp, BRCP

HA, N/D, LESS nephrotoxicity and LESS decreases in BMD, reverse alopecia,

increase TC and HDL, weight gain, cough, ab pain, fatigue

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19
Q

what is the difference between TDF and TAF

A

lower TAP serum concentration improves bone and kidney safety profile

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20
Q

NRTI and CYP450

A

Do not inhibit or induce CYP450 isoenzymes

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21
Q

how is Tenofovir alafenamide best absorbed

A

with a high fat meal

22
Q

p-gp substrate

23
Q

HBV activity

A

lamivudine, TDF, emtricitabine ,TAF

-abrupt d/c may cause severe acute exacerbations
-hepatic function monitored closely with with clinical and laboratory f/u for at least severe month if pt d/c anti-HBV therapy, resumption may be warranted

24
Q

chain terminators

25
CYP3a4 inhibitors
Protease inhibitors
26
Protease inihibitors
Ritonovir (very potent, given to other PI makes= more tolerable Atzanavir Darynavir (less SE)
27
Possible Side effects of Protease inhibitors
dyslipidemia, glucose intolerance,GI doors, lipodystrophy, GI (N/V/D), hepatotoxicity, rash, weight gain take with food to decrease GI upset and enhance absorption of some PIs.
28
does ritonavir have retroviral activity?
no, boost concentration
29
Ritonavir Side effect
taste perversion, parathesias, asthenia
30
atazanavir
hyperbilirubinemia (scleral icterus) nephrolithiasis, PR prolongation
31
darunavir
see class effects, sulfonamide
32
CYP Inducers
NNRTIs
33
Integrase Inhibitors
* Raltegravir (Isentress®, Isentress HD®) * Elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide (Stribild®) * Dolutegravir (Tivicay®) * Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy®) * Cabotegravir (Vocabria®, Apretude®)
34
Dolutegravir possible side effects
HA, insomian N/D, HSR, hepatototicity, wt gain, depression, and suicidal ideations (rare)
35
DDI of Dolutegravir
-UGT1A1 and CYP3A inducers -AI or Mg-containing: separate INSTI administration > 2 hrs before or >6 hrs after antacid -Fe and Ca-containing: take together with food or administer INSTI > 2hrs before or >6hrs after supplement -Metformin start low and titrate slow
36
how is Dolutegravir taken
Once or BID taken with or without food
37
Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) adverse effects
HA, N/D, wt gain
38
Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) metabolism
UGT1A1 and CYP3A
39
Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) DDI
* UGT1A1 and CYP3A inducers * Al or Mg-containing: INSTI can be taken under fasting conditions ≥ 2 hrs before. Avoid simultaneously with or 2 hrs after polyvalent cations * Fe or Ca-containing: take together with food. Do not coadminister INSTI under fasting conditions simultaneously with, or 2 hrs after
40
how is Bictegravir, emtricitabine, tenofovir alafenamide (Biktarvy) taken
Once daily taken with or without food!
41
Renal impairment for INSTI?
no dose adjustment
42
post-attachment inhibitor
* Ibalizumab-uiyk (Trogarzo®)
43
post-attachment inhibitor
* Heavily treatment experienced * Administration: Loading dose, 2000 mg IV infusion; maintenance dosage, 800 mg IV infusion every 2 week * Side effects: N/D, dizziness, and rash
44
Capsid Inhibitor
Lenacapavir (Sunlenca)
45
Lenacapavir (Sunlenca)
* Inhibits capsid formation disrupting release of HIV from CD4 cells after replication * 927 mg SC once every 6 months (Oral lead-in period) * Sustrate: CYP3A, UGT1A1, p-gp * Inhibitor: Moderate CYP3A * Role in therapy: Treatment experienced patients
46
Initial ARV-Naive Combination
2 NRTI or 1NRTI + Integrase inhibitor
47
Treatment-Naïve Preferred Regimens Once-Daily Single Tablet Regimens
* Biktarvy (Bictegravir/emtricitabine/tenofovir alafenamide) * Triumeq (Dolutegravir/lamivudine/abacavir)* * Dovato (Dolutegravir/lamivudine) * Symtuza (Darunavir/cobicistat/emtricitabine/tenofovir alafenamide)
48
Treatment-Naïve Preferred Regimens Multi Tablet Regimens
* Tivicay (Dolutegravir) + Descovy (emtricitabine/tenofovir alafenamide) or Truvada (emtricitabine/tenofovir disoproxil fumarate) * Prezcobix (Darunavir/cobicistat)+ Descovy (emtricitabine/tenofovir alafenamide) or Truvada (emtricitabine/tenofovir disoproxil fumarate)
49
Barrier to Resistance
NNRTs (lowest barrier to resistance) NRTIs INSTIs PIs (highest barrier to resistance)
50
PrEP
* Tenofovir DF/emtricitabine (Truvada®) PO daily for high-risk adults and adolescents ≥ 35 kg (FDA approved July 2012) * Tenovir AF/emtricitabine (Descovy®) PO daily for at-risk adults and adolescents ≥ 35 kg excludes receptive vaginal sex (FDA approved Oct 2019) * Cabotegravir (Apretude®) long-acting inj IM once every 2 mo. for high-risk adults and adolescents ≥ 35 kg ± PO (Vocabria®) lead-in x1 mo. (FDA approved Dec 2021) * ADEs: inj site reaction, HA, N/D, ab pain or discomfort * Substrate: UGT1A1 >> UGT1A9 * Contraindications: rifampin, rifapentine, AEDs (CBZ, oxcarbazepinem phenobarbital, phenytoin)
51
Postexposure Prophylaxis (PEP)
* Occupational vs. Non-Occupational * Time to initiation: 72 hours * Duration of treatment: 28 days
52

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