HIV Flashcards by Alexandria Arnett

How do you screen and confirm HIV?

Screen with ELISA test

Confirm with western blot test

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As HIV progresses, CD$ T cell count goes ___ and viral load goes __. And AIDS diagnosis is when CD4 is ____

Down

<200cells/mm

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Fostemsavir

Brand
MOA and receptor
Indication
Dose
ADE
Contraindication

Rukobia

Binding entry inhibitor that targets gp120

HIV-1 with MDR

600mg ER BID

Hepatotox, QT prolongation

Strong 3A4 inducers (rifampin, st.john’s wort, carbamazepine)

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Ibalizumab-uiyk

Brand
MOA and receptor
Indication
Dose
ADE

Trogarzo

Binding entry inhibitor that targets CD4R

HIV with MDR

800mg Q2wks IV

Increase uric acid, dizzy

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Selzentry

Brand
MOA and receptor
Indication
Dose
ADE
Drug interaction

Maraviroc

Binding entry inhibitor that targets CCR5

HIV

300mg BID PO

Hepatotox (BWW) , OH, heart problems

St.Johns wort

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Enfuvirtide

Brand
MOA and receptor
Indication
Dose
ADE

Fuzeon

Fusion inhibitor that tarets gp41

HIV

90mg BID SC

Infection

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NRTI ADE

Headache
lactic acidosis
hepatic steatosis
Renal (except abacavir)

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Zidovudine

Brand
MOA
Indication
Dose
ADE

Retrovir

NRTI

HIV

300mg BID PO/IV

Myelosuppression, purple discoloration of nails, myopathy

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Abacavir

Brand
MOA
Indication
Dose
ADE
Testing

Ziagen

NRTI

HIV

300mg BID PO

Rash

HLAB5701

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Lamivudine

Brand
MOA
Indication
Dose
ADE

Epivir

NRTI

HIV and hepatitis B

150mg BID

Normal class ADE

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Emtricitabine

Brand
MOA
Indication
Dose
ADE

Emtriva

NRTI

HIV

200mg PO QD
240mg PO solution in fridge

Darkening of palms and soles ; hepatitis B flare up

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Tenofovir disoproxil fumarate

Brand
MOA
Indication
Dose
ADE

Viread

NRTI

HIV >2y.o
Hep B >12y.o

300mg QD PO

Rash, fat distribution, osteoporosis , acute renal failure

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Tenofovir alafenamide

Brand
MOA
Indication
Dose

Vemlidy

NRTI

Chronic hepatitis B

25mg QD with FOOD

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Ripivirine

Brand
MOA
Indication
Dose
ADE

Edurant

NNRTI

HIV

25mg QD PO with FOOD

Depression, hepatotox, rash, insomnia

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Nevirapine

Brand
MOA
Indication
Dose
ADE

Viramune

NNRTI

HIV

200mg QD x 14d then 200mg BID

Life-threatening hepatotox, SJS

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Efavirenz

Brand
MOA
Indication
Dose
ADE

Sustiva

NNRTI

HIV

600mg HS PO on EMPTY STOMACH

CNS (vivid dreams) , false CBD test, hepatotox, rash

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Etravirine

Brand
MOA
Indication
Dose
ADE

Intelence

NNRTI

HIV

200mg BID PO after meal

SJS , TENS

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Doravirine

Brand
MOA
Indication
Dose
ADE
Contraindications

Pifeltro

NNRTI

HIV

100mg PO QD

dizzy, HA, abdominal pain

Strong 3A4 inducers

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INSTI ADE and Counseling

ADE - diarrhea, nausea, headache, insomnia, dizzy, fatigue

Counseling - take with or without food and separate from antacids

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Raltegravir

Brand
MOA
Indication
Dose
ADE

Isentress

INSTI

HIV

400mg BID or 1200mg QD PO (also comes in chewable tabs)

SJS, myopathy, rhabdo , increase ALT, increase glucose

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Doultegravir

Brand
MOA
Indication
Dose
ADE

Tivicay

INSTI

HIV

50mg QD PO

Increase LFT , increase glucose

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Apretude

Generic
MOA
Indication
Dose
ADE

Cabotegravir

INSTI

PReP for HIV

600mg IM every 2 months

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Vocabria

Generic
MOA
Indication
Dose
ADE

Cabotegravir

INSTI

Short term to assess tolerability before starting cabenuva ( cabotegravir + ripivirine)

30mg PO QD x 1 month

Depression, hepatotox

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Who would be best to give apretude?

CrCl <30
Aderence to oral meds is concerning
Patient’s want less frequent dosing

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Protease inhibitor class ADE and drug interaction and counseling

N/V/D Lipodystrophy Hyperglycemia Hyperlidiemia Increased risk of myocardial infarction and bleeding Hepatotox ALL PI's are contraindicated with st.johns wort , avoid PPI, avoid simvastatin and lovastatin Give MOST with FOOD

Lopinavir + Ritonavir Brand MOA Indication ADE Clinical comments

Kaletra PI HIV Pancreatitis Contains 42% alcohol and has propylene glycol

Atazanavir Brand MOA Indication Dose ADE Drug interaction

Reyataz PI HIV - typically given with ritonavir or cobicistat to boost levels 100/200/300 mg QD PO with food Nephrolithiasis and cholelithiasis Can decrease clarithromycin by 50% ; Viread can decrease Reyataz

Nelfinavir Brand MOA Indication Dose ADE Can it be boosted?

Viracept PI HIV 750mg PO TID Explosive diarrhea NO

Darunavir Brand MOA Indication Dose ADE Allergy

Prezista PI HIV - treatment naive Can be boosted with ritonavir or cobicistat Contains SULFA

Fosamprenavir Brand MOA Indication Dose Allergy

Lexiva PI HIV 700mg BID with ritonavir Contains SULFA

Ritonavir Brand MOA Indication Dose Contraindication

Norvir 3A4 inhibitor to BOOST 600mg BID PO Amiodarone and eletriptan

Tipranavir Brand MOA Indication Dose ADE Allergy

Aptivus PI HIV 500mg BID WITH ritonavir 200mg with food Intracranial bleeding , hepatotox Contains SULFA

Cobicistat Brand MOA Indication Dose ADE Contraindication

Tybost CYP3A4 inhibitor To BOOST 150mg PO QD with FOOD Renal tox CrCL <70

Combivir Generic

Lamivudine + Zidovudine

Epzicom generic

Lamivudine + + abacavir

Triumeq

Lamivudine + Abacavir + dolutegravir

Dutrebis

Lamivudine + + Raltegravir

Cimdue

Lamivudine + TDF

Delstrigo

Lamivudine + doravirine + TDF

Symfi

Lamivudine + efavirenz + TDF

Symfi LO

Lamivudine + efavirenz (lower than symfi) + TDF

Truvada Generic Indication Renal adjustment

Emtricitabine + TDF Prevention of HIV infection in adults not for crcl <30

Descovy Generic Indication Renal adjustment

Emtricitabine + TAF HIV prevention in >12y.o and >35kg Not for crcl <30

Atripla Generic

Efavirenz + emtricitabine + TDF

Complera generic Renal adjustment

Rilpivirine + emtricitabine + TDF not for crcl <50

Odefsey generic Renal adjustment

Rilpivirine + entricitabine + TAF not for crcl < 30

Symtuza generic Renal adjustment

Darunavir + cobicistat + emtricitabine + TAF Not for CrCl <30

Stribild generic Renal adjustment

Elvitegravir + cobicistat + emtricitabine + TDF not for Crcl < 70

Genvoya generic renal adjustment

Elvitegravir + cobicistat + emtricitabine + TAF not for crcl <30

Biktarvy generic Renal adjustment

Bictegravir + emtricitabine + TAF Not for crcl <30

Juluca generic When to use (4) ADE

Dolutegravir + rilpivirine 1. Virologically suppressed 2. On stable antiretroviral regimen for >6 months 3. No history of treatment failure 4. No resistance to dolutegravir or rilpivirine Suicidality, rash, hepatotox

Dovato generic Indication

Dolutegravir + lamivudine Two drug regimen for HIV patients who have never received treatment

Cabenuva generic Indication Dose Storage

Cabotegravir + Rilpivirine IM monthly or every two months Refrigerated

What is the recommendation for treatment naive HIV patients?

2 NRTI's with a third agent from a different class

Recommendation for pregnant HIV patients? What about during labor? Do you give anything to the baby?

Three drug combination Then during labor give zidovudine IV until deliver For the infant, give zidovudine oral syrup within 6-12 hours after birth

What is a good treatment-naive option for pregnant HIV patients?

TAF + emtricitabine + dolutegravir

Which 2 HIV meds must be taken on an empty stomach?

Efavirenz = sustiva Fosamprenavir - lexiva oral suspension in ADULTS

Which 3 HIV meds must be taken with food?

Rilpivirine Etravirine All PI's (fosamprenavir with food in pediatrics)

What is the regimen for post-exposure prophylaxis?

Start ASAP for at least 28 days 2 NRTI's + a 3rd agent

What are the 3 PrEP options? brand name.

Truvada Descovy Apretude

When is it okay to give MMR or varicella to AIDS patients? IS it different for HIV?

NEVER for AIDS Can give to asymptomatic HIV patients with CD4 > 200