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Naplex 2025 > HIV > Flashcards

HIV Flashcards

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1
Q

What is Human Immunodeficiecny Virus (HIV)?

A
  • Single stranded RNA Retrovirus that used the machinery in CD4 T Helper Cells to replicate - once replicated they burst through the CD4 cell membrane = Destruction of the cell

Viral overload can decrease CD4 levels = increased risk for opportunisitic infedctions

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2
Q

What is the way that HIV is able to be spread? What are some of the common ways?

A
  • Direct contact with infected bodily fluid and mucus membranes or open wounds
  • Most commonly spread by unprotected vaginal or anal sex, woman to child via birth or breastfeeding
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3
Q

What are the screening recommendations for HIV?

A
  • ALL patients 13 - 64 yo should be screened ONCE
  • Annual testing for those that have Hx of STIs, Hepatitis or TB
  • Those that engage in high risk activities: Sex with multiple partners, Men having sex with men, anal or vaginal sex with someone that has HIV, sharing needles
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4
Q

When is AIDS diagnosed?

A
  • When CD4 count < 200 or AIDS defining condition is present: OIs (PJP, MAC), Kaposi’s Sarcoma, Wasting Syndrome (loss of fat)
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5
Q

What is the diagnostic testing algorith for HIV?

A
  • 1st: screening for HIV-1, HIV-2 Antigen, Antibody immunoassay (looking for p24)
  • Positive?: Confirmation Test (HIV-1, HIV-2)
  • Inderterminate or Negative: HIV-1 Nucleic Acid Test (looks at viral load)
  • or Positive: find subtype

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6
Q

What is the OTC HIV Testing Kit?

A
  • OraQuick: detects the presence of HIV antibodies
  • If positive MUST get a follow up with the confirmatory lab test
  • Testing sooner than 3 months after exposure = false negative
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7
Q

What are the Stages of HIV repliaction?

A
  • 1.: Binding and Attachment (HIV attaches to CD4 receptors
  • 2.: Fusion (HIV viral envelope infuses with cell membrane releasing contents into it)
  • 3. Reverse Transcription (HIV RNA id converted to HIV DNA)
  • 4.: Nuclear Import (HIV capsid transports into cell)
  • 5. Integration (HIV DNA inserts into host DNA)
  • 6.: Transcription and Translation (Host machinery is used to make the new HIV DNA/RNA)
  • 7. Assembly (New HIV RNA, proteins, enzymes are made at cell surface)
  • 8. Budding and Meturation (Immature viruse is pinched off to repeat the process)
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8
Q

What drug classes work on the 1. Binding and Attachment stage of HIV replication?

A
  • CCR5 Antagonist: Maraviroc
  • Attachment Inhibitors: Fostemsavir
  • Post-Attachment Inhibitors: Ibalizumab-uiyk
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9
Q

What drug classes work on the 2. Fusion stage of HIV replication?

A
  • Fusion Inhibitors: Enfuvirtide
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10
Q

What drug classes work on the 3. Reverse Transcription stage of HIV replication?

A
  • NRTIs
  • NNRIs
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11
Q

What drug classes work on the 4. Nuclear Import stage of HIV replication?

A
  • Capsid Inhibitors: Lenacapavir
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12
Q

What drug classes work on the 5. Integration stage of HIV replication?

A
  • INSTIs
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13
Q

What drug classes work on the 6. Transcription and Translation stage of HIV replication?

A
  • NONE
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14
Q

What drug classes work on the 7. Assembly stage of HIV replication?

A
  • Capsid Inhibitors: Lenacapavir
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15
Q

What drug classes work on the 8. Budding and Maturation stage of HIV replication?

A
  • PIs
  • Capsid Inhibitors: Lenacapavir
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16
Q
A
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17
Q

What are the One-Pill, Once Daily ART regimens that are preferred for those with needing initial ART treatment?

A
  • Biktarvy: Bictegravir/ Emtricitanine/ Tenofovir Alafenamide
  • Triumeq: Dolutegravir/ Abacavir/ Lamivudine
  • Dovato: Dolutegravir/ Lamivudine
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18
Q

What are the Two-Pills Once Daily ART regimens that are preferred for those with needing initial ART treatment?

A
  • Tivicay + Truvada: Dolutegravir + Emtricitabine/ Tenofovir Disoproxil Fumarate
  • Tivicay + Descovy: Dolutegravir + Emtricitabine/ Tenofovir alafenamide
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19
Q

What are the Drug classes that are used in ART regimens?

A
  • NRTIs
  • INSTIs
  • NNRTIs
  • PIs
  • Enhancers (boosters)
  • Entry & Attachment Inhibitors
  • Capsid Inhibitors
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20
Q

What are the Nucleoside/Nucleotide Reverse transcriptase Inhibitors (NRTIs) that are used fro HIV

Remember Z ❤️ LATTE

A
  • Abacavir
  • Emtricitabine
  • Lemivudine
  • Tenofovir Disoproxil Fumareate [TDF] (Viread)
  • Tenofovir Alafenamide
  • Zidovudine
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21
Q

What is the MOA for the NRTIs?

A
  • Competitively inhibits the reverese transcriptase enzymes = prevention of HIV RNA to DNA
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22
Q

What are some important administration information about the NRTIs used for HIV?

A
  • Tenofovir (both of them): once daily
  • Abacavir & Lamivudine: once daily and twice daily regimens
  • ALL NRTIs: dose adjust for Renal Impairment (except abacavir)
  • Zidovudine: Give IV during labor and delivery to prevent HIV transfer

ABACAVIR needs HLA-B * 5701 testing

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23
Q

What are some of the key features and safety issues for all of the NRTIs used for HIV?

A
  • Warning: lactic acidosis and hepatomegaly with steatosis (boxed warnings with zidovudine)
  • Common side effects: Nausea, Diarrhea
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24
Q

What are some Key feature and safety issues for Abacavir used for HIV?

A
  • Boxed warnings: Hypersenstivity reactions - MUST test for HLA-B * 5701, patient must carry a card about the HSR, NEVER rechall
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25
What are some **key features and safety issues** for **emtricitabine** used for **HIV**?
- Hyperpigmentation on palms of hands and soles of feet
26
What are the **Integrase Strand Transfer Inhibitors (INSTIs)** that are used in **HIV** ## Footnote **-tegravir** Remember **B CRED**
- **Betegravir** (**ONLY** in combo with **bictarvy**) - **Cabotegravir (Apretude)** [Also a component of **Cahenuva**] - **Doluetgravir (Tivicay)** [Also a component of **Triumeq, Dovato** & Juluca] - **Elvitegravir** (**ONLY** in combo with **Genoya & Stribild**) - **Raltegravir (Isentres)**
27
what is the **MOA** for the **INSTIs**?
- Blocks the **integrase** enzyme, preventing HIV DNA from **inserting** into the host cell DNA
28
What are some important **administration** information about the **INSTIs** used for **HIV**?
- **ONCE DAILY** everything except Insentress (**twice daily**) - CrCl **< 70** DO NOT start **Stribild** - CrCl **< 50** DISCONTINUE **Stribild** - CrCl **< 30** DO NOT start **Biktarvy or Genvoya** - Apretude is ONLY for **PrEP**
29
What are some **side effects and warnings** for **ALL INSRTIs** used for **HIV**?
- Weight gain, insomnia, rare risk of depression and suicidal ideations in patients with pre-existing conditions
30
What are some **key features and safety issues** for **INSTIs** used for **HIV**?
- Cations and INSTIs do **NOT** go together - Take **INSTIs 6 hours before** or **6 hours after** anything contianing **Al, Ca Mg, or Fe**
31
What are the **Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)** that are used for **HIV**? ## Footnote Contian **-vir-** in name Remember **REDEN**
- **Efavirenza** - **Rilpivirine** (Component of **complera, Odefsey, Cabenuva**) - Doravirine - Etravirine - Nevirapine
32
What is the **MOA** for the **NNRTIs**?
- Non-competitively **inhibit** the **reverse transcriptase** enzymes, preventing the conversion of HIV RNA to DNA
33
What are some importent **administration** information about the **NNRTIs** that are used for **HIV**? ## Footnote Rilp & Efav
- Rilpivirine: **Oral** - take with **meal** and water (DO NOT substitute with protein drink) & NEEDS **acidic enviroment** for absorpation (DO NOT use with PPIs and separate from H2RAs/Antacids); **IM** - part of Cabenuva - Efavirenz: take on **emtpy stomach QHS** (helps with bioavailability and decrease CNS effects)
34
What are some **key features and safety issues** for **ALL NNRTIs** used for **HIV**?
- Have risk of **heptaotoxicity and Rash** (highest risk with Nevirapine)
35
What are some **key features and safety issues** for **efavirenz** used for **HIV**?
- Psych Symptoms (i.e.; depressoin, suicidal thoughts) - CNS effects (why you tak on empty stomach QHS) - Can increase Cholesterol and Trigylcerides
36
What are some **key features and safety issues** for **Rilpivirine** used for **HIV**?
- Depression - Increase SCr with no effect on eGFR - DO NOT use with high viral loads and low CD4 counts - Cabenuva IM: injection site reactions
37
What are some of the **Protease Inhibitors (PIs)** that are used in **HIV**? ## Footnote **-navir**
- Atazanavir - Darunavir - Ritonavir
38
What is the **MOA** for the **PIs**?
- Inhibits the HIV **Protease Enzymes** preventing the formation of the mature virus during the **budding and maturation stage**
39
What are some Important **administration** information for the **PIs** used for **HIV**?
- For **ALL PIs** take with a booster (**ritonavir or cobicistat**) - Atasanavir: Take with food, needs **acidic environment** (DO NOT use with PPIs & separate from H2RAs/Antacids) - Darunavir: Take with food
40
What are some **key features and safety issues** for **ALL PIs** used for **HIV**?
- **Metabolic Issues** (hyperglycemia/Insulin resistance, dyslipidemia, increased body fat) - **Hepatic Dysfunctions** (increased LFTs, Hepatitis, exacerbation of preexisiting hepatic diseases - **Hypersensitivity Reactions** (rashes, angioedema) - **Diarrhea, Nausea**
41
What are some **key features and safety issues** for **Darunavir, Fosamprenavir, Tipanavir** used for **HIV**?
- Caution with sulfa allergy
42
What are the **pharmackinetic boosters (enhancers)** that are used for **HIV**?
- **Ritonavir (Norvir)** [Componet of Kaletra and Paxlovid] - **Cobicistat (Tybost)** [Component of **Genvoya, Stribild, Symtuza**, Prezcobix, Evotaz]
43
What is the **administration** of **both Ritonavir & Cobicistat**?
- Ritonavir: **100 - 200 mg** PO once or twice daily **with** boosted drug (Darunavir or Atazanavir) and **with food** - Cobicistat: 150 mg PO daily **with** the boosted drug and **with food**
44
What are some **key features and safety issues** for **pharmacokinetic boosters (Enhancers)** used for **HIV**?
- Riton & Cobic are **3A4 Inhibitors** (where the "boost" toward the ARTs come from) - Ritonavir is **NOT** well tolerated at higher doses - Riton & Cobic are **NOT** interchangable & **DO NOT** use both together - **DRUG INTERACTIONS**
45
What are the **entry and attachment inhibitors** that are used for **HIV**
- CCR5 Antagonist - **Maraviroc (Salzentry)** - Attachment Inhibitor - **Fastemsavir (Rukobia)** - Post-Attachment Inhibitor - **Ibalizumab-uiyk (Trogarzo)** - Fusion Inhibitor - **Enfuviritide (Fuzeon)**
46
What is the **MOA** for **Maraviroc**?
- **Blocks** HIV from **binding** and **entering** to CD4 cell that use the **CCR5 receptors**
47
What are some **key features and safety issues** for **Maraviroc** used for **HIV**?
- Must have **tropism assey** before starting (**ONLY** binds to **CCR5**) - If HIV can bind to **CXCR4 or MIXED** (CXCR4/CCR5) then Maraviroc **will not work**
48
What is the **MOA** for **Fostemsavir**?
- Converted to temsavir which binds to gp120 = **inhibition between the virus and host cell**
49
What is the **MOA** of **Ibailizumab-uiyk**
- Monoclonal antibody that binds to CD4 receptors, **blocking the entry of the virus into the cell**
50
what is the **MOA** for **Enfuviritide**
- Prevents HIV from **fusing** to the CD4 cell = **prevents entry**
51
What are some **key features and safety issues** for **Enfuvirtide** used for **HIV**?
- Local **injection site reactions** - SubQ injection
52
What is the **brand name** of **Bictegravir/ Emtricitabine/ Tenofovir Alafenamide** used for **HIV**? ## Footnote INSTI Based
- Biktarvy ## Footnote **1st line** **DO NOT** start if CrCl < 30 (due to alafenamide)
53
What is the **brand name** of **Cabotegravir/ Ripivirine** used for **HIV**? ## Footnote INSTI Based
- Cabenuva ## Footnote **IM once monthly** **ONLY** indicated to replace a stable ART regimen in patient with Virologic suppression
54
What is the **brand name** of **Dolutegravir/ Abacavir/ Lamivudine** used for **HIV**? ## Footnote INSTI based
- Triumeq ## Footnote **1st Line**
55
What is the **brand name** of **Dolutegravir/ Lamivudine** used for **HIV**? ## Footnote INSTI based
- Dovato ## Footnote **1st line**
56
What is the **brand name** of **Elvitegravir/ Cobicistat/ Emtricitabine/ Tenofovir Disoproxil Fumarate** used for **HIV**? ## Footnote INSTI based
- Stribild ## Footnote CrCl **< 70** DO NOT start **take with food**
57
What is the **brand name** of **Elvitegravir/ Cobicistat/ Emtricitabine/ Tenofovir Alafenamide** used for **HIV**? ## Footnote INSTI based
- Genvoya ## Footnote CrCl **< 30** DO NOT start **take with food**
58
What is the **brand name** of **Rilpivirine/ Emtricitabine/ Tenofovir Disoproxil fumarate** used for **HIV**? ## Footnote NNRTI based
- Complera ## Footnote CrCl **< 50** do not start **take with food**
59
What is the **brand name** of **Rilpivirine/ Emtricitabine/ Tenofovir Alafenamide** used for **HIV**? ## Footnote NNRTI based
- Odefsey ## Footnote CrCl **< 30** DO NOT start **Take with food**
60
What is the **brand name** of **Darunavir/ Cobicistat/ Emtricitabine/ Tenofovir Alafenamide** used for **HIV**?
- Symtuza ## Footnote Take with food CrCl **< 30** DO NOT start
61
What is the **brand name** of **Abacair/ Lamivudine** used for **HIV**? ## Footnote NRTI combo (must be used with additionla ART reg)
- Epzicom ## Footnote Requires **HLA-B * 5701
62
What is the **brand name** of **Emtricitabine/ Tenofovir Alafenamide** used for **HIV**? ## Footnote NRTI combo (must be used with additional ART reg)
- Descovy ## Footnote Part of **1st line** regs CrCl **< 30** DO NOT start
63
What is the **brand name** of **Emtricitabine/ Tenofovir Disoproxil Fumarate** used for **HIV**? ## Footnote NRTI Combo (must be used with additional ART reg)
- Truvada ## Footnote Part of **1st line** regs CrCl **< 50** DO NOT start; **< 60** if using for PrEP
64
What are the **treatment options** for **HIV prevention**?
- **PrEP**: giving ARTs to prevent HIV infection for those that do **HIGH RISK activities** - **PEP**: for emergency situations (when a non-infected person comes in contact with infected fluids)
65
What are the **Treatment options** for **PrEP**?
- Oral **Truvade or Descovy** daily (90 day supply) - **+** IM **Cabotegravir** monthly for 2 dosesm then every 2 months
66
What are some things that need to be done **before** starting **PrEP**?
- **CONFIRM** HIV **NEGATIVE** - Check **CrCl** (< 60 cannot start **Truvada** or < 30 cannot start **Descovy**) - Screen for Hep B and STIs
67
What are some things that need to be done at **PrEP follow up visits**?
- Test for HIV and **confirm its NEGATIVE**
68
What are the **two types** of **PEP**?
- nPEP: used **after sex without condom, injection drug use** - oPEP: for healthcare professional that are exposed (i.e.; Needlestick) ## Footnote Should start **ASAP within 72 hours** and continue for **28 days**
69
What are the **drugs** that are used for **PEP**?
- Truvada + Dolutegravir or Raltegravir

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