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HIV Flashcards

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1
Q

Transmission of HIV

A
  • Infected body fluids of mucosal membranes and open wounds
  • Unprotected sex
  • Sharing injection
  • mother-to-child vertical transmission
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2
Q

HIV Screening recommendations

A

At least once for all patients
Annual testing is recommended for those with history of STIs, hepatitis, or TB
High risk activities:
- Multiple sexual partners
- MSM
- Sex with person infected
- Sharing drug injection equipment

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3
Q

Sx of acute HIV infection

A

Flu-like sx

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4
Q

Complications of AIDS progression

A

CD4 <200 or AID-defining conditions:
- Opportunistic infection
- Kaposi’s sarcoma
- HIV wasting syndrome (lipoatrophy, anorexia, diarrhea)

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5
Q

Treatment for HIV wasting syndrome

A

Stimulate appetite: dronabinol (Marinol, Syndros), Megestrol (progestin)

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6
Q

How to diagnose HIV

A

Initial HIV antibody and antigen screening → confirmatory test to determine if HIV 1 or 2 (antibody differentiation immunoassay)

Nucleic acid test: HIV RNA (viral load)

Antibody detection appears 4-12 weeks

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7
Q

HIV test at home

A

OraQuick

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8
Q

Counseling on OraQuick

A

1 line = negative
2 line: positive

Testing sooner than 3 months after exposure can lead to false negative → due to lag in antibody production

If positive must follow-up with a confirmatory test

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9
Q

Drugs that inhibit the binding and attach of HIV

A

CCR5 antagonist: Maraviroc
Attachment inhibitor: fostemsavir
Post-attachment Ibalizumab-uiyk

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10
Q

Fusion inhibitors

A

Enfuvertide

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11
Q

Classes of drug that inhibit reverse transcription

A

NNRTI
NRTI

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12
Q

Drugs that inhibit nuclear import

A

Capsid inhibitor: Lenacapavir

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13
Q

Class the prevents HIV DNA from combining to host DNA

A

Integrase inhibitor

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14
Q

Class of drug that prevents the assembly of the new HIV virus

A

Capsid inhibitor: Lenacapavir

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15
Q

Class of drug that prevent maturation and budding of the HIV

A

PIs
Capsid inhibitor: Lenacapavir

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16
Q

Describe the HIV replication stages

A

Attachment and Binding: HIV binds to CD4 recpetor and coreceptors (CCR5 or CXCR4) on the surface of the host CD4 cell
Fusion: Viral envelope fuse with CD4 membrane and inner capsid is released
Revere transcription: HIV RNA is converted to HIV DNA by reverse transcriptase
Nuclear import: HIV capsid enters the cell necleus via nuclear pore
Integration: Integrase inserts HIV DNA into host DNA
Transcription and translation: Host cell machinery translate HIV DNA to HIV RNA and protein
Assembly: HIV protein, enzymes, and RNA assmeble and the cell surface
Budding and Maturation: Immature virus pinches off the cell → protease breaks down viral chain forming new capsid and mature virus infects other CD4

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17
Q

Drug that needs specific screenings

A

Abacavir: HLA-B*5701
Maraviroc: Tropism assay

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18
Q

Most preferred treatment for HIV naive

A

2NRTIs and 1 INSTIs
- Truvada and Descovy make up NRTI backbone

Dovato (NRTI+INSTI) can be used with the exception of HIV RN >50,000, HBV coinfection, HIV genotypic is not preformed

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19
Q

One pill medication

A

Biktarvy
Triumeq
Dovato

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20
Q

2 pill once daily regimins

A

Trivicay + Truvada
Trivicay + Descovy

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21
Q

Biktarvy

A

Bictegravir + Emtricitabine + TAF

INSTI + NRTI + NRTI

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22
Q

Triumeq

A

Doltegravir + Abacavir + Lamivudine

INSTI + NRTI + NRTI

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23
Q

Dovato

A

Doltegravir + Lamivudine

INST + NRTI

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24
Q

Trivicay

A

Doltegravir

INSTI

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25
Truvada
Emtricitabine + TDF | NRTI + NRTI
26
Descovy
Emtricitabine + TAF | NRIT + NRTI
27
What are components of alt HIV regimens
2 NRTI (backbone) with 1 base of: - PI + PK booster (Cobicastat, ritonavir) - NNRTI - INSTI
28
HIV regimen for pregnancy
2 NRTIS + INSTI (doltegravir preferred) or a boosted PI (darunivir preferred) IV zidovuzine to prevent perinatal HIV transfusion
29
What is IRIS
Immune reconstitution inflammatory syndrome: paradoxical worsening of known underlying condition after ART was started (Unmasked due to recovering immune system) Continue ART treatment and treat unmasked condition
30
RF of developing IRIS
1. CD4 is low and beginning to recover 2. Underlying OI, HSV, Hep B or C, autoimmune condition, cancers (Kapok's sarcoma)
31
NRTIs
Zidovudine Lamivudine Abacavir TAF TDF Entricitabine
32
Viread
TDF | NRTI
33
NRTI that doesn't require renal adjustment
Abacavir
34
Warning of all NRTIs
Lactic acidosis, hepatomegaly with steatosis BBW in zidovudine
35
NRTIs that can exacerbate HBV
HBV can exacerbated when abruptly discontinuing emtricitabine, tenofovir, lamivudine
36
Counseling on Abacavir
HLA-B*5701 → hypersensitivity Do not rechallenge
37
Drug that causes hyperpigmentation
Emtricitabine
38
Risks with TAF and TDF
TDF > TAF Renal impairment, Fanconi syndrome Decreased bone mineral density → supplement with Calcium and Vit D TAF: lipid abnormalities
39
BBW of zidivudine
Hematologic toxicity: neutropenia and anemia (macrocytotic)
40
INSTIs
Biktegravir Cabotegravir Raltegravir Elvitegrivir Dolutegravir
41
Isentress
Raltegravir | INSTI
42
Apretude
Cabotegravir | INSTI
43
ADR of all INSTIs
Weight gain, insomnia, depression/suicidal ideation (with preexisting psychiatric conditions)
44
INSTIs that ↑ sCr with no effect to GFR
Bictegravir, Dolutegravir
45
INSTIs that cause myopathy, CPK elevation and rhabdo
Raltegravir, dolutegravir
46
ADR of dolutegravir
Hepatotoxicity
47
Drug interaction of INSTI
Cation should be taken 2 hrs before or 6 hrs after INSTI (decreases INSTI absorption)
48
Renal parameters of starting INSTI regimens
CrCl <70: don't start Striblid CrCl <60: DC Stribild CrCl <30: Don't start Biktarvy or Genvoya
49
NNRTIs
Rilpivirine Efavirenz Doravirine Etravirine Navirapine
50
NNRTI that requires an acidic environment
Rilpivirine: avoid PPIT and separate from H2RAs and antacids Avoid PPIs Separate H2RA 12 hrs before or 4 hr after Separate antacids 2 hrs before or 4 hrs after
51
NNRTI that require a meal and water
Rilpivirine
52
Counseling on efavirenz
Take on an empty stomach QHS to ↓ CNS effects
53
ADR of all NNRTIs
Hepatotoxicity, rash (SJS/TEN) Highest in nevirapine
54
ADR of Efavirenz
Psychiatric sx (depression, suicidal ideation) CNS effects resolves in 2-4 wks ↑ total cholesterol and TG
55
ADR of Rilpivirine
Depression ↑ sCr with no effect on GFR Don't use if VL is >100,000 and CD4 <200 → higher failure rate
56
DDI of NNRTI
All NNRTIs are CYP3A4 substrates Avoid inducers for rilpivirine and doravirine Efavirenz and etravirine are CYP3A4 inducer
57
PIs
Atazanavir Darunivir
58
Reyataz
Atazanavir
59
Prezista
Darunavir
60
Recommendation of PIs
Recommend with PK booster No renal adjustment Take with food to ↓ GI upset (daranuvir and atazanavir)
61
PI that needs an acidic gut
Atazanavir
62
ADR of all PIs
Metabolic abnormalities: DLD, ↑ BG, insulin resistance, ↑ body fat and lipodystrophy → ↑ CV risk Hepatic dysfunction: ↑ LFTs, hepatitis, exacerbation of preexisting hepatic disease Rash (SJS/TEN) Diarrhea, nausea
63
PI to avoid in sulfa allergies
Darunivir
64
ADR of Atazanavir
Hyperbiluremia (reversible, no need to dc) Acidic gut: avoid PPIs 12hrs after PPI (don't exceed omeprazole 20 mg)
65
PK booster
Ritonavir Cobicistat
66
Dosing of PK booster
Ritonavir: 100-200 mg with food Cobicistat: 150 mg with food
67
DDI of PK booster
Inhibitors of CYP3A4 Not interchangeable
68
Drugs that are CI with PK boosters
Alpha-1 blocker Amiodarone, dronedarone Anticoagulants and platelets Azole Hep C PI Lovastatin and simvastatin PDE5I CYP3A4 inducers Systemic, inhaled, IN steroids
69
CCR5 antagonsit
Maraviroc
70
Attachment inhibitor
Fostemsavir (Rukobia)
71
Post-attachment inhibitor
Ibalizumab-uiyk
72
Fusion inhibitor
Enfuvirtide
73
Stages lencapavir inhibits
1. Capsid transport 2. Virus assembly 3. Capsid formation
74
Cabenuva
Cabotegravir + Rilpivirine | INSTI + NNRTI
75
Juluca
Doltegravir + Rilpivirine | INSTI + NNRTI
76
Stribilid
Elvitegravir + Cobicistat + Emtricitabine + TDF | INST + PK + NRTI + NRTI
77
Genvoya
Elvitegravir + cobicistat + emtricitabine + TAF | INST + PK + NRTI + NRTI
78
TAF and TDF renal adjustments
CrCl <50: don't start TDF products (<70 for Stribild) CrCl <30: don't start TAF products (Genvoya, Biktarvy)
79
Symfi
Efavirenz + lamivudine + TDF | NNRTI + NRTI + NRTI
80
Complera
Rilpivirine + emtricitabine + TDF | NNRTI + NRTI + NRTI
81
Odefsey
Rilpivirine + emtricitabine + TAF | NNRTI + NRTI + NRTI
82
Symtuza
Darunavir + cobicistat + emtricitabine + TAF | PI + PK + NRTI + NRTI
83
Epzicom
Abacavir + lamivudine | NRTI + NRTI
84
Counseling on cobicistat products
Take with food
85
What to check before starting PrEP
1. Negative HIV 2. Confirm CrCl 3. Screen for hepatitis B
86
How often to follow up with PrEP
Truvada and Descovy: Q3M Cabotegravir: 1 month after inj then Q2M
87
What is nPEP
Nonoccupational: - After sex without condom - Injection drug use
88
What is oPEP
Needlestick injury
89
How long is PEP
Started within 72 hrs and continued for 28 days
90
Tx for PrEP
Before high-risk activity: PO QD: Truvada or Descovy (men only) OR IM drug QM x 2 months then Q2M (Cabotegravir)
91
Tx for PEP
After HIV exposure: Truvada (CrCl ≥60) + Dolutegravir (Trivicay) or Raltegravir (Isentress)

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