HIV Flashcards
(13 cards)
AIDS dx
<200 CD4 or an AIDS defining condition (see below)
- opportunistic infectiono
- certain cancers (Kaposi’s sarcoma is one of them)
- HIV wasting syndrome - loss of fat tissue, muscle mass, and appetite
stages of the HIV life cycle and what targets what
- binding and attachment of HIV to host CD4: maraviroc, fostemsavir, ibalizumab
- fusion (enters the cell): enfuviritide
- reverse transcriptase (HIV RNA turns into DNA): NNRTI, NRTI
- HIV DNA enters nucleus of CD4: lenacapavir
- integration into host DNA: INSTI
- transcription and translation
- assembly: lenacapavir
- budding and maturatoin: PI, lenacapavir
lenacapavir acts at stage 4, 7, and 8
important lab tests for HIV pts
- CD4 count and viral load
- HIV genotype testing
- CMP
- HepB and C screening
- pregnancy test
- HLA-B*5701 if consideringg abacavir
- troponin assay if considering maraviroc
HIV once daily pill options
- one pill a day: Biktarvy, Triumeq (HLA-B*5701 testing required dt abacavir component), Dovato^
- 2 pills once a day: Tivicay plus one of the following - Truvada or Descovy
- ^ Dovato is NOT preferred if viral load >500,000, HepB co infection or if genotype is unidentified
- these are the initial preferred treatment for most pts but canNOT be used if CrCl < 30
- the difference between Truvada and Descovy is that one is TAF and the other is TDF
what is IRIS
immune reconstitution inflammatory syndrome
- worsening of underlying condition because your immune system was too weak to mount an response and suddenly now it can so now you have symptoms
- treat symptoms but do NOT stop ART
HIV ART regimens consist of what
- an NRTI backbone consisting of (TDF, TAF or abacavir) + (emtricitabine or lamivudine)
- a base
NRTIs and safety issues
Z-LATTE
- Zidovudine: administered IV during labor and delivery; warning for hematologic tox
- Lamivudine
- Abacavir: needs HLA-B*5701 screening, hypersensitivty warning- pt must carry a card
- TDF: da fuq (it bad) - renal imparment and decreased bone mineral density
- TAF: cool AF
- Emtricitabine: hyperpigmetation of palms and soles
- ADR for lactic acidosis and hepatomegaly,
- exept for abacavir, all need renal adjustment
INSTIs and safety issues
B-CRED
- Bictegravir: only available in Biktarvy, do NOT start if CrCl < 30; can increase SCr without affecting eGFR
- Cabotegravir: Apretude is PrEP only
- Raltegravir: the only BID one; hypersensitivty rxn and rhabdo concerns
- Elvitegravir: available in 2 combo drugs - do NOT start Stribild if CrCl < 70, stop if < 50; do NOT start Genvoya if CrCl < 30
- Dolutegravir: increae in SCr without affecting eGFr, hypersensitivty and rhabdo concerns; hepatotox
- take 2 hrs before or 6 hours after products containing Ag, Ca, Mg, Fe
NNRTIs and safety concerns
REDEN
- rilpivirine: needs acidic gut for absorption, take with meal and do NOT use a PPI, separate from an H2RA; can increase SCr without affecting eGFR, do NOT use if initial viral load >100,000 or CD4 < 200
- efavirenz: take on an empty stomach; CNS effects and increase in TC and TG
- doravirine
- etravarien
- nevirapine
hepatotox, SJS, TENS
all are major CYP3A4 substrates - rilpivirine esp; efavirenz is actually a mdoerate inducer
PIs and safety considerations
- atazanivr: take with food to decrease GI upset, but also needs an acidic envirornment (no PPI, separate from H2RAs)
- darunavir: take wtih food to decrease GI upset; caution with sulfa allergy
recommend booster (cobicistat or ritonvair) - take with food
- metabolic abnormaities - insulin resistance, dyslipidemia, increased body fat
- hepatic dysfunction
- hypersenstiivity reaction: angioedema, anaphylaxis, SJS/TENS
PI and boosters DDI
CYP3A4 that are contraindicated or should be avoided
- alpha-1 blockers (tamsulosin)
- amiodarone, dronaderone
- apixaban, xarelto, ticagrelor
- azole antifongals
- HepC protease inhibitors
- lovastatin and simvastatin
- PDE-5 inhibiitors (sildenafil, tadalafil)
- strong CYP3A4 inducers: CBZ, phenytoin, rifampin, st. john wort)
- systemic, inhaled, and intranasal steroids
maraviroc MOA and safety considerations
- blocks HIV from binding to CCR5 and entering CD4 cells - only works if that’s the way the virus gets in though (if it binds to CXCR4 or is mixed, will not work)
- needs a baseline tropism assay to determine HIV strain
PrEP meds and PEP meds
PrEP
- apretude (cabotegravir only inj)
- truvada
- descovy
need to confirm that that pt is HIV (-) for PrEP
PEP - start within 72 hrs and take for 28
- Truvada
- Tivicay
- Raltegravir
