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HIV Flashcards

(52 cards)

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1
Q

What is HIV?

A

Retrovirus, attacks immune system, mainly the CD4+ T-helper cells

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2
Q

How does HIV spread?

A

Via blood, semen, vaginal secretions

Also can go from mother to child during pregnancy, childbirth, or breastfeeding

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3
Q

When do HIV antibodies show positive on a diagnostic test? What about HIV p24 antigen?

A

4-8 weeks after contracting the disease, up to 3-6 months for some people
HIV p24 antigen shows up 2 weeks after infecgtion

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4
Q

CDC recommended testing algorithm

A

Combination HIV Ab and p24 antigen immunoassay test

If positive, perform confirmatory testing with HIV-1/HIV-2 antibody differentiation immunoassay test

(not underlined but if 2nd test is negative, use an HIV nucleic acid test to confirm)

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5
Q

Why do we monitor CD4

A

Indicator of immune function, also determines need for OI prophylaxis
Monitor every 3-6 months

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6
Q

Why do we monitor HIV viral load

A

Determines response to antiretroviral therapy

Goal: undetectable

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7
Q

Drug specific testing required?

A

HLA-B*5701 for abacavir

Tropism for maraviroc

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8
Q

Where do CCR5 antagonists work?

A

Binding/attachment (stage 1)

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9
Q

Where do fusion inhibitors work?

A

Fusion lol (stage 2)

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10
Q

Where do NRTI’s and NNRTI’s work?

A

Reverse transcription (stage 3)

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11
Q

Where do INSTI’s work?

A

INSTI = integrase strand transfer inhibitors

Work at integration (stage 4)

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12
Q

Where do protease inhibitors work?

A

Budding and maturation (stage 7)

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13
Q

Pregnant women ART regimen

A

2 NRTI’s
PLUS
either a boosted PI or INSTI

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14
Q

Boxed warnings for NRTI’s

A 
Abacavir
Lamivudine
Emtricitabine
Tenofovir disoproxil
Tenofovir alafenamide

Lactic acidosis
Severe hepatomegaly with steatosis

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15
Q

Which drug requires a warning card to be dispensed with the medguide?

A

Abacavir (Ziagen)

and combos - Epzicom, Triumeq

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16
Q

Lamivudine can be used for HBV or HIV. Can you use the same dose?

A

No, dose used in HBV is lower and can result in HIV drug resistance

Epivir-HBV =/= Epivir
If treating both, use higher HIV dose

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17
Q

SE lamivudine

A

N/V/D

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18
Q

SE abacavir

A

hypersensitivity rxn

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19
Q

SE emtricitabine

A 
N/V/D
Rash
Dizziness
HA
Insomnia
Hyperpigmentation
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20
Q

SE tenofovir disoproxil fumarate

A

Renal toxicity, osteoporosis, Fanconi syndrome

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21
Q

SE tenofovir alafenamide

Study These Flashcards
A

Nausea

Less risk of renal toxicity, osteoporosis, Fanconi syndrome vs TDF

22
Q

Which medications should be taken with food?

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A

Complera (rilpivirine + 2 NRTI)
Stribild (elvitegravir + cobicistat + emtricitabine + TDF)
Odefsey (rilpivirine + 2 NRTI)
Genvoya (elvitegravir + cobicistat + emtricitabine + TAF)
Prezista (Darunavir)
Reyataz (Atazanavir)

PI’s due to N/V/D (darunavir, atazanavir)

23
Q

1 tab qdaily regimens

Study These Flashcards
A

Atripla (efavirenz + tenofovir DF + emtricitabine)
Complera (rilpivirine + tenofovir DF + emtricitabine)
Genvoya (Stribild w/ TAF instead of TDF)
Stribild (Elvitegravir + cobicistat + tenofovir DF + emtricitabine)
Triumeq (dolutegravir + abacavir + lamivudine)

24
Q

Which medications should be taken on an empty stomach?

Study These Flashcards
A

Atripla (efavirenz)

25
Which medication should be dispensed in its original container?
Tenofovir disoproxil fumarate (TDF) | Atripla, complera, stribild, and truvada all have TDF
26
NNRTI class effects
No renal dose adjustment needed Primarily CYP450 inducers (rilpivirine is a substrate) Hepatotoxicity and rash (including SJS/TEN)
27
Efavirenz SE
``` Psychiatric symptoms (suicidal ideation, depression) CNS symptoms (impaired concentration, abnormal dreams, confusion, dizziness) rash, convulsions, QT prolongation ```
28
Rilpivirine SE
Depressive disorders, mood changes, insomnia CONTRAINDICATED w PPI's
29
Drug intx NRTI's
None really yay
30
Drug intx NNRTI's
CYP inducers Efavirenz = CYP inducer and inhibitor Rilpivirine = contraindicated with strong 3A4 inducers because it is also a 3A4 substrate (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, PPI's) Methadone levels can be reduced with efavirenz Hormonal contraceptive levels can be reduced with efavirenz
31
Protease inhibitor class things
``` end in -navir Mostly CYP inhibitors No renal dose adjustments Take with booster (ritonavir, cobicistat) to inc levels N/V/D ECG changes (atazanavir) Rash Inc CVD risk Metabolic abnormalities (lipohypertrophy, insulin resistance) ```
32
Darunavir brand, SE, considerations
Prezista Drug induced hepatitis, serious skin reactions, caution w sulfa allergy N/V/D, rash, inc LFTs, headache Must be given with ritonavir or cobicistat Take with food and swallow whole
33
Atazanavir brand, SE
Reyataz PR interval prolongation, severe skin reactions, hyperbilirubinemia, hepatotoxicity, nephrolithiasis, cholelithiasis "Bananavir" = hyperbilirubinemia, jaundice N/V/D, headache, severe skin reactions, depression, myalgia
34
PI drug intx
``` All metabolized via CYP450; most are strong 3A4 inhibitors Avoid inducers (rifampin, St Johns wort): can lower PI conc Avoid dronedarone (contraindicated w all PI's) Avoid Xa's and ticagrelor Avoid alfuzosin ``` PI's induce 2C9, reduce INR Dec hormonal levels w contraceptives Methadone: levels reduced w ritonavir PI's inc PDE-5 levels and inc toxicity Can increase statin levels; rosuvastatin and atorvastatin are preferred; lovastatin and simvastatin are contraindicated
35
Cobicistat vs ritonavir: boxed warnings
ritonavir: interacts w many medications, can result in potentially life threatening adverse events (strong 3A4, 2C8 inhib; also moderately inhibs many others) cobicistat: none
36
Ritonavir vs cobicistat: special considerations
Take both with food | ritonavir: 43% alcohol
37
Contraindications w ritonavir, cobicistat
Alfuzosin, amiodarone, carbamazepine, dronedarone, lovastatin, phenobarbital, phenytoin, rifampin, simvastatin, St John's wort
38
INSTI class considerations
generic names end in -tegravir No rena dosing needed but avoid Stibild < 70 mL/min or Genvoya < 30 mL/min No major CYP intx Inc CPK Headache, insomnia Take without regard to meals EXCEPT elvitegravir - w/ food
39
Elvitegravir side effects
Stribild Genvoya Proteinuria, headache, insomnia
40
Elvitegravir dose considerations
Stribild: CrCL < 70 do not initiate, d/c if drops below 50 Genvoya: CrCL < 30 do not initiate
41
Dolutegravir side effects
Tivicay (or combo Triumeq) | Insomnia, headache, inc SCr without affecting GFR
42
Raltegravir side effects
Isentress Inc CPK, myopathy, and rhabdo
43
INSTI drug intx
-gravirs (Stribild, Genvoya, Tivicay, Triumeq, Isentress) Take 2 hours before or 6 hours after cation containing antacids or laxatives Stribild and Genvoya: contraindicated w Alfuzosin, amiodarone, carbamazepine, dronedarone, lovastatin, phenobarbital, phenytoin, rifampin, simvastatin, St John's wort (contain cobicistat)
44
Maraviroc considerations
Brand is Selzentry Prevents HIV from entering cell, stage 1 of life cycle Prior to therapy pts must undergo tropism test; only wokrs in patients with CCR5 tropic disease (must be negative for CXCR4 or dual/mixed tropic disease) Can cause hepatotoxicity
45
How to handle a patient w lactic acidosis and severe hepatomegaly with steatosis on ART
Stop treatment | Most commonly associated with NRTI's
46
What is IRIS
Paradoxical worsening of a pre-existing OI or malignancy when ART is initiated Inc in immune function = inflammatory reaction at site of preexisting infection Stands for immune reconstitution inflammatory syndrome Continue ART, add or continue OI treatment
47
Which meds cause lipodystrophy
Lipoatrophy = NRTI's, specifically stavudine Lipohypertrophy = buffalo hump, caused by PI's
48
Which class causes diarrhea
PIs | Darunavir [Prezista] / Atazanavir [Reyataz]
49
What is PrEP and how do you monitor?
Truvada (emtricitabine/tenofovir) - 1 tab daily | Follow-up every 3 months
50
What is nPEP? What do you use?
nonoccupational postexposure prophylaxis INSTI-based regimens preferred, use within 72 hours of exposure for 28 days
51
What is PEP? What do you use?
Occupational exposure prophylaxis Use ART within 72 hours Raltegravir (insentress) + emtricitabine/tenofovir (truvada) for 4 weeks
52
TDF powder counseling
Measure with dosing scoop only, mix with soft food that does not have to be chewed (ie applesauce), do not mix with liquids; give entire dose right away after mixing

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