Seroconversion window period time of infection to production of antibodies average 3-4 weeks but up to 6 months acute HIV HIV tetsing Rapid (antibody test)- bllod or oral fluid, rapid test requires confirmation if reactive Combination immunotherapy (4th gen)- HIV-1 or HIV-2 antibodies and HIV-1 protein 24, more sensetive to early detection PCR test- viral load test detects genetic material of HIV

HIV Flashcards by Puja Patel

HIV1 vs HIV2

HIV-1- more prevelant in the U.S and more pathogenic (rapid progression to AIDS)

HIV-2- more in Western Africa, less pathogenic, more resistant to NNRTs

Souce of Transmission: body fluids of infected person

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Cell surface receptors for HIV

CD4

CCR5

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HIV testint

Seroconversion window period

time of infection to production of antibodies
average 3-4 weeks but up to 6 months
acute HIV

HIV tetsing

Rapid (antibody test)- bllod or oral fluid, rapid test requires confirmation if reactive
Combination immunotherapy (4th gen)- HIV-1 or HIV-2 antibodies and HIV-1 protein 24, more sensetive to early detection
PCR test- viral load test detects genetic material of HIV

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Emtriva (emtricitabine, FTC)

NRTI

Headache, GI intolerance, rash

Emtricitabine used for HIV and HBV

Rare hyperpigmentaition of palms and soles of feet more with African Americans

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Epivir (lamivudine, 3TC)

NRTI

Headache, GI intolerance, rash

Can be used in HBV infections

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Viread (tenofovir disoproxil fumarate or TDF)

NRTI

GI intolerance (fatulence and diarrhea), headache,

decreased bone marrow density, osteomalacia, renal impairment (TDF), Fanconi Syndrome

TDF associated with lower lipid levels (good patients with hyperlipidemia)

Used to treat HBV too

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Vemlidy (tenofovir alafenamide, TAF)

NRTI
Higher lipid levels but better for the kidneys
substrate of p- glycoprotein- DDI will lower the TAF levels (subtheraputic)
- Phenytoin, oxcarbazepine, phenobarbital, rifampin, rifabutin, rifapentine, St. John’s Worts
Used to treat HBV too

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Ziagen (abacavir, ABC)

NRTI

Liver metabolism via alcohol dehydrogenase- caution in hepatic impairment and alocholics

Hypersenitivity reactions- check HLA-B*5702 test

Positive then avoid the drug and report as allergy on patient chart
Even if the test is negative report signs and symptoms if they develop

Increased risk of MI

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Travada (emtricitabine/ tenofovir disoproxil furarate, FTC/ TDF)

NRTI

Can be used as prophylaxis too

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Descovy (emtricitabine/ tenofovir alafenamide, FTC/TAF)

NRTI

For HIV and HBV

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Epzicom (lamivudine/ abacavir, 3TC/ABC)

NRTI

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Generally what is the MOA of NRTIs and drug class side effects?

Pharmacokinetics?

MOA- inhibit HIV-1 reverse transciptase (RT) by competitive inhibition of the enzyme as well as chain termination

drug binds to RT instead of virus

ADR- lactic acidoisis and hetaptic steatosis, lipodystrophy/ lipoatrophy (more common with stavudine)

Pharmacokinitics- mostly renally excreted except Ziagen (abacavir)- liver metabolism via ADH

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Which NRTI can be used to treat HBV?

Emtriva (emtricitabine)

Epivir (lamivudine)

Viread (tenofovir disoproxil fumarate, TDF)

Vemlidy (tenofovir alafenamide, TAF)

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Pifeltro (doravirine)

NNRT

LEAST CNS TOXICITY IN CLASS

Nausea, diarrhea, abdominal pain, dizsiness, headache, fatigue, abnormal dreams

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Edurant (rilpivirine, RPV)

NNRT

A bit more CNS effetcs then doravirine

Depression, insomnia, headache, rash

Take with food (need acidic environment for absportion)

Contraindicated with PPIs

Take H2 anatagonist at least 12 hours before or 4 hours after rilpivirine

Take anatacids 2 hours before or 4 hours after rilpivirine

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Sustiva (efavirenz, EFV)

NNRTI

MOST CNS EFFECTS

dizziness, drowsiness, sleepiness, insomnia, vivid dreams

Lipophilic drug so take on an empty stomach _(_food would cause increase CNS effects)

CYP2B6 substrate induction pathway- genetic polymorphism may lower the metabolism (increased ADR)

give lower dose efavirenz in symfi Lo may be better tolerated

Neural tube defects in first trimester of pregnancy

Decreases levels of rifampin, rifabutin, voriconazole, methoaone, statin

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Delstrigo (doravirine/ lamivudine/ TDF)

NNRTI/ NRTI/ NRTI

Complera (rilpivirine/ emtricitabine/ TDF)

NNRTI/ NRTI/ NRTI

Rilpivirine

Contraindicated with PPIs
Take H2 anatagonist at least 12 hours before or 4 hours after rilpivirine
Take anatacids 2 hours before or 4 hours after rilpivirine

Odefsey( rilpivirine/ emtricitabine/ TAF)

NNRTI/ NRTI/ NRTI

Rilpivirine

Contraindicated with PPIs
Take H2 anatagonist at least 12 hours before or 4 hours after rilpivirine
Take anatacids 2 hours before or 4 hours after rilpivirine

Atripla (efavirenz/ emtricitabine/ TDF)

NNRTI/ NRTI/ NRTI

What is the MOA of NNRTI and drug class side effects?

MOA- inhibits RT by directly binding to it (non-competitve inhibition of RT)
ADR
- Toxic epidermal necrolysis (TEN)
- Stevens- Johnson Syndrome (SJS)
- Liver toxicity
NNRTI levels decrease with
- rifampin, carbamazepine and phenytoin
CYP 3A4 inducer
Kinietics- liver elimination

Prevista (darunavir)

Protease Inhibitors

600 mg tablet + Norvir (ritonavir)- for pregnant women

800 mg tablet+ norvir (ritonavir) or cobicistate- everyone else

Possible skin reaction due to sulfonamide

Potenial CV risk

Norvir (ritonavir)

Protease Inhibitior

but used as PK booster

Reyataz (atazanavir)

Protease Inhibitor

Hyperbilirubinemia and nephrolithiasis

Interactions with acid sepressive therapy (no PPI and spacing with H2 blockers, and antacids)

Symtuza (darunavir/ cobicistat/ emtricitabine/ TAF)

Protase inhibitor/ PK booster/ NRTI/ NRTI

Prezocobix (darunavir/ cobicistat)

Protase Inhibitor/ PK booster NOT for pregnant women combined formulation only comes with darunavir 800 mg

Evotaz (atazanavir/ cobicistate)

Protease inhibitor and PK booster ## Footnote **Atazanavir- Interactions with acid sepressive therapy (no PPI and spacing with H2 blockers, and antacids)**

What is the MOA of protease inhibitors? class side effects? Pharmacokinites?DDI?

MOA- inhibit HIV protease to prevent cleavage of proteins, resulting in no active proteins ADR- GI intolerance, Hyperlipidemia, CV risk, blood glucoase elevation, liver toxicity, possible bleeding risk in hemophiliacs, **body fat re-distribution (lipodystrophy)** PK- Liver metabolism CYP 450 and P-gp- cyp inhibitor- statins, fluticasone, salmeterol, rifampin, hep c antiviral, anticoagulant, certain antifungals, quetiapinem st, johns worts

Isentress (raltegravir)

Integrase Inhibitor ## Footnote **Pg-P substrate**

Trivicay (dolutegravir)

Integrase Inhibitor ADR- **Neuropsychiatric effects (insomnia, depression, etc. do not use if there is underlaying psych condition), nural tube defects (avoid in women of childbearing age not on contreception or within12 weeks post conception** **Metformin interactions- increase metformine levels (1000mg daily max)- increases diarrhea**

Virekta( elvitegravir)

Integrase inhibitor ## Footnote **Take with food**

Biktarvy (emtricitabine/ TAF/ Bictegravir)

NRTI/ NRTI/ INTI ## Footnote **Bictegravir-increases metformin levels but done need to adjust dose just monitor**

Genvoya (emtricitabine/ TAF/ elvitegravir/ cobicistat)

NRTI/NRTI/ INSTI/PK * **Elvitegravir** * **Take with food- less GI effects** * **Cobicistat** * **nausea, diarrhea, lipid abnormalitiesand glucose elevation**

Stribild (emtricitabine/ TDF/ Elvitegravir/ cobicistat)

NRTI/ NRTI/ INSTI/ PK * **Elvitegravir** * **Take with food- less GI effects** * **Cobicistat** * **nausea, diarrhea, renal impairment, decrease bone mineral density**

Triumeq (lamivudine/ abacavir/ dolutegravir)

NRTI/ NRTI/ INSTI

MOA if intergrase inhibitors? class side effects? metabolism? DDI?

MOA- inhibit integrase, prevent integration of viral DNA into human DNA ADR- **Insomnia**, headache, **possible weight gain**, increase in liver enzymes and **creatine kinase (CK)** **Metabolism- UGT1A1** **DDI- calcium or iron supplements, cation containing antacids or laxatives, sucralfate, buffered metabolism (spacing from INSTI)** **DDI- Rifampin, carbamazepine, phenytonin, St. Johns Worts (reduce plasma levels of integrase inhibitors)**

Juluca (rilpiverine/ Dolutegravir)

NNRTI/ INSTI must have undetectable viral load **Rilpivirine effects- has to be taken with food,** * **Contriindicated with PPIs, defetilide** * **interactions with antacids, H2 blockers** **Dolutegravir** * **interactins between metformin and rifampin**

Tybost (cobicistat)

PK booster inhibitor of CYP 3A4

Sekzentry (maraviroc)

CCR5 inhibitor must have CCR5 receptor- CCR5 tropism test Treatemt for HIV resistance+ added to therapy **_Side effects- LIVER TOXICITY- BLACK BOX WARNING_** **_METABOLISM- CYP 3A4 and P-gp_**

Fuzeon (enfuvirtide)

Infusion infections only injectable part of HIV regimen inhibits function of transmembrane gp 41 No significant DDI

Trogarzo (ibalizumab)

Post attachment inhibitor Recombinant monoclonal antibodies binds to host CD4 cell and interfers with post-attachment steps Used for HIV resistance or people born with HIV **Administered IV- loading dose, followed by maintenance dose every 2 weeks**