HIV Flashcards

1
Q

Most common test used for established HIV infection

A

-HIV antibody test

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2
Q

Test used for HIV and indeterminate WB

A

-HIV 1 RNA

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3
Q

4th generation EIA test

A

-HIV p24 antigen

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4
Q

Who should be screened for HIV

A
  • All patients ages 13 to 64 working in health care
  • Pts seeking treatment for STDs
  • Patients starting TB treatment
  • Pregnant patients
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5
Q

How is HIV transmitted?

A
  • Unprotected sex with an infected partner
  • Sharing needles
  • From infected mother to child
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6
Q

When is HIV not transmitted

A

-If patient’s viral load is undetectable

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7
Q

Why is adherence so poor in ART

A
  • Complexity and pill burden
  • Unstable housing
  • Mental illness
  • Lack of patient education
  • Fear of adverse rxn
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8
Q

When to start ART

A
  • All HIV infected individuals regardless of CD4 count
  • Start therapy ASAP
  • Pt should understand that treatment will be indefinite
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9
Q

When should you test for drug resistance?

A

-BEFORE initiation of ART

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10
Q

If HLA-B*5701 is positive then…

A

-Pt should NOT receive ABC

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11
Q

HAART guidelines initial regimen

A

-NRTI Background + Integrase inhibitor

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12
Q

Truvada

A

-Tenofovir DF + Emtricitabine

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13
Q

Descovy

A

-Tenovovir AF + Emtricitabine

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14
Q

Triumeq

A
  • Abacavir
  • Lamivudine
  • Dolutegravir
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15
Q

INSTI Based initial regimens

A
  • BIC/TAF/FTC
  • DTG/ABC/3TC
  • DTG + TDF/FTC or TAF/FTC
  • RAL + TDF/FTC or TAF/FTC
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16
Q

What to use when ABC, TAF, TDF cannot be used

A
  • DRV/r + RAL (if HIV < 100,000 copies/ml and CD4 200

- LPV/r + 3TC

17
Q

Lab monitoring for Viral load

A
  • HIV viral load 2 to 4 weeks after starting ART
  • Repeat at 4 to 8 weeks until undetectable
  • Goal is undetectable within 8 to 24 weeks
  • Then monitor q3 to 4mo
18
Q

Lab monitoring for CD4

A
  • Should increase by 50 to 150 during 1st year of ART
  • If CD4 is stable (300 to 500) after 2 yrs, measure annually
  • CD4 > 500 monitoring = optional
19
Q

Limitations/ restrictions for ABC/3TC

A

-Must be HLA-B*5701 negative
-Risk of possible CV events
-Possible inferior if HIV
> 100,000 copies

20
Q

Pros of TAF/FTC

A
  • Once daily dosing
  • High virologic efficacy
  • Active against HBV
  • Approved for eGFR > 30mL/min
21
Q

What drugs can you NOT use if CD4 < 200

A
  • RPV based ART

- DRV/r + RAL

22
Q

What drugs can you NOT use if HIV RNA > 100,000

A
  • RPV based ART

- ABC/3TC + EFV or ATV/r

23
Q

What drugs can you NOT use if HLA-B*5701 positive

A
  • ABC

- Risk of hypersensitivity

24
Q

What should you give if resistance is not know yet

A
  • DRV/r or DRV/c + TAF/FTC

- DTG + TAF/FTC

25
Q

If CKD use which meds

A
  • TAF
  • ABC
  • LPV/r + 3TC
26
Q

What drugs can you NOT use if pt has a psychiatric illness

A

-Avoid EFV and RPV

27
Q

What drugs can you NOT use if pt has dementia

A
  • Avoid EFV

- Use DRV or DTG based regimen

28
Q

What drugs can you NOT use if pt is receiving methadone

A
  • Avoid EFV based regimens

- EFV can increase methadone concentrations

29
Q

Which drugs also have HBV coverage

A

-TDF or TAF
with
-FTC or 3TC

30
Q

Adverse effects with NRTIs

A
  • Lactic acidosis

- Lipodystrophy

31
Q

Emtricitabine (FTC) and Lamivudine (3TC) adverse effects

A
  • Minimal toxicity
  • Hyper pigmentation (Emtricitabine)
  • Can exacerbate HBV if discontinued
32
Q

Zidovudine (ZVD) adverse rxn

A
  • Headache
  • Bone marrow suppression
  • GI intolerance
  • Lipoatrophy
33
Q

Abacavir (ABC) adverse rxn

A
  • Hypersensitivity
  • Rash
  • Increased risk of MI
34
Q

TAF and TDF adverse rxns

A
  • Renal impairment (TDF)
  • Decreased bone marrow density (TDF)
  • Headache
  • GI
  • TDF helps with lipid profile (GOOD)
35
Q

Adverse effects of INSTIs

A
  • Hypersensitivity

- Depression/ suicidal ideation

36
Q

Dolutegravir (DTG) adverse rxn

A
  • Headache

- Insomnia

37
Q

Elvitegravir/Cobicistat (EVG/c) adverse rxn

A
  • Decreased CrCl

- Nausea/Diarrhea

38
Q

Raltegravir (RAL) adverse rxn

A
  • Nausea
  • Headache
  • Diarrhea
  • CPK elevation
  • Rhabdomyolysis