HIV/AIDS

Question 1

HIV – best initial test? Confirmation test?

Answer 1

Best initial = ELISA

Confirmation = Western Blot

** except infants = PCR or viral culture b/c maternal antibodies may be present up to 6 months after delivery

Question 2

How are infected infants diagnosed w/ HIV?

Answer 2

PCR or viral culture

ELISA unreliable in infants b/c maternal HIV antibodies may be present for up to 6 months after delivery

Question 3

What should be done in an HIV+ patient prior to starting Tx?

Answer 3

Genotyping

Viral Resistance Testing

Question 4

When is HIV treatment initiated?

Answer 4

• CD4 drops below 500/microL in an asymptomatic patient
• Viral load is very high (> 100k/microL)
• Opportunistic infection occurs

Question 5

HIV – best initial drug regimen?

Answer 5

Atripla (“E-Tripl-E”)

- Emtricitabine (nRTI) + Tenofovir (nRTI) + Efavirenz (nnRTI)

Question 6

Which is more accurate in measuring response to therapy – CD4 or viral load?

Answer 6

Viral load

– CD4 lags behind & changes are slower to occur (since they’re in response to the virus)

Question 7

If Atripla cannot be used b/c of resistance, what’s next best option(s)?

Answer 7

Emtricitabine/Tenofovir
+
Atazanavir, Darunavir, or Raltegravir (protease inhibitors)

Question 8

Zidovudine – AEs?

Answer 8

Anemia

Question 9

Stavudine – AEs?

Answer 9

• Peripheral Neuropathy

- Pancreatitis

Question 10

Didanosine – AEs?

Answer 10

• Peripheral Neuropathy

- Pancreatitis

Question 11

Abacavir – AEs?

Answer 11

Hypersensitivity, Stevens-Johnson reaction

Question 12

Protease inhibitors – AEs?

Answer 12

• Hyperlipidemia

- Hyperglycemia

Question 13

Indinavir – AEs?

Answer 13

Nephrolithiasis (crystal-induced nephropathy) & Hematuria

– caused by precipitation of the drug in the urine & obstruction of the urine flow

Question 14

Tenofovir – AEs?

Answer 14

Renal insufficiency

Question 15

Name 4 common nnRTIs (non-nucleoside RTIs)

Answer 15

• Efavirenz
• Etravirine
• Nevirapine
• Rilpivirine

Question 16

Name 2 entry inhibitors

Answer 16

Enfuvirtide & Maraviroc

Question 17

Name an Integrase inhibitor

Answer 17

Raltegravir

Question 18

What 3 classes of medications are First-Line Antiretrovirals?

Answer 18

• Nucleoside & Nucleotide RTIs
• Non-nucleoside RTIs
• Protease inhibitors

Question 19

5 common acute life-threatening reactions ass’d w/ HIV therapy?

Answer 19

1. Didanosine – Pancreatitis
2. Abacavir-related hypersensitivity syndrome
3. NRTIs – Lactic Acidosis
4. NNRTIs – Stevens-Johnson Syndrome
5. Nevirapine – Liver failure