HIV/AIDS Lecture #2 Flashcards
(52 cards)
What are the goals of therapy for HIV treatment?
maximally/durably suppress plasma HIV RNA to below the lower level of detection of the assay (20-30 copies/mL)
restore + preserve immunologic function
reduce HIV associated morbidity and prolong the duration and quality of survival
prevent transmission
When to start ART?
recommended for all HIV-infected patients regardless of CD4 count
should be initiated immediately after diagnosis
except should withhold ~2wks if meningitis from TB or cryptococcus due to IRIS
What to start?
two NRTIs in combo with a 3rd active ARV from one of three drug classes: INSTI, NNRTI, or PI boosted with a PK enhancer (ritonavir or cobicistat)
can also do dolutegravir + lamivudine for initial treatment
What is an INSTI-based regimen? - INSTI plus 2 NRTIs
bictegravir/tenofovir alafenamide/emtricitabine - 1 pill QD
dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus emtricitabine or lamivudine) - 2 pills once daily (not as common)
What is an INSTI-based regimen? - INSTI plus 1 NRTI
dolutegravir/lamivudine
do NOT use in those with HIV RNA >500,000 copies/mL, HBV co-infection, or in whome ART is to be started before results of HIV genotypic resistance testing or HBV testing as available
What is an INSTI-based regimen if HLA-B*5701 negative and without chronic HBV co-infection?
dolutegravir/abacavir/lamivudine
What is a PI-based regimen?
darunavir/cobicistat or darunavir + ritonavir plus tenofovir alafenamide or tenofovir disoproxil fumarate plus emtricitabine or lamivudine
(darunavir/cobicistat or darunavir + ritonavir) plus abacavir/lamivudine if HLA-B*5701 negative
What is an NNRTI-based regimen?
doravirine/tenofovir disopril fumarate/lamivudine
OR
doravirine plus tenofovir alafenamide/emtricitabine
rilpivirine/tenofovir alafenamide/emtricitabine if HIV RNA <100,000 copies/mL and CD4 >200 cells/mm^3
Boosted PIs are what?
strong CYP3A4 inhibitors
except for tipranavir
NNRTIs are what?
CYP3A4 inducers
except rilpivirine and doravirine are not CYP3A4 inducers, only substrates
INSTIs are what?
UGT1A1 substrates
have fewer drug interactions
Which drugs are substrates of 3A4?
maraviroc, fostemavir, lenacapavir
What have few drug interactions?
NRTIs - ibalizumab and enfuvirtide
What are the drug interactions with acid reducers?
need to separate antacids from PO INSTIs by 6 hours to prevent cationic chelation
NEVER give raltegravir with Al or Mg
atazanavir, PO rilpivirine are reduced by acid reducers
rilpivirine contraindicated with PPIs
What are the drug interactions with benzodiazepines?
with protease inhibitors and cobicistat preferred benzos are lorazepam, oxazepem, and temazepam (LOT)
What are the drug interactions with corticosteroids?
with protease inhibitors and cobicistat, beclomethasone is preferred
AVOID OTC nasal fluticasone
What are the drug interactions with statins?
with protease inhibitors and cobicistat, low doses of atorvastatin, rosuvastatin, pitavastatin, or pravastatin are preferred
with NNRTIs, statin dose may need increased
What are drug interactions with biguanide?
dolutegravir increases metformin, so a dose decrease of metformin may be necessary
What are drug interactions with PDE5 inhibitors?
with protease inhibitors and cobicistat, use very low doses of PDE5 inhibitors q48-72 hours
What are drug interactions with polyvalent cation supplements?
with integrase inhibitors, space apart by 6 hours
coadministration of Ca/Fe with dolutegravir or bictegravir ok if also taken WITH food
What is the FDA-approved adult doses of dolutegravir?
50 mg daily (INSTI naive)
50 mg BID (INSTI experienced)
What are the special administration requirements of efavirenz?
Take PO on empty stomach at bedtime
What are the special administration requirements of neviripine?
dose titration over 14 days
What are the special administration requirements of etravirine?
take PO with food
