Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IPFC 6 > HIV ART Treatment > Flashcards

HIV ART Treatment Flashcards

(48 cards)

Start Studying
1
Q

What is the structure of a typical ART regimen

A

2 NRTIs
+
either
- INSTI
- PI + PK enhancer
- NonNRTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 6 NRTIs

A
  • Tenofovir disoproxil fumarate (TDF)
  • Tenofovir alafenamide (TAF)
  • Emtricitabine (FTC)
  • Lamivudine (3TC)
  • Abacavir (ABC)
  • Zidovudine (ZDV)

TT ELAZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 5 NNRTIs

A
  • Doravirine (DOR)
  • Rilpivirine (RPV)
  • Efavirenz (EFV)
  • Nevirapine (NVP)
  • Etravirine (ETR)

DRE NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 Protease inhibitors

A

Darunavir/r or /c (DRV)
Atazanavir (ATV)
Lopinavir (LPV)

-vir

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 5 INSTI (integrase strand transfer inhibitor)
-gravir

A
  • Raltegravir (RAL)
  • Elvitegravir (EVG)
  • Cabotegravir (CAB)
  • Dolutegravir (DTG)
  • Bictegravir (BIC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 attachment and entry inhibitors

A
  • Enfuvirtide (T-20)
  • Maraviroc (MVC)
  • Fostemsavir (FTR)
  • Ibalizumab (IBA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drug is a Capsid inhibitor

A
  • Lenacapavir
    (LEN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differentiate between the 2 PK boosters Ritonavir and Cobicistat
Availability/usage
Enzyme inhibition/induction
ADR
anti-HIV activity?

A

Ritonavir
Availability
- used with many PIs
- single entity drug

Enzyme
- Potent CYP3A4
- has induction effects

ADR
- GI effects
- insulin resistance
- hyperlipidemia

HIV activity?
- Anti-HIV activity at higher doses

Cobicistat
Availability
- Used with PIs atazanavir, darunavir & elvitegravir (INSTI)

Enzyme inhibition
- CYP 3A4
- no induction effects

ADR
- GI effects
- inc Screatinine without affecting GFR

HIV activity?
- None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 options for triple drug regimens in Newly diagnosed HIV patients who are treatment naive

A

TAF / FTC / Bictegravir

TAF / FTC + Dolutegravir

TDF / FTC + Dolutegravir

FTC = emtricitabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When can you give double therapy in newly diagnosed patients (3)
Which ones to give

A
  • No HBV co-infection
  • No resistance
  • HIV RNA < 500,000 copies/mL

Lamivudine 3TC + Dolutegravir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What options of treatment are for HIV patients if they used
Cabotegravir for prep
+ no resistance test results are back (4)

A

Add Protease inhibitor + Booster

TAF / FTC / Darunavir / cobicistat

TDF / FTC + Darunavir / cobicistat

TAF/ FTC + Darunvair + Ritonavir

TDF / FTC + Darunavir + Ritonavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which drugs/classes cause weight gain

A

INSTI
+
TAF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NRTI
TDF vs TAF
Advantages
Disadvantages
Dose + renal dose

A

TDF
Adv
- favourable lipid effects

Disadv
- Decline in kidney function
- BMD reduction

Dose
- 300mg
- CrCl <50 = less frequent dosing intervals

TAF
Adv
- Favourable effects on renal markers & BMD

Dose
- 10mg daily with PI & booster
- 25mg daily with non-booster
- TAF not recommended CrCl <30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Wha is the dosing for other NRTIs such as Embtricitabine (FTC) and Lamivudine (3TC)

A

Embtricitabine (FTC)
- 200mg
- available only as combo product

Lamivudine (3TC)
- not really used
- 300mg
- Flexible renal dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are important things to note when treating HIV with HBV co-infection

A

If Hep B co-infection, need 2 drugs that are active against Hep B
- TAF/TDF + FTC/3TC

**Cannot discontinue those therapies as it may cause serious hepatocellular damage which can reactivate Hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is abacavir not recommended as first line anymore (3)

A

HLA B*5701 testing required (takes >7 days and we want to start ARV within 7 days of diagnosis)

Risk of abacavir hypersensitivity syndrome

*NO association with CV disease – meta-analysis proved this association is wrong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the abacavir hypersensitivity syndrome
Symptoms

A
  • Potentially life-threatening, multi-system reaction
    • Non-specific sx: fever, rash, GI, malaise, respiratory issues
    • Median onset: 9 days
    • Symptoms worsen with continuation of abacavir
    • Stopping abacavir will prompty reverse HSR

HLA-B* 5701 testing:
* Positive result has a strong association (40-50% chance) to abacavir HSR

Screening for patients is required ONCE in their lifetime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the dosing for the 2 main INSTI we use

A

Bictegravir (BIC)
- 50mg

Doulegravir
- Tx naive: 50mg daily
- INSTI resistance or INSTI naive w/ booster: 50mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ADRs with bictegravir

A

WEIGHT GAIN
Headache
Diarrhea
Nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ADRs with Dolutegravir

Study These Flashcards
A

WEIGHT GAIN
Headache
Insomnia
Depression & suicidal ideation (rare)

21
Q

What is the main reaction that occurs with Bictegravir and dolutegravir

Study These Flashcards
A

False CrCl elevation
Follow up on CrCl at 1 month: this becomes new baseline

Due to inhibitor of renal proximal tubule secretion of creatinine

22
Q

When can raltegravir + 2 NRTIs be preferably used (3)

Study These Flashcards
A
  • Pregnancy
  • Chemotherapy
  • TB treatment
23
Q

What is the main alternate treatment if a patient cannot use an INSTI (usually due to weight gain)?
Dose?

Study These Flashcards
A

Use a PI + booster: Darunavir

  1. Treatment naive/Pi naive
    - 800mg daily
    - w/ ritonavir 100mg daily or cobicistat 150mg
  2. Treatment with 1 of 11 darunavir resistance associated mutations (RAMs)
    - 600mg BID
    - w/ ritonavir 100mg BID
24
Q

Why is the PI Atazanavir not used anymore as an alternate for INSTI? (3)

Study These Flashcards
A
  • Moderate barrier to resistance
  • Low gastric pH required (PPI interaction)
  • Bilirubin elevates (surrogate marker for adherence)
25
What is the dosing for atazanavir
300mg PO daily with: - Ritonavir 100mg PO daily 400mg PO daily - NO BOOSTER
26
What is the reaction between atazanavir and bilirubin Enzyme? Symptoms? Treatment? Reversible/irreversible?
- Blocking UGT 1A1 causes unconjugated hyperbilirubinemia (which is BENIGN) Symptoms: - Causes some yellowing of the skin, eyes – consider this if a patient has a co-infection with Hep B Treatment - Does NOT require management Reversible - Elevation in indirect bilirubin is REVERSIBLE when stopping atazanavir (this is independent of liver toxicity)
27
What are common PI side effects
Hyperlipidemia (esp triglycerides) - CV risk with some GI intolerance: nausea, diarrhea
28
What is the other option if INSTI (like weight gain) is not preferred? (2) Dose food requirements
DoraVIRine (DOR) - Resistance to both DOR and NRTIs at virologic failure - 100mg daily - with our without food RilpiVIRine (RPV) - 25mg daily - With A BIG meal - PPI interaction
29
Why is Efavirenz not used anymore as an NNRTI option instead of INSTI (4)
- Resistance - Can cause ABNORMAL VIVID DREAMS - CNS: dizziness, headache, depression, suicidality, somnolence, insomnia - Skin rash: Occurs within 2 weeks of starting treatment (resolves within 1 month while on treatment) - Lipids: Can increase LDL and TG
30
What is the greatest predictor of mother-to-child transmission
High maternal viral load
31
What are benefits to achieving and maintaining viral suppression on ART in pregnancy
- optimize Mother's health - Prevent transmission to baby (biggest transmission occurs during labour – but can occur at any time during pregnancy) - Prevent postpartum transmission through breastfeeding - Prevent transmission to serodiscordant partner
32
What are the preferred treatment for pregnancy in HIV (3)
TAF + FTC + Dolutegravir TDF + FTC + Dolutegravir If INSTI intolerance, use PI + booster - use Darunavir-ritonavir
33
What is an alternate regimen for pregnancy?
Zidovudine Efavirenz Raltegravir Atazanavir-ritonavir
34
What is the baseline monitoring for all HIV treatments with labwork (7)
- Basic metabolic panels (lytes, creatinine) - ALT, AST, total bilirubin - CBC with differential - LIPID profile - Random or fasting glucose - Urinalysis - Pregnancy test
35
Which lab values do you monitor 4-8 weeks after initiation/modifcation
- Basic metabolic panels - ALT, AST, total bilirubin - Lipid profile
36
Which drug switching have the lowers risk of virologic failure
- NRTI: TDF to TAG - NNRTI: Efavirenz to rilpivirine - INSTI: Raltegravir to dolutegravir - Booster: Ritonavir to cobicistat
37
What are good reasons to switch a patient their ART regimen (7)
- Reducing pill burden - enhance tolerability and decrease toxicity - prevent DDI - Eliminate food/fluid requirements - Pregnancy - Reduce costs - need for a switch to a long-acting injectable
38
Which switching has higher risk of virologic failure
Not within class: - Boosted PI to NNRTI (Rilpivirine) - Boosted PI to INSTI (Raltegravir) - Dolutegravir to elvitegravir/c (not usually used)
39
What is the monitoring plan for after switching ART
Clinical monitoring for 3 months after ARV switch - At 1-2 weeks: check for tolerability & adherence - At 4-8 weeks: repeat VL (check for rebound viremia) - At 3 months: can resume to normal monitoring schedule (in absence of new complications, lab abnormalities, viral rebound)
40
When can you switch a patient do the new long-acting IM injection? (2) Criteria? (5)
- virologically suppressed on ART 3+ months - do no want to take PO daily Criteria - no baseline resistance to either medication - No prior virologic failures - No active Hep B (requires 2 NRTIs) - Not pregnant - Not receive meds with significant DDI with PO - not receiving injectable cabetogravir or rilpivirine
41
What drugs do we give IM Administration?
Combo INSTI + NNRTI Cabotegravir + Rilpivirine Administration - bring to room temp 6 hours - inject in each cheek
42
What do you monitor in IM injections
Viral load 4-8 weeks after switch Test for resistance
43
What is the monthly dosing schedule for IM
Can do oral lead-in for 28+ days - initiate injection on last day of PO-period Initial injection Cabotegravir (600mg): 3mL IM + Rilpivirine (900mg): 3mL IM Every month (+/- 7 days) Cabotegravir (400mg): 2mL IM + Rilpivirine (600mg): 2mL IM
44
What is the q2month dosing schedule for IM treatment
Initial injection x1 * At month 2 * At month 3 Cabotegravir (600mg): 3mL IM + Rilpivirine (900mg): 3mL IM Continuation injections * At month 5 * Every 2 months ( +/- 7 days) Cabotegravir (600mg): 3mL IM + Rilpivirine (900mg): 3mL IM
45
How do you switch from monthly to q2monthly dosing
Monthly: Cabotegravir (400mg): 2mL IM + Rilpivirine (600mg): 2mL IM (lower dose to ease in) TO Q2months: Cabotegravir (600mg): 3mL IM + Rilpivirine (900mg): 3mL IM
46
T/F FLAIR & ATLAS says CAB/RPV injections are non-inferior to PO ARV standard of care
True
47
T/F ATLAS 2M says Q2month injections are non-inferior to q monthly injections
True
48
How do you deal with missed doses for IM
For planned missed dosing (travel): - PO bridging therapy (travelling for work)

IPFC 6 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions