HIV prophylaxis and treatment AB

Question 1

Pre-exposure prophylaxis - what is the NNT?

Answer 1

NNT 13-18

Question 2

Post-exposure prophylaxis - what is the treatment for low risk?

Answer 2

2 NRTI

i.e. Emtricitabine + Tenofovir

or

Lamivudine + Zidovudine

Question 3

PEP for higher risk?

Answer 3

Same as for low risk - 2 NRTI (e.g. Lamivudine + Zidovudine)

PLUS

Raltegravir

Or

Lopinavir + Ritonavir

Question 4

What is the primary prophylaxis for PCP?

Answer 4

Bactrim DS 1 daily

Question 5

What is the primary prophylaxis for CNS toxoplasma?

Answer 5

Bactrim DS 1 daily

Question 6

What drug is indicated for primary prophylaxis when CD4

Answer 6

Azithromycin 1g weekly

Question 7

When can you cease Bactrim DS as prophylaxis for PCP, CNS toxo, cryptococcus?

Answer 7

Once CD4 >200 for 3-6 months, completed induction therapy and asymptomatic

i.e. double the CD4 count you’d be most likely to get the infection at

Question 8

When can you cease Azithromycin as MAC prophylaxis?

Answer 8

CD4 >100 for 3-6 months, completed 12 months of treatment for MAC and asymptomatic

i.e. double the CD4 count you’d be most likely to get the infection at

Question 9

When can you cease prophylaxis for CMV retinitis?

Answer 9

CD4 >100-150 for 6 months

i.e. double (or more) the CD4 count you’d be most likely to get the infection at

Question 10

Give examples of nucleoside/nucleotide reverse transcriptase inhibitors?

Answer 10

Abacavir
Emtricidabine
Lamivudine
Zidovudine

Question 11

What is a common adverse effect of NRTI?

Answer 11

Peripheral neuropathy

Question 12

Given an example of a non-nucleoside reverse transcriptase inhibitor

Answer 12

Efavirenz
Etravirine
Nevirapine

Question 13

What are common adverse effects of NNRTI?

Answer 13

P450 enzyme inducers

Rash

Question 14

Give examples of protease inhibitors?

Answer 14

-navir

Ritonavir, Atazanavir

Question 15

What are common adverse effects of protease inhibitors?

Answer 15

Ritonavir: CYP3A4 inhibitor, p-glycoprotein inhibitor

General: DM, hyperlipidaemia, buffalo hump, central obesity

Question 16

What are two types of entry inhibitors?

Answer 16

Fusion inhibitors - Enfuvirtide

CCR5 inhibitors - Maraviroc

Question 17

Give an example of an integrase inhibitor

Answer 17

• gravir

Raltegravir, Dolutegravir

Question 18

What HLA is associated with Abacavir hypersensitivity?

Answer 18

HLA-B5701

Question 19

Which ARV may cause Fanconi syndrome?

Answer 19

Tenofovir

Question 20

Which drug doubles the risk of AMI?

Answer 20

Abacavir

Question 21

Which drug is associated with CNS toxicity with vivid dreams and sleep change?

Answer 21

Efavirenz

Question 22

Which drugs are most strongly associated with lipodystrophy

Answer 22

Older retrovirals (NRTI)

Question 23

Which drugs are associated with hyperbilirubinaemia and renal stones?

Answer 23

Atazanavir (PI)

Indinavir (PI)

Question 24

Which drugs are contraindicated with the use of Ritonavir?

Answer 24

Cisapride - QTc prolongation
Simvastatin - rhabdomyolysis
Midazolam - prolonged sedation

Question 25

Which ART inhibits CYP 3A4?

Answer 25

Protease inhibitors - especially Ritonavir

Question 26

Which ART induces CYP 3A4

Answer 26

NNRTI (e.g. Nevirapine)

Question 27

Which drugs have little or no p450 activity?

Answer 27

Integrase inhibitors (e.g. Raltegravir)

Question 28

Which drug may methadone interact with?

Answer 28

Methadone is metabolised by 3A4 Nevirapine results in methadone withdrawal Cessation of Nevirapine - potential for overdose

Question 29

Which drug do PPIs reduce the absorption of?

Answer 29

Atazanavir (protease inhibitor)

Question 30

Which ART cause hepatotoxicity?

Answer 30

Nevirapine (NNRTI) | Protease inhibitors

Question 31

Which are the preffered ART drugs to use in pregnancy?

Answer 31

Zidovudine Lamivudine Lopinavir/Ritonavir

Question 32

Which ART should you use intrapartum if pre-delivery maternal viral suppression inadequate/unknown or late presentation?

Answer 32

Zidovudine

Question 33

How effective is ART at reducing the risk of HIV transmission in pregnancy?

Answer 33

Risk reduced from 25% to

Question 34

When should you deliver with C-section in HIV?

Answer 34

Consider if maternal viral load >50 at 36 weeks | Recommended if viral load >400

Question 35

When should you start neonatal ART?

Answer 35

As soon as possible after birth (6-12 hours) and continue for 4 weeks

Question 36

Is breastfeeding advised in pregnancy?

Answer 36

No; avoid breastfeeding