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PT3 ID 1 (HIV) > HIV therapeutics > Flashcards

Flashcards in HIV therapeutics Deck (73):
1

significance of HIV-1 and HIV-2 strains

-HIV-1 more common in the west
-some ARVs are not active against HIV-2

2

how long does it take 4th gen Ab/Ag HIV test to detect invection

within 4 weeks of infection

3

what to do if you get a negative Ab/Ag test result

test second time 3 months after the first test to confirm

4

main tests to do in HIV positive patients

viral load
CD4 T cell count
resistance testing (genotypic assays)

5

viral load looks at what

current level of virus in the blood

6

when to do viral load in untreated patients

at baseline
monitoring is optional

7

when to do viral load in treated patients

-immediately before starting ART
-2-4 weeks after start or change in ART, then q4-8 weeks until suppressed
-every 3-4 months when stable, may consider 6 months

8

goal of therapy in terms of viral load measurements

-0.5-1 log drop
-undetectable amounts of virus within 12-24 weeks

9

when to do CD4 in untreated patients

-baseline
-then every 3-6 months

10

when to do CD4 after initiating or modifying ART

every 3-6 months during first 2 years or if CD4 is still under 300

11

when to do CD4 after 2 years of ART with suppressed viral load

-if 300-500 then every 12 months
-if over 500 then its optional

12

what constitutes an adequate response to ART in terms of CD4 test

-30% change in absolute count
-50-150 increase in 1st year, 50-100 per year afterwards

13

drug class HIV is most resistant to

NNRTI's
single mutation can be enough for resistance

14

signs and symptoms of HIV infection

-mononucleosis like illness of non-specific signs and symptoms that present 1-4 weeks after exposure
-40-90% are symptomatic

15

opportunistic infections that can appear when CD4 count is 200-500

kaposi sarcoma
oropharyngeal candidiasis

16

opportunistic infections that can appear when CD4 count is <200

pneumocystis jiroveci pneumonia
disseminated histoplasmosis
coccidioidomycosis

17

opportunistic infections that can appear when CD4 count is <100

toxoplasmosis
cryptococcosis
cryptosporidiosis
esophageal candidiasis

18

opportunistic infections that can appear when CD4 count is <50

cytomegalovirus (eye infections)
mycobacterium avium complex

19

most common opportunistic infection in HIV

pneumocystis jiroveci pneumonia

20

surprising benefits of ART

-decrease in transmission to sexual partners
-decrease in perinatal transmission

21

who should be on ART

all HIV infected individuals regardless of CD4 count

22

things to treat before starting ART if possible

substance abuse
psychiatric disorders

23

immune reconstitution inflammatory syndrome (IRIS)

-exacerbation of an opportunistic infection that occurs as a result of ART initiation

24

when does IRIS usually occur

within 4-8 weeks of initiating ART

25

how do we manage IRIS that occurs

NSAIDS
corticosteroids

26

prophylaxis for mycobacterium avium complex

CD4 <50
clarithromycin or azithromycin

27

prophylaxis for pneumocystis jiroveci pneumonia

CD4 <200
Bactrim DS

28

prophylaxis for toxoplasmosis

CD4 <100 and Toxo is IgG positive
Bactrim DS

29

adverse effects of TDF

-nausea/gas
-renal insufficiency
-osteomalacia

30

adverse effects of TAF

-nausea/gas
-low renal/bone toxicities

31

adverse effects of Abacavir

hypersensitivity reactions
MI

32

how renal toxicity in TDF occurs

TDF can't exit through MRP2/4 and accumulates in the proximal tubule

33

tenofovir relationship with active hep B virus

if tenofovir is stopped acute exacerbation of hepatitis may occur

34

screening that needs to be done before starting abacavir

HLA-B*5701

35

drug that comes with a warning card

abacavir

36

adverse effects of emtricitabine

-hyperpigmentation of palms and soles
-acute exacerbation of hepatitis if active HBV and you discontinue

37

adverse effects lamivudine

-well tolerated
-acute exacerbation of hepatitis if discontinued

38

risk factors for lactic acidosis with hepatic steatosis

women
obesity
pregnancy
prolonged use of NRTIs

39

dietary restrictions of NRTIs

take with or without food

40

backbone drugs for all regimens in treatment-naive patients

NRTIs

41

adverse effects of protease inhibitors

N/V/D
insulin resistance
rash (sulfa)
hepatotoxicity
fat maldistribution on waist and neck

42

protease inhibitors to know

darunavir
ritonavir

43

adverse effects of dolutegravir

rash
insomnia
headaches

44

adverse effects of elvitegravir/cobicistat

N/D
increase in SCr w/COBI

45

adverse effects of raltegravir

N/D
headache
CPK elevation (potential muscle injury)

46

special warning for integrase inhibitors

all may cause depression or suicidal thoughts

47

integrase inhibitor that needs to be taken with food

elvitegravir/cobicistat

48

ritonavir use in HIV

boosts other drugs by inhibiting 3A4

49

ritonavir adverse effects

N/V/D
metabolic complications
hepatitis

50

drug that causes circumoral paresthesias

ritonavir

51

cobicistat use in HIV

boosts other drugs by inhibiting 3A4, 2D6, and others

52

cobicistat adverse effects

-may elevate creatinine clearance and alter eGFR
-N/D

53

when starting ART in naive patients how many drugs are needed

at least 3
usually 2 NRTIs and one from one of the other 4 classes

54

regimens with dolutegravir as anchor

-TDF/emtracitabine (2 tabs qd)
-TAF/emtracitabine (2 tabs qd)
-abacavir/lamivudine (triumeq, 1 tab qd)

55

regimens with elvitegravir/COBI as anchor

-TDF/emtracitabine (stribild, 1 tab qd)
-TAF/emtracitabine (genvoya, 1 tab qd)

56

regimens with raltegravir as anchor

-TDF/emtracitabine (3 tabs qd)
-TAF/emtracitabine (3 tabs qd)

57

regimens with darunavir/ritonavir as anchor

-TDF/emtracitabine (3 tabs qd)
-TAF/emtracitabine (3 tabs qd)

58

integrase inhibitors that are susceptible to viral mutations

eltegravir/COBI
raltegravir

59

the NRTI that isn't renally excreted

abacavir

60

avoid what class of drugs with PIs and COBI

corticosteroids

61

dose adjustments for PIs and COBI and steroids

beclomethasone - none
prednisone - AUC is increased, use with caution

62

what class of drugs needs consideration with polyvalent cations

integrase inhibitors

63

what class of drugs has increased risk of myalgias when used with statins

PIs and COBI
(simvastatin contraindicated, others use with caution)

64

supplements to avoid with PIs, NNRTIs, and integrase inhibitors

st john's wort
garlic
ginkgo

65

counseling points for patients on ARVs

-pick up all meds at same time
-do not start any medications/supplements without consulting with provider/pharmacist
-use reminders
-do not stop taking w/o talking to provider

66

PrEP

preexposure prophylaxis

67

who is PrEP recommended for

-MSM with HIV partner, or many partners
-hetero with HIV or many partners
-injection drug uses w/ HIV positive partner

68

clinical eligibility for starting PrEP

-negative HIV test
-normal renal function
-HBV status/vaccines

69

PrEP drug(s)

TDF
emtracitabine

70

monitoring PrEP

-every 3 months need HIV test
-every 6 months need STI test
-every 3-6 months renal function
-every 12 months reevaluate need

71

drugs that can cotreat HBV

TDF/TAF
with
emtricitabine or lamivudine

72

drugs that have adverse effects on lipids

-darunavir/ritonavir
-elvitegravir/cobicistat

73

drug that has beneficial effect on lipids

TDF