Human Immunodeficiency Virus

Question 1

AIDS diagnosed when…

Answer 1

CD4 count > 200 or patient has an AIDs-defining condition

Question 2

HIV transmission

Answer 2

Direct contact with blood, semen, vaginal or rectal secretions or ingestion of breast milk.

Question 3

High risk indicators for HIV are….

Answer 3

Sharing drug injection equipment
High risk sexual behavior: MSM, multiple partners, hx of STIs
Hx of hepatitis or TB infection

Question 4

HIV antibody testing

Answer 4

can be detected in people 4-12 weeks after getting disease, but can take up to 6 months

Question 5

OraQuick Test

Answer 5

OTC test that tells you instantly
have to get follow up test with HCP
should be used > 3 months after exposure, if sooner can be false negative

Question 6

Which drug is CCR5 antagonist

Answer 6

Maraviroc

CCR5 co-receptor on CD4 cell that HIV stages to

Question 7

Which drug is attachment inhibitor

Answer 7

fostemsavir

Question 8

Which drug is a post-attachment inhibitor

Answer 8

ibalizumab-uiyk

Question 9

Which drug is a fusion inhibitor

Answer 9

enfuvirtide

Question 10

Which drugs are nucleoside reverse transcriptase inhibitors (NRTIs)

Answer 10

emtricitabine
tenofovir

Question 11

Which drugs are non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Answer 11

efavirenz
rilpivirine

Question 12

Which drugs are Integrase strand Transfer inhibitors (INSTIs)

Answer 12

Bictegravir
Dolutegravir
Raltegravir

Question 13

Which drugs are protease inhibitors (PIs)

Answer 13

Atazanavir
Darunavir

Question 14

Which allele do you test for if considering using abacavir?

Answer 14

HLA-B*5701

Question 15

Which assay do you perform if considering using maraviroc?

Answer 15

Tropism assay

Question 16

Preferred initial ART treatment

Answer 16

Biktarvy, Triumeq, Dovato = 1 single pill

Tivicay + Descovy/Truvada = 2 pills once daily

Question 17

Triumeq should not be taken if test for….

Answer 17

HLA-B*5701

contains abacavir

Question 18

Which HIV meds should not be used if CrCl < 30

Answer 18

Biktarvy, Triumeq, Dovato, Truvada and Descovy

Question 19

Which HIV medication is given IV to mother to protect baby?

Answer 19

Zidovudine

in patients with unknown HIV RNA lvl or > 1,000

Question 20

list of NRTIs

Answer 20

Abacavir
Emtricitabine
Lamivudine
TDF
TAF
Zidovudine

Question 21

Warnings for All NRTIs

Answer 21

lactic acidosis and hepatomegaly with fatty liver

all can cause N/D/HA inc LFTs

Question 22

Emtricitabine side effecrts

Answer 22

hyperpigmentation of palms of hands or soles of feet

Question 23

TDF has higher risk for….

Answer 23

renal impairment
dec bone mineral density

Question 24

Abacavir boxed warnings

Answer 24

boxed warning for hypersensitivity reaction

Avoid with CVD due to inc risk of MI

Question 25

List of INSTIs

Answer 25

BRED Bictegravir (in Biktarvy combo) Raltegravir (Isentress) Elvitegravir (In Genvoya/Stribild combo) Dolutegravir (Tivicay)

Question 26

CrCl cut off for Stribild?

Answer 26

< 70 dont start < 50 d/c

Question 27

CrCl cut off for Biktarvy and Genvoya

Answer 27

Dont start < 30

Question 28

Cabotegravir IM injection indicated for...

Answer 28

PrEP

Question 29

Cabotegravir PO is only used for....

Answer 29

lead in treatment before starting combo injection w/ rilpivirine

Question 30

Which drug is preferred in pregnancy for HIV treatment?

Answer 30

Dolutegravir

Question 31

INSTI and cations should be separated by.....

Answer 31

2hra before or after aluminum, calcium, magnesium and iron containing products Dolutegravir/Bictegravir can be taken with calcium/iron if taken with food also**

Question 32

List of NNRTIs

Answer 32

REDEN Rilpivirine Efavirenz Doravirine Etravirine Nevirapine

Question 33

Rilpivirine additional info

Answer 33

req acidic environment, dont sue with PPI, and separate from H2RA/antacids Take w/ meal and water

Question 34

Efavirenz additional info

Answer 34

food inc bioavailability and risk of CNS effect, take on empty stomach at bedtime

Question 35

Best way to remember PIs

Answer 35

End in -navir

Question 36

Info about all PIs

Answer 36

take with a booster (ritonavir or cobicistat) no renal dose adjust take w/ food to dec GI upset

Question 37

Atazanavir requires a XXXX gut for absorption

Answer 37

acidic

Question 38

Drug interactions with PI

Answer 38

too many to remember

Question 39

Which PI can be used as boosters

Answer 39

Ritonavir Cobicistat - products containing this should be taken with food dont use together, not interchangeable and have many drug interactions

Question 40

When can you use Maraviroc

Answer 40

When of tropism assay and if HIV strain only binds to CCR5 co-receptor. If binds CXCR4 or CXCR4/CCR5 then cant use

Question 41

Fostemsavir is indicated in....

Answer 41

combination with other ARTs in heavily treatment-experienced patients who are failing current therapy

Question 42

Cabenuva has to be preceded by 1 month of....

Answer 42

cabotegravir to asses tolerability

Question 43

Stribild and Genvoya should be taken with....

Answer 43

food

Question 44

TDF contain treatments shouldn't be started in CrCl below what?

Answer 44

< 50

Question 45

TAF contain treatments should be started in CrCl below what?

Answer 45

< 30

Question 46

Which NNRTI based therapy should be taken with food?

Answer 46

Complera and Odefsey

Question 47

Which NNRTI based therapy should be taken on empty stomach?

Answer 47

Atripla, Symfi, Symfi Lo

Question 48

Which ART require HLA-B testing?

Answer 48

Epzicom Trizivir

Question 49

AIDs defining conditions?

Answer 49

Opportunistic infections Kaposi's sarcoma HIV wasting syndrome - can use dronabinol and megestrol to stim appetite

Question 50

Immune reconstitution inflammatory syndrome

Answer 50

IRIS unexpected worsening of underlying condition once starting ART or changing to more effective therapy regimen symptoms can range from mild-severe but self limiting and ART should be continued

Question 51

If breastfeeding with HIV, you should....

Answer 51

replace with formula to not pass on HIV to child

Question 52

PrEP treatment options

Answer 52

90 day supply of Truvada or Descovy Cabotegravir (Apretude) monthly for 2 doses, then every 2 months

Question 53

What to know before starting PrEP

Answer 53

confirm person is HIV negative CrCl > 60 for Truvada or > 30 for Descovy screen Hep B n STI have to have HIV test before each refill

Question 54

oPEP

Answer 54

occupational post-exposure prophylaxis usually HCP needle stick Start within 72hrs, take for 28 days HIV test at 4-6wk, 3 months and 6 months after exposure