Human Immunodeficiency Virus

Question 1

AIDS Diagnosis

Answer 1

CD4 count < 200 cells/m2
OR
AIDS-defining condition (Opportunistic infections, Kaposi’s sarcoma, HIV wasting syndrome)

Question 2

Nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) medications (6 drugs)

Answer 2

Abacavir
Emtricitabine
Lamivudine
Tenofovir disoproxil fumarate
Tenofovir alafenamide
Zidovudine
(Z-LATTE)

Question 3

MOA of NRTIs

Answer 3

Competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA

Question 4

Which NRTIs require renal adjustments

Answer 4

All but Abacavir (Lamivudine, both tenofovirs, emtricitabine, zidovudine)

Question 5

Which NRTI can be administered IV

Answer 5

Zidovudine (during labor and delivery)

Question 6

Integrase strand transfer inhibitor (INSTI) medications (5 drugs)

Answer 6

Bictegravir
Cabotegravir
Dolutegravir
Elvitegravir
Raltegravir
(B-CRED, all end in -tegravir!)

Question 7

MOA of INSTIs

Answer 7

Block the integrase enzyme, preventing HIV DNA from inserting into the host cell of the DNA

Question 8

Which HIV drugs have a higher barrier to resistance than NRTIs, NNRTIs, and other INSTIs (2 drugs)

Answer 8

Bictegravir and dolutegravir

Question 9

Which INSTI is dosed BID?

Answer 9

Isentress (raltegravir)

Question 10

What are the renal dose cut-offs for Stribild

Answer 10

CrCl < 70 mL/min: do not start Stribild
CrCl < 50 mL/min: discontinue Stribild

Question 11

What is the renal dose cut-off for starting Genvoya?

Answer 11

CrCl < 30 mL/min

Question 12

What is the renal dose cut-off for starting Biktarvy?

Answer 12

CrCl < 30 mL/min

Question 13

Which INSTI has an extended-release IM injection and what is it’s purpose?

Answer 13

Cabotegravir
Only for pre-exposure prophylaxis

Question 14

Which class of HIV medications needs to be separated from cations?

Answer 14

INSTIs - take the INSTI 2 hours before or 6 hours after products containing Al, Ca, Mg, Fe

Question 15

Which drugs carry the HBV and HIV Coinfection Boxed Warning?

Answer 15

Severe acute HBV exacerbation can occur if emtricitabine, lamivudine, or tenofovir-containing products are discontinued.
Do not use Epivir-HBV for the treatment of HIV (contains a lower dose of lamivudine than what is needed to treat HIV)

Question 16

Which medication may cause hyperpigmentation of the palms of the hands or the soles of the feet?

Answer 16

Emtricitabine

Question 17

Most preferred HIV regimens

Answer 17

2 NRTIs + 1 INSTI
Emtricitabine + tenofovir make up the NRTI backbone in most regimens
Lamivudine and emtricitabine are interchangeable but should NOT be used together
Dovato is also preferred

Question 18

When is it not recommended to use Dovato in treatment-naive patients?

Answer 18

HIV RNA > 500,000 copies/mL
HBV coinfection/status unknown
HIV genotypic testing is not preformed or resistance to either drug component is identified

Question 19

Alternative ART regimens

Answer 19

One “base” (PI, NNRTI, INSTI) plus two NRTIs

Question 20

Non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs

Answer 20

Efavirenz
Rilpivirine
Doravirine
Etravirine
Nevirapine
(REDEN)

Question 21

MOA of NNRTIs

Answer 21

Non-competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA

Question 22

Rilpivirine counseling points for administration

Answer 22

Take with a meal and water (do not substitute with a protein drink)
Requires an acidic environment for absorption; do no use with PPIs and separate from H2RAs and antacids

Question 23

Efavirenz counseling points for administration

Answer 23

Food increases the bioavailability and the risk for CNS effects; take on an empty stomach QHS

Question 24

Protease inhibitor (PI) drugs

Answer 24

Atazanavir
Darunavir
Fosamprenavir
Lopinavir/ritonavir
Tipranavir
(D-FLAT)
Names end in -navir

Question 25

MOA of PIs

Answer 25

Inhibit the HIV protease enzyme, preventing long viral protein chains from being broken down into the smaller chains needed to produce mature (infectious) virus during the building and maturation stage of the HIV life cycle

Question 26

All PIs require which other drug(s) to be with it?

Answer 26

Ritonavir or cobicistat

Question 27

What is the renal dose cut-off for starting TDF?

Answer 27

CrCl < 50 mL/min

Question 28

What is the renal dose cut-off for starting TAF?

Answer 28

CrCl < 30 mL/min

Question 29

PrEP regimens

Answer 29

Daily Truvada or Descovy OR Cabotegravir IM monthly x2 doses, then Q2Months.

Question 30

PEP regimens

Answer 30

Truvada (if CrCl >/=60 ) + Dolutegravir (Tivicay) or Raltegravir (Isentress) After HIV-exposure, start within 72 hours and take for 28 days

Question 31

What needs to be done before starting PrEP?

Answer 31

Confirm that the patient is HIV-negative Confirm CrCl >/= 60 mL/min for Truvada and CrCl>/= 30 mL/min for Descovy Screen for HBV and STIs

Question 32

When can patients take the OraQuick In-Home HIV Test?

Answer 32

No sooner than 3 months after exposure due to the lag in antibody production. Must be followed up with a confirmatory lab test if positive.

Question 33

Which protease inhibitors are cautioned for those with a sulfa allergy?

Answer 33

Darunavir, fosamprenavir, and tipranavir

Question 34

Which HIV medication may cause hyperbilirubinemia?

Answer 34

Atazanavir Reversible, does not require discontinuation

Question 35

Atazanavir counseling points for administration

Answer 35

Separate from H2RAs and antacids. Avoid PPIs with unboosted atazanavir Take boosted atazanavir at least 12 hours after the PPI (dose should not exceed omeprazole 20 mg or equivalent)