Mercier HIV

Question 1

NRTIs

Answer 1

Abacavir (ABC)
Emtricitabine (FTC)
Lamivudine (3TC)
Tenofovir DF (TDF)
Tenofovir alafenamide (TAF)
Zidovudine (AZT, ZDF)

Question 2

NNRTIs

Answer 2

Efavirenz (EFV) eff my friends -non

all -ines

Question 3

PI

Answer 3

require boosting

-navir

Question 4

Integrase inhibitors

Answer 4

-gravir

Question 5

Fusion inhibitor

Answer 5

Enfuviritide

Question 6

CCR5

Answer 6

Maraviroc

Question 7

Post-attachment inhibitor

Answer 7

Ibalizumab

Question 8

Pharmacokinetic boosters

Answer 8

Ritonavir

Cobicistat

Question 9

TAF v TDF

Answer 9

TAF delivers high potency while minimizing off-target renal and bone side effects

Question 10

Preferred NRTI backbone choices

Answer 10

Truvada= TDF + emtricitabine *renal and bone density concerns
Descovy= TAF + emitricitabine
Triumeq = ABC/3TC/dolutegravir *only if HLAB absent

Question 11

Initial regimens for most people

4 options

Answer 11

Biktarvy (BIC/TAF/FTC)

Triumeq (DTG/ABC/3TC) *HLAB -

Tivicay (doluteg) + Truvada (TDF/FTC) or Descovy (TAF/FTC)

Isentress (roluteg) + Truvada or Descovy

Question 12

Rilpivirine considerations

Answer 12

DO NOT use if viral load > 100,000 and CD4 > 200

Question 13

TDF considerations

Answer 13

NOT recommended for individuals with or at risk of kidney or bone disease

Question 14

2-drug regimen considerations

Answer 14

Only recommended in rare situations in which pt cannot take ABC, TAF, or TDF

Question 15

HIV viral load monitoring

Answer 15

2 to 4 weeks after starting ART, no later than 8 weeks.
Repeat every 4 to 8 weeks until undetectable
Goal: undetectable within 8-24 weeks then check q 3 to 4 months
Check q 6 months if undetec. after 2 years

Question 16

CD4 count monitoring

Answer 16

Check 3 months after initiation of ART
If stable CD4 (300-500) after 2 years measure every year
Goal: 50-150 increase during 1st year of ART

Question 17

Dual-NRTIs

ABC/3TC considerations

Answer 17

Combined w/ doluteg in Biktarvy
Once daily dosing 
Use only for HLA-B negative
Caution in patients with CV risk factors
Possible inferior efficacy if HIV RNA >100k and used with EFV, ATV/r, or RAL

Question 18

Dual-NRTIs

TDF/FTC considerations

Answer 18

Once daily dosing
Active against HBV
Potential for renal and bone toxicity
Avoid if CrCl < 60mL/min

Question 19

Dual-NRTIs

TAF/FTC

Answer 19

Once daily dosing
Active against HBV
Approved for eGFR >30mL/min

Question 20

CD4 <200

Answer 20

Do not use higher rate of virologic failure:

• RPV-based ART
• DRV/r + RAL

Question 21

HIV RNA >100,000

Answer 21

Do not use higher rate of virologic failure:

• RPV based ART
• ABC/3TC + EFV or ATV/r

Question 22

Taken on an empty stomach

Answer 22

EFV based regimens

Question 23

Options when ABC or TAF cannot be used

Answer 23

LPV/r +3TC

DRV/r + RAL (if HIV <100k and CD4 >200)

Question 24

Psychiatric illness considerations

Answer 24

Consider avoiding EFV and RPV

Question 25

Require dosage modification or cautious use

Answer 25

Lipid-lowering agents
Antimicrobials, especially rifampin
Antifungals
Psychotropics- midazolam, triazolam
Alkaloids
Anithistamines - astemizole
Anticonvulsants

Question 26

Atazanavir considerations

Answer 26

2 hours before or 10 after for H2s
12 hours apart from PPIs
Needs stomach acid

Question 27

Rilpivirine contraindications

Answer 27

PPIs

12 hours apart form H2

Question 28

Lipid lowering agent considerations

Answer 28

Simva and lova contraindicated w/ PIs
Prava and fluva least likely to interact with ARVs
Atorva at low doses
Rosuva start off low and slowly increase

Question 29

Breastfeeding considerations

Answer 29

Not recommended for anyone even those on ART therapy