HIV (NAPLEX)

What is the CD4 count?

indicator of immune function

When the CD4 count falls below ____ cells/mm3, the immune system cannot ward off opportunistic infections.

200

CD4 _______ with ART

A. Increases

B. Decreases

A. Increases

HIV viral load ______ with ART

A. Increases

B. Decreases

B. Decreases

All persons aged ____-___ years should be screened for HIV at least once

13-64 yo

What is the OTC HIV test?

OraQuick - tests for antibodies

OraQuick results (1 line vs 2 line)

1 line = negative

2 lines = positive

How often can you perform the OraQuick?

every 3 months

Typical HIV regimen components **

BASE + 2 NRTIS as backbone

Base: PI, NNRTI, INSTI

NRTI MOA

inhibit reverse transcription, blocking the conversion of HIV RNA to HIV DNA

NRTI drugs (6)

LATTEZ

Lamivudine

Abacavir

TDF

TAF

Emtricitabine

Zidovudine

NRTI BW (1)

HBV/HIV coinfection

Warning with NRTI's (2)

lactic acidosis

severe hepatomegaly

What drug has BBW of HLAB5701?

Abacavir (NRTI)

Abacavir

A. HLA-B*7801

B. HLA-B*5701

C. HLA-B*5801

B. HLA-B*5701

Contraindicated with CrCl < 50

A. TDF

B. TAF

A. TDF

Contraindicated with CrCl < 30

A. TDF

B. TAF

B. TAF

Causes more renal dysfunction and decreased bone mineral density

A. TDF

B. TAF

A. TDF

lipid abnormalities

A. TDF

B. TAF

B. TAF

What drug can cause hyperpigmentation of hands/feet?

Emtricitabine (NRTI)

T/F: if a pt takes abacavir they must carry a medication card indicating that HSR is a medical emergency

True

What drug should be given during labor?

Zidovudine (NRTI)

Zidovudine side effect (1)

Hematologic toxicity (anemia, neutropenia, and macrocytosis)

INSTI MOA

Directly block integrase

INSTI drugs (5)

BCRED - tegravir

Bictegravir

Cabotegravir

Raltegravir

Elvitegravir

Dolutegravir

What 2 INSTI's increase Scr with little to no effects on GFR?

Bictegravir

Dolutegravir

What 2 INSTI's can increase CPK and cause rhabdo?

Raltegravir

Dolutegravir

Class side effects with INSTI's (3)

Weight gain

Insomnia

Depression

INSTI main DDI

Do not take with polyvalent cations (decrease INSTI absorption)

Take INSTI 2 hours before or 6 hours after

What class causes weight gain? (1)

INSTIs

"BCRED"

NNRTI drugs (5)

REDEN

Rilpivirine

Efavirenz

Doravirine

Etravirine

Nevirapine

What NNRTI must be taken with food & water?

Rilpivirine

What NNRTI can be taken on an empty stomach?

Efavirenz

What drug should not be used if viral load >100,000 or CD4 <200?

Rilpivirine (NNRTI) due to high failure rates

What drug can cause bad CNS and psychiatric effects? and how long

Efavirenz (NNRTI) - resolves in 2-4 weeks for most patients

What drug can increase cholesterol and triglycerides?

Efavirenz (NNRTI)

T/F: Rilpivirine needs an acidic gut for absorption

True

What NNRTI drug requires an acidic enviorment and should not be taken with PPIs?

Rilpivirine (NNRTI)

What NNRTI should NOT be used with PPIs!!! and why

Rilpivirine bc it needs an acidic gut for absorption

What DDI are seen with NNRTI's?

Major CYP3A4 substrates

PI drugs (2)

Atazanavir

Darunavir

"navirs" + BOOSTER

What medication should be avoided with sulfa allergies?

Darunavir

What drug class causes metabolic side effects?

PI's

What medication can cause hyperbilirubinemia, which is reversible?

Atazanavir (PI)

Maraviroc class and MOA

CCR5 antagonist

blocks HIV from binding to CD4 cell in virus strains

Maraviroc BW (1)

Hepatotoxicity

What drug requires a baseline tropism assay before starting?

Maraviroc

What drug can cause orthostatic hypotension in pts with renal impairment?

Maraviroc

What is PrEP?

Pre-exposure prophylaxis to prevent HIV in patients who engage in high risk activities

PrEP treatment (3 options)

Truvada or Descovy daily with no more than a 90 day supply

LA IM Cabenuva monthly for two months, then every 2 months

What is PEP?

Post exposure prophylaxis for emergency situations when a non-infected person is exposed

non-occupational (sex, IVDU) vs. occupational (healthcare worker)

When and for how long is PEP treatment?

TX ASAP within 72 hours of exposure and continued for 28 days

Toxo PPX in HIV (start, regimen, d/c)

Start: toxo IgG positive and CD4 <100

REGIMEN: bactrim DS daily

D/C: CD4 >300 for >3 months and remains on ART

MAC PPX in HIV (start, regimen, d/c)

START: not taking ART and CD4 <50 and no active MAC infection

REGIMEN: azithromycin 1,200mg weekly

D/C: taking fully suppressive ART

PJP PPX in HIV (start, regimen, d/c)

Start: CD4 <100 or CD4 <100-200 and HIV RNA detected

Regimen: Bactrim DS or SS daily

D/C: CD4 >200 for >3 months and remain on ART