HIV

HIV markers

Host cell receptors

Meds summary

• Entry inhibitors

• Inhibits reverse transcription

• Inhibits integration

• Inhibits translation

Entry (Binding, Fusion) →

Reverse Transcription →

Integration →

Replication (transcription, translation) →

Assembly →

Budding

HIV Access HIV-1 test system → …sample, answer within…

OraQuick → what swab, answer within…

HIV Access HIV-1 test system → blood sample sent to the office, answer within 3-7 days

OraQuick → oral swab, answer within 20-40 min

When first diagnosing HIV

Prevention for PCP when…

Viral load should be…

…testing

Prevention for PCP when CD4 <200

Viral load should be undetectable

Resistance testing

Rukobia

Generic

Class, MOA

Fostemsavir

Entry inhibitor, gp120 inhibitor (on HIV)

Fuzeon (Enfuvirtide) → fusion inhibitor, gp41 inhibitor

Trogarzo

Generic

Class, MOA

Formulation

ibalizumab

Entry inhibitor, binds to CD4 receptor (our cells)

IV

Selzentry

Generic

Class, MOA

Use the … to confirm

BBW

Maraviroc

Entry inhibitor, binds to CCR5 (our cell)

Use the tropism test to confirm susceptibility to medication

BBW: hepatotoxicity (just like PI, NNRTI)

Fuzeon

Generic

Class, MOA

Formulation

Enfuvirtide

Fusion inhibitor, inhibits gp41

SQ

Fostemsavir (Rukobia) → inhibits gp120

NRTI

Acronym Med names

ADE

Goes through the…

ZALE-T

• Zidovudine

• Abacavir

• Lamivudine

• Emtricitabine

• Tenofovir

ADE: hepatic steatosis, HA, lactic acidosis

Goes through the kidneys

DOC in HIV → 2 NRTIs + 3rd drug

Retrogen

Generic, Class

BBW

• ADE

  • ADE → use …(stop when …)

• ADE → avoid with…

Zidovudine, NRTI

BBW

• Bone marrow suppression

  • Anemia → use epogen (stop when Hgb >12)

• Myopathy → avoid with daptomycin, raltegravir

Abacavir (Ziagen)

Ziagen

Generic, class

ADE → testing

Abacavir, NRTI

ADE: Hypersensitivity reaction → HLAB-5701 testing

• Allopurinol → HLAB-5801

• Carbamazepine → HLAB-1502

Zidovudine (Retrogen)

Epzicom (→ generic)

Abacavir (Ziagen) + Lamivudine (Epivir)

Remember HLAB-5701 testing

Trizivir → generic

Triumeq → generic

Trizivir → Abacavir + Lamivudine + Zidovudine (3 NRTI)

Triumeq → Abacavir + Lamivudine + Dolutegravir (2 NRTI + 1 integrase inhibitor)

Remember HLAB-5701 testing

Dolutegravir (Trivicay)

Epivir, Epivir-HBV

Generic, class

Lamivudine, NRTI

Epivir-HBV lower dose than Epivir (for HIV)

Emtriva

Generi, class

Chemically similar to…

Counseling point →

Combo meds → (2)

Emtricitabine, NRTI

Chemically similar to lamivudine

Counseling point → darkening of the palms and soles 3 months after use

Combo meds - Truvada, Descovy

Truvada, Descovy (→ generic)

Both used for…as long as CrCl…

TruvAdA → Emtricitabine + TDF

Descovy → Emtricitable + TAF

Both used for PrEP as long as CrCl >30 (Apretude if CrCl <30)

(Both 2 NRTIs)

NOTE → think opposite of what you would usually think

Viread → generic

Vemlidy → generic

ADE → TAF has lower rates of…than TDF

Indications → TDF for…, TAF for…

Viread → Tenofovir disoproxil fumarate (TDF)

Vemlidy → Tenofovir alafenamide (TAF)

ADE → TAF has lower rates of osteoporosis and renal toxicity than TDF

Indications → TDF for HIV, TAF for chronic HBV

NNRTI

Acryonym Name Summary

ADE

RED

• RilpiVIRine

• EfaVIRenz

• DoraVIRine

ADE: rash, hepatotoxicity (just like PI and Selzentry), vs NRTI renal)

Edurant

Generic, class

Needs …for absorption

• Regards to food

• DDI

Combination meds → (2)

Rilpivirine, NNRTI

Needs acidic environment for absorption

• Take with food

• Avoid with antacids and PPI that increase pH

Combination meds → Complera, Odefesy

Complera, Odefesy (→ generic)

Complera not recommended when CrCl

Regards to food

Complera → Rilpivirine + Emtricitabine + TDF

Odefsey → Rilpivirine + Emtricitabine + TAF

Complera not recommended when CrCl <50

Take with food (rilpivirine)

(Emtricitabine + TDF or TAF → Truvada, Descovy)

Sustiva

Generic, class

Best to be taken… → decrease…

Avoid in

CYP

Combination med → (1)

Efavirenz, NNRTI

Best to be taken at night on empty stomach → decreases vivid dreams

Avoid in psychiatric disorders → increased suicidality

CYP3A4 inducers

Combination med → Atripla

Atripla (→ generic)

Regards to food

Efavirenz + Emtricitabine + TDF (double A)

Take on empty stomach (Efavirenz)

(Emtricitabine + TDF → Truvada)

Pifelto, Delstrigo (→ generic)

Pifelto → Doravirine, NNRTI

Delstrigo → Doravirine + lamivudine + TDF

Darunavir (Prezistra)

Integrase inhibitors

Acronym name summary

Regards to food

ADE

DDI

RBED

Raltegravir

Bictegravir

Elvitegravir

Dolutegravir

Without regards to food

ADE → GI, insomnia

DDI → separate from antacids

Isentress

Generic, class

DDI

• Increase dose while on …

• Increased…(ADE) with …

Raltegravir, integrase inhibitor

DDI

• Increase dose while on Rifampin

• Increased myopathy with Zidovudine

Biktarvy (→ generic)

BiktAvry → Bictegravir + Emtricitabine + TAF

(Emtricitabine + TAF → Descovy)

Stribild, Genvoya (→ generic)

Don’t initiate Stribild if CrCl

Regards to food

Elvitegravir + cobicistat + emtricitabine + TDF → StribilD

Elvitegravir + cobicistat + emtricitabine + TAF → GenvoyA

Don’t initiate Stribild if CrCl <70 (TDF)

Take with food (cobicistat)

(Emtricitabine + TDF/TAF → Truvada, Descovy)

Trivicay (→ generic)

Dolutegravir, integrase inhibitor

Dovato, Juluca (→ generic)

Dolutegravir + lamivudine → Dovato

Dolutegravir + rilpivirine → Juluca

(Cabotegravir + rilpivirine → Cabenuva)

Generic

Apretude

• Formulation, frequency, location

• Indicated for… (good for…)

Vacobria

• Formulation, indication

Cabotegravir

Apretude

• IM every 2 months in the glutes only

• Indicated for HIV PrEP (good for when CrCl <30 and cant use Truvada/Descovy)

Vacobria

• Oral lead in therapy prior to starting injectables (Apretude/Cabenuva)

Cabenuva (→ generic)

Cabotegravir + rilpivirine → Cabenuva (integrase + NNRTI)

(Dolutegravir + rilpivirine → Juluca)

Protease inhibitor

ADE

• (3)

• Increase risk of …

Goes through the…

DDI → CYP

• CI with

• Never give with

Regards to food

Lopinavir, Ritonavir, Darunavir

ADE

• Lipodystrophy - fat redistribution

• Hyperglycemia

• Hyperlipidemia (except in Atazanavir)

• Increase risk of bleeding, MI

Goes through the liver → hepatotoxicity (just like NNRTI)

DDI → CYP3A4 substrate and inhibitor

• CI with Rifampin (CYP3A4 inducer)

• Never give with simvastatin, lovastatin (CYP3A4 substrate)

Taken with food (reduce GI upset)

Don’t put 2 PI together

Kaletra

Generic

Formulation → ADE with what med

Contains… → avoid in

Lopinavir + Ritonavir (PI + booster)

Oral solution → disulfiram reaction with metronidazole

Contains polyene glycol → avoid in infants

Reyeza

Generic, class

Unique

ADE

DDI → separate from

Atazanavir, PI

Minimal hyperlipidemia (vs other PIs)

ADE → nephrolithiasis, cholelithiasis

DDI → separate from antacids → Needs acidic environment

Prezista

Generic, class

Avoid in…

Darunavir, PI

Avoid sulfa allergy

Doravirine (Pifeltro)

Evotaz, Prezcobix (→ generic)

Evotaz → atAZanavir + Cobicistat

Prezcobix → Darunavir (Prezista) + Cobicistat

Symtuza (→ generic)

Regards to food

Darunavir + Cobicistat + Emtricitabine + TAF → Symtuza

Take with food (cobicistat)

(Darunavir + Cobicistat → Prezcobix)

(Efavirenz → Sustiva)

Generic

Sunlenca → indication

Yeztugo → indication

-

MOA

Frequency

DDI → CYP

Lenacapvir

Sunlenca → Tx of HIV

Yeztugo → PrEP

-

MOA → inhibits HIV replication in multiple stages

Both SQ every 6 months

DDI: CYP3A4 substrate → CI with CYP3A4 inducers during HIV Tx

HIV in pregnancy

…drug preferred

DOC in tx-naive pregnant patients →

Give …during labor

Recommend …to prevent HIV transfer to infant

2 NRTI + 3rd drug preferred

DOC in tx-naive pregnant patients → Dolutegravir + Descovy (emtricitabine + TAF)

Give zidovudine during labor

Recommend C-section and no breastfeeding to prevent HIV transfer to infant

PEP Options

2 NRTIs (Tenofovir + Emtricitabine) +

• Integrase inhibitor (Raltegravir BID, Daltegravir QD)

• Boosted PI (Darunavir boosted with Ritonavir)

Immunizations in patients with HIV

Never give…

Never give live vaccines in patients with AIDS (HIV with CD4 count <200)

Ie. MMR, Varicella, live influenza, Yellow fever

Note live vaccines are okay if HIV w/ CD4 >200)

Kaposi sarcomoa

…malignancy…

AIDS malignancy occuring mainly on the face