HIV Study Guide Part 1 (LAM)

What are the 3 enzymes involved in the HIV life cycle?

reverse transcriptase, protease, integrase

Based on the current HHS HIV treatment guidelines, which class is the preferred effective backbone for an antiretroviral therapy (ART)?

backbone class are NRTIs (nucleoside reverse transcriptase inhibitors (1 or 2)

Based on the current HHS HIV treatment guidelines, which class is preferred as the anchoring class for an effective ART regimen?

anchoring class are INSTs (integrase strand transfer inhibitor (1 or 0)

Which antiretrovirals (ARVs) inhibit the integrase enzyme? (SATA)

1. Darunavir

2. Dolutagravir

3. Elvitegravir

4. Rilpivirine

Answer: Dolutegravir, Elvitegravir (-gravirs)

• Darunavir = protease inhibitors (PIs)

• Rilpivirine = nonnucleoside reverse transcriptase inhibitors (NNRTIs)

Which ARVs inhibit the reverse transcriptase enzyme? (SATA)

1. Tenofovir disoproxil fumarate (TDF)

2. Darunavir

3. Abacavir

4. Doravirine

5. Cabotegravir

Answer: Tenofovir disoproxil fumarate (TDF), Abacavir, Doravirine

• Cabotegravir = integrase inhibitor (INST)

Which ARVs inhibit the protease enzyme? (SATA)

1. Darunavir

2. Dolutegravir

3. Atazanavir

4. Tenofovir alafenamide (TAF)

5. Lopinavir/ritonavir

Answer: Darunavir, Atazanavir, Lopinavir/ritonavir (-navir)

• Dolutegravir = integrase strand transfer inhibitors (INSTIs)

• Tenofovir alafenamide (TAF) = nucleoside reverse transcriptase inhibitors (NRTIs)

Describe the class specific adverse effects of NRTIs.

1. lactic acidosis

2. myopathy

3. hepatic steatosis

4. lipodystrophy: tummy bloat and nerd neck

Describe the class specific adverse effects of NNRTIs

1. rash/SJS (NVP > EVP > RPV = ETR)

2. hepatotoxicity

Describe the class specific adverse effects of PIs

1. insulin resistance (→ hyperglycemia → T2DM)

2. hyperlipidemia (except ATV + DRV)

3. lipodystrophy

Before initiating an HIV+ patient on maraviroc (Selzentry), what test needs to be performed for this patient?

HLA-B* 5701 (higher risk of developing hypersensitivity (rash))

List 2 lab monitoring parameters associated with TAF and TDF

Nephrotoxicity (eGFR) and osteopenia/osteoporosis (BMD)

Provide 2 reasons why TAF is better than TDF

1. TDF has higher risk for nephrotoxicity and osteopenia/osteoporosis

2. TDF can cause fanconi syndrome (proximal renal tubules can reabsorb nutrients)

Provide 2 reasons why TDF is better than TAF

1. TAF causes weight gain

2. TDF has a better lipid profile than TAF

T/F - A patient can be rechallenged on abacavir after developing hypersensitivity reaction

False

A 55-year-old patient is newly diagnosed with HIV-1 infection. She presents to the clinic for discussion about antiretroviral treatment (ART) options. Based on her labs, you notice that she has mild-to-moderate renal impairment (CrCl 40 mL/min). She has NKDA. Which NRTI would be most appropriate for her with NO dose adjustment needed?

Abacavir (Ziagen, ABC)

• the only NRTI that does not need renal adjustment (all other NRTI do)

Which 2 NNRTI agents could cause CNS side effects?

1. Efavirenz (more severe)

2. Rilipivirine

Which NNRTI has a C/I w/ PPIs?

Rilipivirine (need to take w/ food to decrease pH)

Identify 2 main differences between efavirenz and rilpivirine

1. Efavirenz: don’t take w/ food (empty stomach); can cause dyslipidemia + Qt prolongation

2. Rilpivirine: take w/ food (acid labile)

What is the main difference between Stribild and Genvouya?

Genvoya has TAF and Stribild has TDF

What is the main difference between Complera and Odefsey?

Odefsey has TAF and Complera has TDF

Which NNRTI and INSTI should be taken with food to increase their absorption and AUC?

1. NNRTI: etravirine (ETR) and rilpivirine (RPV)

2. INSTI: Elvitegravir