HIV/AIDS

Dr. Eisenhower only Slideshow

what kind of virus is HIV

retrovirus

what does the HIV retrovirus target

white blood cells, specifically CD4 cells

what does HIV do

infects the cell, converts RNA into DNA using reverse transcriptase; viral DNA gets into host cell DNA and retrovirus replicates

where is HIV-1 enedimic to

US

where is HIV-2 endemic to

West Africa

what are some risk behaviors that can lead to HIV transmission

blood transfusion, needle-sharing, needle-sticks, anal, penile, and oral intercourse

what are some symptoms of HIV

fever, sore throat, swollen lymph nodes, rash, muscle aches, night sweats, mouth ulcers, chills, fatigue

who should be screened for HIV

everyone ages 13-64 at least once; people who are pregnant during each pregnancy; annually for people with risk factors

what testing should you do to evaluate for HIV

HIV antibody/antigen testing, CD4 T lymphocyte cell count, plasma HIV RNA load, HLA-B*5701 serotype testing

if the test is highly sensitive and the result is negative, what can we be nearly certain about

the person does not have the disease

SNOUT

sensitivity rules out

if the test is highly specific and the result is positive, what can we be nearly certain about

the person has the disease

SPIN

specificity ruled in

when should someone with CD4 <300 cells/mm3 have CD4 cells monitored

every 3 months

when should someone with CD4 >300 cells/mm3 have CD4 cells monitored

every 6 months for 2 years

when should someone with CD4 300-500 cells/mm3 after 2 years have CD4 cells monitored

every 2 months

when should someone with CD4 <500 cells/mm3 after 2 years have CD4 cells monitored

whenever - it’s optional

what is the RNA monitoring goal for patients with HIV

to be undetectable

how do you get diagnosed with AIDS

presenting with an AIDS-defining condition or CD4 <200 cells/mm3

integrase strand transfer inhibitors (INSTIs) suffix

-gravir

what are some warnings and precautions for INSTIs

SJS, myopathy, rhabdo,, hepatotoxicity, depression or suicidal ideation

what are the 5 INSTIs

bictegravir, cabotegravir, dolutegravir, elvitegravir, raltegravir

protease inhibitor (PI) suffix

-navir

what are some warnings and precautions for PIs

SJS, hyperbilirubinemia, hepatotoxicity

if sulfa allergy, use fosamprenavir, tipranavir, or darunavir

what are the 9 PIs

atazanavir, darunavir, fosamprenavir, indinavir, lopinavir/ritonavir, nelfinavir, ritonavir (booster), saquinavir, tipranavir

non-nucleoside reverse transcriptase inhibitors (NNRTIs) suffix

-ine

what are some warnings and precautions for NNRTIs

SJS, hepatotoxicity, serious depression/SI, lipodystrophy

what are the 6 NNRTIs

delavirdine, efavirenz, etravirine, nevirapine, rilpivirine, doravirine

nucleoside reverse transcriptase inhibitors (NRTIs) suffix

-ine

what are some warnings and precautions for NRTIs

peripheral neuropathy, lactic acidosis, hepatotoxicity, anemia, hypersensitivity reactions

what are the 8 NRTIs

abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir alafenamide, tenofovir disoproxil fumarate, zidovudine

is TDF or TAF better

TAF

what NRTI requires special testing before initiation

abacavir

what testing does abacavir need before initiation

HLAB*5701 testing

Triumeq (INSTI + 2 NRTIs)

dolutegravir/abacavir/lamivudine

Genvoya (INSTI + CYP450i + 2 NRTIs)

elvitegravir/cobicistat/TAF/emtricitabine

Biktarvy (INSTI + 2 NRTIs)

bictegravir/emtricitabine/TAF

Striblid (INSTI + CYP450i + 2 NRTIs)

elvitegravir/cobicistat/TDF/emtricitabine

Symtuza (PI + CYP450i + 2 NRTIs)

darunavir/cobicistat/emtricitabine/TAF

Atripla (NNRTI + 2 NRTIs)

efavirenz/emtricitabine/TDF

Odefsey (NNRTI + 2 NRTIs)

rilpivirine/emtricitabine/TAF

Dovato (INSTI + NRTI)

dolutegravir/lamivudine

Juluca (INSTI + NNRTI)

dolutegravir/ripivirine

Cabenuva (INSTI + NNRTI)

cabotegravir/rilpivirine

Descovy (PrEP) (2 NRTIs)

emtricitabine/TAF

Truvada (PrEP) (2 NRTIs)

emtricitabine/TDF

CCR5 co-receptor antagonist indication

CCR5-tropic HIV-1

CCR5 co-receptor antagonist drug

maraviroc

CCR5 co-receptor antagonist warnings and precautions

hepatotoxicity, SJS, myocardial infarction

Fusion protein inhibitor indication

treatment-experienced patients with HIV-1 replication despite ongoing treatment

Fusion protein inhibitor warnings and precautions

injection site reactions, immune reconstitution inflammatory syndrome (IRIS)

Fusion protein inhibitor drug

enfuvirtide

gp120-directed attachment inhibitor indication

treatment-experienced adults with MDR HIV-1 who are failing current ARV

gp120-directed attachment inhibitor warnings and precautions

IRIS, QT prolongation, virologic failure

gp120-directed attachment inhibitor drug

fostemsavir

CD4-directed post-attachment HIV-1 inhibitor indication

treatment-experienced adults with MDR HIV-1 failing their current treatment

gp120-directed attachment inhibitor warnings and precautions

IRIS

gp120-directed attachment inhibitor drug

ibalizumab-uiyk

HIV-1 capsid inhibitor indication

treatment experienced adults with MDR HIV-1 who is failing their current treatment

HIV-1 capsid inhibitor warnings and precautions

IRIS, coadministration with strong CYP3A4 inducers

HIV-1 capsid inhibitor drug

lenacapavir

what are 4 additional safety concerns with ARV

MI, GI effects, increase in SCr, ostropenia

what NRTIs have HBV activity

emtricitabine, tenofovir, lamivudine

what are some DDIs with HIV treatments

alpha blockers, anticoagulants, antiplatelets, CNS medications,

PrEP regimen for cisgender men or cisgender women

Truvada (emtricitabine 200mg/TDF 300mg) PO QD

PrEP regimen for cisgender men or transgender women

Descovy (emtricitabine 200mg/TAF 25mg) PO QD

what is CAB-LA

long-acting injectable cabotegravir; PrEP

who should get CAB-LA

adults and adolescents who report sexual behaviors placing them at substantial risk for HIV

what do you do if you plan to miss a dose of CAB-LA by >7 days

take daily oral cabotegravir for up to 2 months; restart injection on last day of daily oral dose or within 3 days

what do you do if you plan to miss a dose of long-acting injectable lenacapavir by <2 weeks

use oral tablets on an interim basis for up to 6 months until injection resumes (PO qweek)

what do you do if you miss doses of long-acting injectable lenacapavir by >28 weeks

restart from day 1

what should you monitor during PrEP

CrCl - baseline and annually, if CrCl baseline <90 or age >50, check every 6 months; HIV Ag/Ab tests

how long should a person wait before having sex with an HIV-positive/unknown partner once PrEP is started

7 days

how many drugs should PEP have

at least 3

how long is PEP duration

4 weeks

what is the preferred drug regimen for nPEP

emtricitabine/TDF 200mg/300mg PO QD AND either raltegravir 400mg BID or dolutegravir 50mg PO QD

what are the different drug regimen combinations for oPEP

2 NRTIs plus INSTI/PI/NNRTI

what are the 2 main goals of ARV

reduce morbidity and mortality and prevent transmission

what is the first-line treatment regimen for patients without a history of using CAB-LA as PrEP

bictegravir/TAF/emtricitabine OR dolutegravir/TAF or TDF/emtricitabine or lamivudine OR dolutegravir/lanivudine

what is the first-line treatment regimen for patients with a history of using CAB-LA as PrEP

INSTI genotype resistance testing; darunavir/cobicistat/TAF or TDF/emtricitabine or lamivudine