HIV/STIs & Hepatitis

What are the five main classes of antiretroviral drugs?

1. Integrase inhibitors (InSTI)

2. Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTIs)

3. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

4. Protease inhibitors (PI)

5. Entry/Fusion/Coreceptor inhibitors.

What is the MOA for NRTIs?

Phosphorylated inside of cells → mimic nucleotides → blocks HIV reverse transcriptase → causes DNA chain termination.

What is the MOA for NNRTIs?

Bind allosterically to HIV reverse transcriptase, changing its shape → directly inhibiting DNA synthesis.

What is the MOA for Protease Inhibitors (PIs)?

They inhibit the protease enzyme, preventing the virus from cleaving large polypeptides into functional mature proteins.

What is the MOA for Integrase Inhibitors?

They bind to integrase and prevent viral DNA from being incorporated into the host DNA.

What is the MOA of Maraviroc?

It is a CCR5 antagonist that blocks the human receptor (not the virus) to prevent entry; tropism testing is required before use.

What genetic testing must be done before prescribing Abacavir?

HLA-B5701 testing to predict hypersensitivity reactions.

Adverse effects associated with NRTIs?

Mitochondrial toxicity, peripheral neuropathy, pancreatitis, lipoatrophy, myopathy, anemia, lactic acidosis and hepatic steatosis.

Adverse effects associated with Protease Inhibitors?

GI distress, increased lipids, glucose intolerance, and lipodystrophy (altered fat distribution, e.g., 'buffalo hump').

Which NNRTI should be avoided in pregnancy due to neural tube defect risks?

Efavirenz.

What is the general composition of an initial HIV treatment regimen?

A minimum of 3 agents, typically including a backbone of 2 NRTIs + a third agent (usually an Integrase Inhibitor).

What drug is recommended during labor to prevent HIV transmission?

Zidovudine.

What is the recommended post-exposure prophylaxis (PEP) regimen?

Tenofovir, Emtricitabine, and Raltegravir for 4 weeks, started as early as possible (1–2 hours post-exposure).

What is the treatment for Pneumocystis jirovecii Pneumonia (PCP)?

Sulfamethoxazole-trimethoprim (Bactrim) x 21 days.

What is the current CDC recommended treatment for Gonorrhea?

Ceftriaxone (Rocephin) 500 mg IM single dose PLUS Doxycycline 100 mg PO BID for 7 days.

What is the treatment for Chlamydia?

Doxycycline 100 mg PO BID for 7 days (or Azithromycin 1 g PO once).

What is the drug of choice for Syphilis?

Parenteral Penicillin G (Benzathine Penicillin G for single dose in early stages).

How is Trichomoniasis treated?

A single 2 g dose of Metronidazole (Flagyl) or Tinidazole.

What is the treatment approach for a first episode of Genital Herpes?

Acyclovir, Valacyclovir, or Famciclovir for 7–10 days.

What are the first-line oral agents for Hepatitis B due to high potency and low resistance?

Entecavir (Baraclude) and Tenofovir (Viread).

What are the severe 'Black Box' psychiatric warnings associated with Interferon-alfa?

Fatal or life-threatening neuropsychiatric disorders, depression, suicidal ideation, and aggression.

What is the Mechanism of Action for Sofosbuvir?

It is a nucleotide prodrug that inhibits NS5B RNA polymerase (acts as a chain terminator).

What is a major adverse effect of Ribavirin requiring careful monitoring?

Hemolytic anemia

What is the pregnancy category of Ribavirin?

Category X (Females must use 2 forms of birth control for up to 6 months after discontinuation).

What is the mechanism by which NNRTIs inhibit HIV replication?

They induce conformational changes in reverse transcriptase.

What is a key side effect of NRTIs?

Lactic acidosis with fatty liver secondary to mitochondrial toxicity.

What is the preferred initial ART regimen for most adults?

A combination of two NRTIs and an Integrase Inhibitor.

What is the preferred method for preventing HIV transmission in pregnant women?

Administering Zidovudine during labor.

What prophylactic regimen is recommended for healthcare workers post-exposure to HIV?

Tenofovir, Emtricitabine, and Raltegravir starting within 1-2 hours.

What is the first-line treatment for Syphilis?

Benzathine Penicillin G (Bicillin)

How is Trichomoniasis typically treated?

With a single dose of Metronidazole.

What is the mechanism of action of Acyclovir in the treatment of Herpes?

It inhibits viral DNA synthesis.

Which Hepatitis virus is commonly spread through fecal-oral transmission?

Hepatitis A.

What are the major first-line antiviral medications for Hepatitis B?

Entecavir and Tenofovir.

How is Hepatitis C infection monitored after treatment?

By checking for Sustained Virologic Response (SVR) at 12 weeks.

What describes a 'Virologic Response' in Hepatitis C treatment?

Finding non-detectable levels of HCV RNA after treatment.

What is a notable side effect of Ribavirin during therapy?

Hemolytic anemia.

What is the function of Integrase Inhibitors in HIV therapy?

They prevent viral DNA from integrating into the host genome.

What is a unique side effect associated with Protease Inhibitors?

Lipodystrophy.

What are the risks of using Efavirenz in pregnancy?

Neural tube defects in the fetus.

What is the MOA of Doxycycline against Chlamydia?

Inhibiting protein synthesis in bacteria.

What class of antiretroviral drugs does Raltegravir belong to?

Integrase inhibitors.

Which Hepatitis virus is associated with chronic infection and is treated with direct-acting antivirals?

Hepatitis C.

What is the MOA of Tenofovir?

NRTI → chain termination

What condition is characterized by an increase in opportunistic infections in HIV patients starting ART?

Immune Reconstitution Inflammatory Syndrome (IRIS).

What is the recommended treatment for acute Hepatitis A infection?

Supportive care, as it is self-limiting.

What are the adverse effects of Ribavirin in treating Hepatitis C?

Hemolytic anemia and teratogenic effects.

What test is crucial before initiating treatment with Interferon for Hepatitis B?

Assessing thyroid function, as it can affect treatment response.

What differentiates Hepatitis C from Hepatitis B regarding transmission?

Hepatitis C is primarily transmitted through blood exposure.

What are common adverse effects of NRTIs in HIV treatment?

Lactic acidosis and peripheral neuropathy.

What adverse effects can occur from NRTI-induced mitochondrial toxicity?

Peripheral neuropathy and lipoatrophy.

What is the MOA of Interferons in treating Hepatitis B and C?

They enhance the immune response against viral infections.

What is a long-term complication of chronic Hepatitis B infection?

Liver cirrhosis and hepatocellular carcinoma.

What is the first-line antiviral treatment for Chronic Hepatitis C?

Direct-acting antivirals (DAAs).

What pharmacological class does Efavirenz belong to?

Non-nucleoside reverse transcriptase inhibitors (NNRTIs).

What is the primary method for checking Ribavirin effect in patients?

Regular complete blood count (CBC) monitoring.

What long-term monitoring is needed for patients with chronic Hepatitis B?

Regular liver function tests and imaging studies.

What is a common side effect noted in both NRTIs and PIs?

Gastrointestinal disturbances.

What does a viral load of <50 copies/mL signify in an HIV patient?

Virologic suppression.

What should be routinely monitored in HIV patients on ART?

Liver function tests (LFTs).

How often should healthcare providers assess kidney function in patients taking Tenofovir?

Regularly, especially if they have preexisting conditions.

What kind of vaccination is critical for patients with Hepatitis B?

Vaccination to prevent Hepatitis A.

Stavudine

NRTI

Zidovudine

NRTI

Emtricitabine

NRTI

Lamivudine

NRTI

Abacavir

NRTI

Didanosine

NRTI

Tenofovir

NRTI

Zidovudine (AZT) belongs to the drug class __.

NRTIs

Abacavir requires __ testing for hypersensitivity.

HLA-B5701

Lamivudine (3TC) is also active against __.

Hepatitis B

Tenofovir is classified as __ and is active against Hepatitis B.

NRTI.

Didanosine belongs to the drug class __.

NRTI.

Delavirdine belongs to the drug class __.

NNRTI.

Efavirenz should be avoided in __ due to neural tube defects.

pregnancy.

Nevirapine is classified as an __.

NNRTI.

Etravirine belongs to the drug class __.

NNRTI.

Rilpivirine is classified as __.

NNRTI.

Atazanavir belongs to the drug class __.

Protease Inhibitors

Darunavir belongs to the class of drugs known as __.

Protease Inhibitors

Lopinavir is often co-formulated with __.

Ritonavir

Ritonavir is primarily used as a __.

booster/CYP3A4 inhibitor.

Raltegravir belongs to the drug class __.

Integrase Inhibitors

Elvitegravir is classified as an __.

Integrase Inhibitors

Bictegravir belongs to the class of drugs known as __.

Integrase Inhibitors

Cabotegravir is an __ drug.

Injectable Integrase Inhibitor

Nystatin is used to treat __.

Oral Candidiasis

Enfuvirtide belongs to the class of __.

Fusion Inhibitors

Maraviroc is a __ that requires tropism testing.

CCR5 Antagonist

Daclatasvir belongs to the drug class __.

NS5A Inhibitors

Ledipasvir is classified as __.

NS5A Inhibitors

Sofosbuvir is a __ Polymerase Inhibitor.

NS5B

Dasabuvir is classified as an __ Polymerase Inhibitor.

NS5B

Simeprevir belongs to the drug class __.

NS3/4A Protease Inhibitors

Ribavirin causes __ and is Category X in pregnancy.

hemolytic anemia

Interferon-alfa belongs to the class of __.

Cytokine/Immunomodulator

Peg-Interferon-alfa is longer acting than __.

standard interferon

Entecavir is a __ Analog (Anti-HBV).

NRTI

Telbivudine belongs to the drug class __.

NRTIs