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PHAR 557 > HIV - Tx Principles, Regimens, and Monitoring > Flashcards

HIV - Tx Principles, Regimens, and Monitoring Flashcards

1
Q

Who is ART indicated for?

A

EVERYONE with HIV, regardless of CD4 count

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2
Q

What is key for a pt to successfully manage an HIV infection and remain non-infectious?

A

ADHERENCE to ARV tx regimen

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3
Q

What are the goals of ARV tx?

A
  1. reduce viral load to < 20 copies/mL (undetectable)
  2. restore CD4+ count to > 500 cells/mm^3
  3. prevent HIV transmission (U=U)
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4
Q

How long does it take for ART to reduce viral load to undetectable?

A

6-12 wks after initiation

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5
Q

When should HIV tx be started?

A

ASAP

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6
Q

Name the NRTIs:

A 
abacavir (ABC)
emtricitabine (FTC)
lamivudine (3TC)
tenofovir (TDF and TAF)
zidovudine (AZT, ZDV)
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7
Q

Name the NNRTIs

A 
Efavirenz (EFV)
Etravirine (ETR)
Nevirapine (NVP)
Rilpivirine (RPV)
Doravirine
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8
Q

Name the PIs

A

Atazanavir (ATV)
Darunavir (DRV)
Lopinavir (LPV)

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9
Q

Name the pharmacokinetic boosters:

A

Cobicistat (/c)

Ritonavir (/r)

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10
Q

Name the INSTIs

A

Raltegravir (RAL)
Eltegravir (EVG)
Dolutegravir (DTG)
Bictegravir (BIC)

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11
Q

How’re HIV drugs usually combined?

A

3 active drugs from 2 diff classes

usually 2 NRTIs and another drug class [usually an INSTI or PI, and s.times an NNRIT]

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12
Q

What’s the most common fixed-dose NRTI combo?

A

Truvada (TDF + FTC)

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13
Q

When should CD4 absolute and HIV viral load be monitored?

A

Baseline (before tx) and after 3-4 mnths of tx

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14
Q

What’s the most IMPORTANT value to monitor?

A

viral load

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15
Q

Which drug requires that we check for HLA B *5701?

A

abacavir

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16
Q

The function of which organs should be monitored while on antiretrovirals?

A

Liver, kidneys

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17
Q

When does resistance develop?

A

When the HIV virus replicates in the presence of drug

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18
Q

Low adherence can lead to viral resistance against antivirals. What kind of HIV drugs are avoided in pts who have sucky adherence?

A

Drugs have low genetic barrier to resistance

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19
Q

1 cause of ARV resistance?

A

Poor or intermittent adherence

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20
Q

Which antiretroviral is preferred in renal dysfn pts?

A

tenofovir (TDF and TAF)

CrCl down to 60 ml/min = TAF and TDF regimens; CrCl down to 30 ml/min = TAF okay

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21
Q

Which antiretroviral is preferred in pts who have comorbid HBV?

A

tenofovir

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22
Q

What kind of ARV tx is preferred in pts w/ osteoporosis?

A

NNRTI regimens (avoid TDF, but TAF is okay > these are NRTIs)

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23
Q

What HIV meds should be avoided in depression/anxiety?

A

EFV and DTG

24
Q

Which HIV meds should be avoided if pt has CV risks?

A

PIs, EFV (may increase lipids), ABC (may increase MI risk)

25
Q

Which HIV meds should be avoided in DM pts?

A

PIs (raises blood glucose)

26
Q

Which of the following does not help w/ improving adherence?

a. phone alarms
b. single pill regimens
c. monthly dispense
d. blister packing

A

c. monthly dispense

Rather, weekly/biweekly dispenses will help

27
Q

What should be done if pt adherence is a concern during ARV tx?

A

Pick a regimen w/ higher genetic barrier to resistance

28
Q

How much should pts pay for their antiretrovirals in SK?

A

$0

29
Q

After how many weeks of ARV should another blood test be taken?

A

~6weeks

30
Q

What are the two most important variables on a blood test in an HIV pt

A
  1. viral load

2. CD4 count

31
Q

As long as HIV virus is still detectable, how often should monitoring be done?

A

q6-8 wks

32
Q

When HIV virus is suppressed, how often should monitoring be done?

A

q6mths

33
Q

When does it become unnecessary to check CD4 counts?

A

when it gets > 500 cells/mm^3

34
Q

Low vs high genetic barrier drugs: what’s the difference?

A

Lower genetic barrier drugs - may only require single base pair change to confer resistance

Higher genetic barrier drugs - require multiple base pair changes to confer resistance

35
Q

T or F: drug resistant HIV can be transmitted.

A

T

36
Q

T or F: Women who get pregnant and who are already on ARV tx’s should halt their tx for the time being until they

A

F

They should continue it

37
Q

How big is the drop in viral load after 6 weeks of ART?

A

2 log drop

38
Q

What is considered a virological failure wrt HIV tx?

A

When pt isn’t achieving a viral load below 200 copies/mL

39
Q

What is considered an immunologic failure?

A

failure to achieve/maintain adequate CD4 counts despite undetectable viral load

40
Q

What is to be done during virological failure?

A

Genotypic testing, assess adherence, pick new regimen + check viral load in 4-6wks

41
Q

T or F: There’s no solution available for immunologic failures other than treating illnesses that may arise as a result of it.

A

T

42
Q

What does an HIV regimen consist of?

A

at least 3 active drugs from 2 diff classes > 2 NRTIs and one of PI/INSTI/NNRTI

43
Q

T or F: Properly treated HIV is still considered a chronic illness.

A

F

It’s considered a chronic “condition”

44
Q

What is PrEP, and what drugs comprise it?

A

It’s a treatment protocol used to prevent acquiring the HIV virus

It’s comprised of FTC/TDF (Truvada) > ONLY PrEP drug available for now

45
Q

What is usually used as a post-exposure prophylaxis (PEP)?

A

PI or INSTI
+
TDF/FTC backbone

46
Q

How long is PEP used for?

A

28 days (or less if source is confirmed to not have HIV)

47
Q

After being exposed to HIV, how much time do you have to receive PEP before its effectiveness becomes negligible?

A

72h

48
Q

What drug is used for infant PEP who are born to HIV+ mothers?

A

AZT (zidovudine)

49
Q

What may happen if Truvada (PrEP tx composed of TDF and FTC) is used in an HIV+ person?

A

Drug resistance to Truvada (since it’s not triple tx)

50
Q

T or F: PrEP is enough as a stand-alone intervention for HIV prevention

A

F

Other methods are important (condoms, clean injection equipment, etc.)

51
Q

Renal fn requirement for PrEP?

A

eGFR > 60 mL/min for TDF/FTC use

52
Q

T or F: It’s appropriate to stop a problematic component of an HIV regimen to reduce AEs.

A

F

NEVER EVER DO THIS > risks resistance

53
Q

T or F: ART in HIV pts is lifelong

A

T

54
Q

What’s the viral load target for ART in HIV pts?

A

< 20 copies/mL
aka < 2.00+E01 copies/mL
aka “target not detected”

55
Q

T or F: Non-adherence is worse than intermittent adherence wrt ART.

A

F

56
Q

Largest comorbidity in HIV pts, even when the virus is suppressed.

A

Inflammation

PHAR 557 (36 decks)

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