Term
| What are the mode of transmission of HIV? |
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Definition
- Sexual: receptive anal or vaginal intercourse
- Parenteral: IVDU, needlesticks
- Perinatal: in utero, Delivery (vertical transmission), breastfeeding |
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Term
| What are methods for detection of HIV? |
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Definition
- Enzyme-linked immunosorbent assay (ELISA): detects Ab against HIV-1 (highly sensitive ans specific), false (-) may be due to new infx
Covenient ELISA methods:
- OraSure: oral collection
- Home access fingerstick
- Calypte: urine test
- OraQuick: rapid (20-40 min), Flexible (clinical & non-clinical settings), Accurate (>99% agreement w/confirmatory western blot)
ELISA repeated, if (+) then confirmatory Western Blot performed ((+) results indicate established HIV infx)
NOTE: is Western Blot intermediate retest after 30 days or perform viral load (VL) assay. |
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Term
| How is HIV dz characterized? |
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Definition
| By depletion of CD4 cells and development of oportunistic infx and malignancies |
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Term
| What is the major prognostic factor in monitoring HIV dz progression and response to therapy? |
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Definition
| HIV viral load (VL): copies of HIV RNA/mL plasma. It quantify degree of viremia |
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Term
| Which marker is critical for evaluation of disease progression? |
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Definition
| CD4 Lymphocyte count (T-helper cells)(normal=500-1600 cells/mm^3): strongest predictor of progression and survival |
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Term
| What is the life cycle of HIV replication? |
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Definition
| Attachement of HIV virion to receptor on host membrane--Fusion/entry--Reverse transcription--integration--transcription--translation--viral assembly--budding and maturation of HIV virion--viral release |
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Term
| What are the sites for pharmacologic intervention? |
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Definition
Attachement: entry inhibitors: SCH-C, SCH-D, BMS806
Fusion inhibitors: T-20
Reverse transcriptase inhibitors: NRTIs, NNRTIs (TMC-125)
Integration inhibitors: S-1360
Buddin/maturation inhibition: protease inhibitors |
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Term
| What are monitoring parameters for HIV? |
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Definition
- CD4 count at baseline, Q3-6 mo to monitor clinical response to ART
- HIV VL testing may be considered for initiation of ART, at or immediately before initiation of tx, ≥2 wks (2wks to mo) after initiation or change in tx, 3-6 mo subsequently
- Genotype testing preferred for ARV-naive pts upon tx start (repeat testing at ART initiation), when suboptimal VL reduction, & to all pregnant women priot to initiation of tx and those entering pregnancy who hace detectable VL while on ART
- HLA-B*5701 screening: for Abacavir sensitivity reaction
- Coreceptor Tropism assays TrofileTM, PhenoscriptTM: When maraviroc (CCR5 inhibitor) considered for tx, or ptz experiencing virologic failure on CCR5 inhibitor
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Term
| What are clinical presentation of Primary HIV infection? |
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Definition
- High VL
- Precipitous drop in CD4
- Latently infected cells established
- Virus disseminates and establishes infection in lymph nodes, gut-associated lymph tissue (GALT) |
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Term
| T/F: Plasma HIV RNA indicates magnitude of HIV replication and CD4 destruction? |
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Definition
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Term
| What factors should be considered for tx of HIV? |
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Definition
- Comorbid conditions
- Adherence and convenience
- ADE
- DI
- Pregnancy/potential pregnancy
- Resistance test results
- HLA-B*5701 |
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Term
| When is resistance testing indicated? |
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Definition
- VL > 1000 copies/mL
- Initial assessment, includin ART-naive pts
- REpeat prior to starting ART
- Following regimen failure (while on therapy)
- Pregnancy (prior to starting ART/entering pregnancy w/ detectable VL) |
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Term
T/F: immunologic AIDS is defined as CD4 > 200 cells/mm^3? |
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Definition
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Term
| What are AIDS0defining illness? |
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Definition
| Esophageal Candidiasis, Cytomegalovirus (CMV), Lymphoma, Kaposi Sarcoma (KS), Pneumocystis carinii pneumonia (PCP), Mycobacterium avium infx/complex (MAI/MAC), cryptococcosis. |
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Term
| What are tx recommendation for naive HIV-infected pts? |
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Definition
- 2 NRTIs + 1 NNRTI
- 2 NTTIs + 1PI or 1PI/RTV (boosted)
- 2NRTIs + INSTI |
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Term
| Which tx require dose adjustment in renal insufficiency? |
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Definition
- NRTI--most renally eliminated
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Term
| What to consider w/ NRTIs? |
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Definition
- ABC (abacavir): Alcohol dehydrogenase
- ZDV (Zidovudine): glucuronidation
- ddI (didanosine) should be taken on empty stomach untless with TDF (tenofovir) (uncommon combination) |
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Term
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Definition
- Lactic acidosis w/ hepatic steatosis (rare): S/SX:GI (N/V/D, abdominal distention and pain), myalgia, difficulty breathing
Risk factors: obesity, prolonged use, females> males |
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Term
| What are specific ADE of NRTIs? |
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Definition
- Abacavir: hyepersensitivity rx (HLA-B*5701)-black box warning
Never rechallenge, DC immediately
- ddI (didanosine) and d4T (stavudine): peripheral neuropathy, pancreatitis
- TDF (tenofovir): GI upset (mild), flatulence, nephrotoxicity
- FTC (emtricitabine): hyperpigmentation of plams & soles
- ZDV (zidovudine): Bone marrow suppression (anemia, neutropenia), fatigue, nausea |
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Term
| What are preferred regimens? |
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Definition
NNRTI-based regimen:
Preferred: FTC/TDF +EFV
Alt: ABC/3TC + EFV or FTC/TDF + RPV, or ABC/3TC + RPV
RPV=ripivirine, EFV= efavirenz, 3TC= lamivudine , FTC= emtricitabine, TDF= tenofovir, ABC= abacavir
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Term
| Which NNRTI is new and marketed for NNRTI-resistant virus? |
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Definition
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Term
|
Definition
- Rash: self limiting vs. stevens-johnson syndrome
NVP (nevirapine)>EFV (efavirenz)
- hepatic transaminase elevations
- EFV: CNS effects
- Etravirine: GI effects, HA, inability to concentrate Dizziness |
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Term
|
Definition
Preferred: FTC/TDF + ATV/r QD, or FTC/TDF + DRV/r QD
Alt: ABC/3TC + ATV/r, or ABC/3TC + DRV/r, or ABC/3TC + FPV/r (QD/BID, or FTC/TDF + FPV/r (QD/BID), or ABC/3TC + LPV/r (QD/BID), or FTC/TDF + LPV/r (QD/BID)
ATV/r= atazanavir/ritonavir, DRV/r= darunavir/ritonavir, LPV/r= lopinavir/ritonavir |
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Term
|
Definition
- Glucose intolerance
- Lipohypertrophy (neck, back, breast or abdomen)
- Lipoatrophy
- Hyperlipidemia, hypertriglyceridemia
- Elevated transaminases
- GI upset |
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Term
|
Definition
- ATV (atazanavir): hyperbilirubinemia
- LPV/r (lopinavir/ritonavir): GI, pancreas
- DRV (darunavir): GI, rash
- TPV (tipranavir): Gi, hepatitis, rash, intracranial hemorrhage (rare)
- APV/FPV (amprenavir/fosamprenavir): GI, rash, oral paresthesias
- IDV (indinavir): hyperbilirubinemia, nephrolithiasis
- NFV (nelfinavir): diarrhea |
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Term
|
Definition
Preferred: FTC/TDF + RAL
Alt: ABC/3TC + RAL
RAL= raltegravir
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Term
| Which regimen is mainly cleared by liver? |
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Definition
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Term
| Which regimen is hepatically metabolized by CYP3A4? |
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Definition
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Term
| Which PI should be taken on empty stomach? |
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Definition
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Term
| Which Drug undergoes UGT1A1- glucuronidation? |
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Definition
| RAL= Raltegravir (BID dosing) |
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Term
| Which drug should not be used during 1st trimester of pregnancy or in women of chilbearing potential? |
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Definition
EFV= Efavirenz
once daily LPV/r=lopinavir/ritonavir is not recommended in pregnant women |
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Term
| Which drug should be used in caution in patients w/ renal insufficiency? |
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Definition
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Term
| Which drug should not be used in patients who require> 20 mg omeprazole equivalent per day? |
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Definition
| ATV/r= Atazanavir/ritonavir |
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Term
| Use of PI is contraindicated with which drug? |
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Definition
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Term
| T/F: use of RPV w/ caution in patients w/ pretreatment HIV RNA> 100,000 copies/mL? |
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Definition
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Term
| What is the preferred regimen for pregnant women? |
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Definition
LPV/r (BID) + ZDV/3TC
ZDV= zidovudine
3TC=lamivudine
LPV/r= lopinavir/ritonavir |
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Term
| What are acceptable regimen for HIV? |
|
Definition
- NNRTI: ZDV/3TC +NVP, or FTC/TDF + NVP, or ABC/3TC + NVP, or ZDV/3TC +EFV
- PI: (ABCor ZDV)/3TC + ATV (unboosted), or ZDV/3TC + FPV/r (QD/BID), or ZDV/3TC+ LPV/r (QD/BID), or ZDV/3TC + ATV/r, or ZDV/3TC +DRV/r
- INSTI: ABC or ZDV/3TC + RAL
- CCR5 inihibitor: ZDV/3TC + MVC, or (TDF/FTC) or (ABC/3TC) + MVC |
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Term
| What are ADE of maraviroc (MVC)? |
|
Definition
- Hepatotoxicity (allergic rx: eosinophilia + rash)
- Dizziness
- Increased risk CV events |
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Term
| What are signs of virologic failure? |
|
Definition
- VL>400 after 24 wks
- VL >50 after 48 wks
- VL>400 after initial suppression
- Immunologic failure
- CD4 increase <25-50 in 1st yr
- CD4 decline below baseline |
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Term
| What are reasons for treatment failure? |
|
Definition
- Acquired resistance
- DI
- Pharmacokinetic differences/inadequate serum concentrations |
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