HIV/AIDS Flashcards
Acute phase of HIV disease
Acute Retroviral Syndrome (ARS): pt has mono like symptoms which presents 1-4 weeks after infection; can persist for 2-3 weeks
Chronic phase of HIV
absence of sx; immune system attempts to control virus but virus replicates and disseminates everywhere and CD4 count declines persistently
Common opportunistic infections with advanced HIV disease
Candida pneumocyctis toxoplasmosis crytococcal cytomegalovirus mycobacterium
Candida infections sx and tx
Thrush is very common, candida esophagitis
Tx: Fluconazole daily until resolved
generally well tolerated but may elevate LFTs
PCP sx and tx
Sx: nagging non productive cough, fever, dyspnea gradually over weeks to months
PROPHYLAXIS: SMX/TMP if CD4 200 for >3mo)
Toxoplasmosis sx and treatment
fever, HA, sz, ataxia
PROPHYLAXIS: SMX/TMP
TOXO TX: Sulfadiazine (wt based; 4x daily; rash, N/V/D) and Pyrimethamine (high loading dose, then 50-75mg qd; *always given with leucovorin to prevent anemias)
TOXO LONG TERM TX: complete tx course of 6 wks, followed by ongoing secondary prophylaxis (may d/c if CD4 >200 for >6mo
Cryptococcal infection sx and tx
HA, photosensitivity, fever, malaise, neck stiffness, sz
NO PROPHYLAXIS INDICATED
TX: Liposomal amphotericin (*Ampho-“terrible”)
multiple IV formulation (doses vary; HOTN, fever, anemias, low MG, low K; at least 14 days)
LONG TERM TX: Consolidation = fluconazole 400 mg qd x 8wks
Secondary prophylaxis of fluconazole for 1 year (may d/c if CD4 >100 ofr >3 mo ON ARVTx)
Cytomegalovirus sx and tx
end organ disease (retinitis, colitis, pneumonia)
NO PROPHYLAXIS (very toxic therapy) TX: Ganciclovir or Valganciclovir (IV solution; fever, cytopenias, renal dysfunc) LONG TERM TX: complete tx of 14-21 days followed by immediate transition to maintanence therapy
Mycobacterium sx and tx
wt loss, fever, D, night sweats, abd pain, weakness
PROPHYLAXIS: azithromycin
TX: azithromcycin (600 mg qd; GI distress) and Ethambutol (wt based dosing; optic neuritis) +/- Rifamycin (either rifampin or rifabutin; major Rx interactions)
LONG TERM TX: complete tx of 12 months, followed by immediate transition to secondary prophylaxis
4classes of drugs that interfere with HIV replication
Nucleoside Reverse Transcriptase Inhibitors
Non-nucleoside Reverse Transcriptase Inhibitors
Integrase Strand Transfer inhibitors
Protease inhibitors
4 different regimens (combination of drugs) for ARVTx
NRTI + NRTI + NNRTI
NRTI + NRTI + INSTI
NRTI + NRTI + INSTI with PK booster
NRTI + NRTI + PI with PK booster
NRTIs (combination drugs because they automatically combine 2 NRTIs together because that’s what ever regimen asks for)
Emtricitabine and Tenofovir (TRUVADA)
AE: fatigue, cramps, elevated CK, hypophosphatemia
Toxicities: renal insufficiency, changes in bone density
Lamivudine and Abacavir (EPZICOM)
Toxicities: hypersensitivity rxn
*need to do genetic screening for HLA B501 because they have a 50/50 chance of hypersensitivity rxn
NNRTIs
Efavirenz (Sustiva)
AEs: vivid dreams, rash, insomnia, depression, increased LFTs, dizziness, hypertriglyceridemia
Toxicities: hepatitis, hepatic necrosis
Metabolism: inducer/inhibitor or CYP450
* take on EMPTY stomach at bedtime to decrease AEs; Pg D
Combo: Atripla (Truvada + Efavirenz)
Rilpivirine (Edurant)
AEs: depression, insomnia, HA, rash
Toxicities: prolongation QT, dyslipidemia, increase LFTs
*Need an acidic environment so take WITH food, CI with PPIs
Combo: Complera (Truvada + Rilpivirine)
INSTIs (and assoc PK booster) *all end in -gravir
Raltegravir (Isentress)
AEs: elevated BGs, increase lipase and ALT, myopathy
Metabolism: hepatic
* take without regards to food; PO tablet must be BID
Combo: Truvada + Isentress
Elvitegravir (Vitekta) AEs: well tolerated Metabolism: hepatic CYP450 pathways *oral tablet taken once daily: MUST TAKE with PK booster and food PK booster: Cobicistat (Tybost) inhbits CYP450 which slows down metabolism of Elvitegravir No antiviral properties AE: N, loose stool Combo: Stribild
Doutegravir (Tivicay)
AEs: well tolerated, HA, hyperglycemia
Metabolism: hepatic CYP450
*PO tablet taken once daily; take without regard to food
PIs *all end in -navir; even the PK booster!
Ataxanavir (Reyataz) AEs: rash, hyperbilirubinemia Toxicities: AV block,nephrolithiasis Metabolism: hepatic, CYP450 *take with food, MUST TAKE with PK booster and only Ritonavir works
PK booster: Ritonavir (Norvir)
AEs: *HA, D/N/V, taste perversion, elevated CK, hyperglycemia, elevated LFTs, hyperlipidemia
Does have antiviral properties: HIV protease inhibitor
Darunavir (Prezista)
AEs: rash (SJS), D, hyperglycemia
Metabolism: hepatic via CYP450
*qday or bid dosing, take with food, always co-administered with Norvir
