Stages and Diagnosis
How is HIV transmitted?
Through direct contact with blood, body fluids/secretions, and breast milk.
The backbone of ART regimens
Nucleoside reverse transcriptase inhibitors (NRTI)
Have to do HLA-B*5701 allele testing prior to use
Abacavir
<200 cell/mm3
bictegravir/emtricitabine/tenofovir alafenamide
Biktarvy
Which type of cells does HIV primarily target?
CD4 cells
First line ART regimen combinations (classes)
2 NRTI + INSTI
NRTI + INSTI
2 NRTI + boosted PI
2 NRTI + NNRTI
Bictegravir side effects
weight gain, insomnia, psychosis, headache, diarrhea
Pneumocystis jirovecii pneumonia (PJP/PCP) criteria for prophylaxis and preferred agent
CD4 <200
Bactrim
Dolutegravir/lamivudine
Dovato
Name labs and testing that should be done for diagnosis and monitoring (name at least 3)
CD4 count, HIV viral load, genotype testing, CBC, lipids, Hepatitis B and C screening, pregnancy test, STI screening, HLA-B*5701 allele
These medications have a lot of drug interactions and don't actually reduce the viral load themselves.
Pharmacokinetic Boosters (ritonavir, cobicistat)
True or False:
Tenofovir disoproxil fumarate is associated with more nephrotoxicity and bone demineralization.
True
mycobacterium avium complex (MAC) preferred prophylaxis agent
azithromycin
emtricitabine/tenofovir disoproxil fumarate
Truvada
True or False:
Patients with an undetectable viral load can transmit HIV to others.
False
What factors are considered when choosing an HIV treatment regimen?
Resistance, side effects, adherence, comorbidities, drug interactions, cost
Take this class of medications 2 hours before or 6 hours after cations
INSTIs
toxoplasma gondii encephalitis preferred prophylaxis agent
dolutegravir/abacavir/lamivudine
Triumeq
What is the nucleic acid test?
Detects the virus and determines the quantity of virus in the blood, also known as the viral load.
Available PrEP options
emtricitabine/tenofovir alafenamide (Descovy)
emtricitabine/tenofovir disoproxil fumarate (Truvada)
cabotegravir (Apretude)
Have to take this class of medications with food and they are associated with metabolic side effects
Protease Inhibitors (atazanavir, darunavir)
Criteria for discontinuing PJP prophylaxis
CD4 count >200 for >3 months on ART
Can consider when CD4 100-200 and viral load has been undetectable for >3-6 months
rilpivirine/emtricitabine/tenofovir alafenamide
Odefsey