ART!
How many drugs are part of a traditional ART regimen?
3
What is the most common OI in PLWH globally?
TB
What are the differences between the following: Genotype, archive (Proviral) genotype, phenotype
Genotype = direct sequencing of viral genes; mutations detected if present in >10-15% viral population
Proviral GT = sequencing of genes, can be done when viral load is suppressed
Phenotype = grow virus in culture and test replicative ability in presence of ART
Name the 3 recommended first line regimens for pregnant women living with HIV
TDF/FTC + RAL (BID)
TDF/FTC + DRV/r (BID)
TDF/FTC + ATV/r
What year did combination ART (HAART) come out?
1996
Name the two second generation integrase inhibitors
Dolutegravir and Bictegravir
When is the ideal time to start ART in someone diagnosed with PCP PNA?
within 2 weeks of starting treatment for PCP
Name the implications of the M184V mutation
Resistance to FTC and 3TC; hypersusceptibility to TDF/TAF; reduction in viral fitness
Which ART has recently been implicated as being associated with an increased risk in NTD?
DTG
How many new HIV infections are estimated to occur annually in the United States?
40,000
Double Jeopardy:
Per the DHHS guidelines, what are the first line regimens for treatment naive patients?
(1 point for each correct response)
ABC/3TC/DTG
TAF(TDF)/FTC/BIC
TAF(TDF)/FTC + DTG
TAF(TDF)/FTC + RAL
When should you start ART for a patient with CNS tuberculosis?
wait at least 8 weeks from starting TB treatment
Name 3 drugs that have a high barrier to resistance
darunavir, bictegravir, dolutegravir
What are the indications for a c section in a pregnant women living with HIV?
VL >1000 copies near time of delivery or unknown viral load in a woman not on ART
*Intrapartum AZT should be given as well
Name one antiretroviral medication that is associated with kidney stones
ATV or indinavir
Name the drug that has a 400 calorie meal requirement
Rilpivirine
LP findings: OP = 250mm hg, WBC = 30, 90% L, 5% N, 4% M, 1% E; Protein = 70 mg/dL; Glucose = 50
CSF Gram Stain = no organisms
1) Diagnosis?
2) Treatment?
Cryptococcal meningitis
liposomal amphotericin B + flucytosine x 2 weeks followed by induction dose fluconazole x 8 weeks --> maintenance dose fluconazole for at least 1 year
What are TAMs?
Thymidine Analog Mutations
Two pathways: TAM 1 and TAM 2 - TAM 1 is associated with tenofovir resistance
What is the risk of perinatal transmission in a woman NOT on ART?
20-30%
The grass roots organization that campaigned for early access to experimental HIV medications in the 1980s and 1990s
ACT UP (AIDS Coalition to Unleash Power)
What is the drug that is associated with severe hepatotoxicity in women with high CD4 counts?
nevirapine
Double Jeopardy:
Name all of the treatments for LTBI for PLWH
1 point for each correct answer
INH x 9 months, Rifampin x 4 months, weekly INH + rifapentine x 3 months, daily INH + rifapentene x 1 month
What drug is the K103N mutation most strongly associated with?
Efavirenz
True/False: Intrapartum IV AZT is given to all pregnant women with HIV
False. IV AZT is only indicated for women who are not controlled on ART, usually set at a cut off of >1000 copies of virus
Describe how the two patients that have been "cured" of HIV came to be
bone marrow transplantation with CCR5 negative cells