HIV Tutoring By Alaina Darby

Genotype resistance testing Plasma HIV RNA Complete blood count (CBC) JD is a 22 yo WM who is suspected to have contracted HIV. Which of the following tests would be most necessary? Genotype resistance testing Plasma HIV RNA Complete blood count (CBC) Fasting blood glucose b

Reduce HIV-associated morbidity Preserve immunologic function JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Which of the following would not be a primary goal for treating his HIV? Reduce HIV-associated morbidity Preserve immunologic function Prevent transmission Minimize adverse effects d

HIV viral load below detection limit Lower CD4 count JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Which of the following would not predict therapeutic success? HIV viral load below detection limit Lower CD4 count High potency ARV regimen Low baseline viremia b

All with HIV should start ART JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Weighing the concerns of starting ART, which of the following would indicate the need to start ART? Low CD4 Homosexual lifestyle High HIV load All with HIV should start ART d

Resistance development Non-adherence JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Which of the following would not be a concern with him taking ART? Immune suppression Quality of life Resistance development Non-adherence a

Which of the following medication classes is the backbone of ART? PI NNRTI NRTI INSTI c

Which of the following medication classes is properly matched with its drug? PI - EFV NNRTI - ATV NRTI - ABC INSTI - TDF c

Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. Which of the following NRTI backbones should she most likely receive? ABC/3Tc FTC/TDF FTC/3Tc ABC/TDF Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 a

Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. You decide to start her on ABC/3Tc. What should you test before starting this NRTI combination as opposed to another NRTI combo? LFTs HLA-B Blood glucose Serum lipids Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 b

Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. You find that she has a history of night terrors. What is your recommendation now? ABC/3Tc FTC/TDF FTC/3Tc ABC/TDF Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 b… and dose adjust

Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. You find that she has a history of night terrors. You start her on FTC/TDF. What is a lab value that you would need to recheck based on ADR’s for both of these drugs? LFTs HLA-B Blood glucose Serum lipids Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 a

What would not be a reason to prescribe FTC/TDF over ABC/3Tc? History of adherence issues Previous hematological problems Previous rash with carbamazepine History of sleep disturbances b

JD has a h/o neuropsychosis and kidney stones JD has a h/o neuropsychosis and kidney stones. Which of the following adjunctive medications to TDF/FTC should he receive? ATV DRV RPV EFV Labs: HIV RNA: 80,000 CD4: 300 Na+: 138 Cl-: 105 K+: 5.2 HCO3: 25 FBG: 108 b

Which of the following should be taken on an empty stomach? ATV DRV RPV EFV d

Which of the following would be least preferred for someone who is also taking a PPI? ATV DRV RPV EFV A and c

Which of the following would be best if a patient is taking carbamazepine for seizures? ATV DRV RPV EFV a

RP has a history of STEMI and adherence issues RP has a history of STEMI and adherence issues. He is currently taking omeprazole. Which of the following would be the preferred PI for him? ATV DRV LPV NFV b

The doctor wants to start JW on a statin but is worried about the increased risk of rhabdo given his current ART therapy. What agent is he likely taking? DTG EVG RAL RTG c

The doctor wants to start JW on a statin but is worried about the increased risk of rhabdo given his current ART therapy. What agent is he likely taking? DTG EVG RAL RTG c

Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 Remember her? BR is a 44 yo WF who is starting ART. Her labs are listed on the left. Which of the following should not be used in her? Atripla Complera Stribild Triumeq Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 c

ADRs/contraindications to remember: ABC: hypersensitivity rash (HLA testing), sleep d/o FTC/3Tc/TDF: HBV exacerbation TDF: bone marrow issues, bone density EFV: neuropsych d/o RPV: not for high RNA/low CD4 LPV: heart issues RAL: rhabdo c

Drug class generalities: NRTIs: hepatomegaly, Cushing's NNRTIs (-vir-): resistance PIs (-vir): hyperglycemia, bleeding, hyperlipidemia INSTIs (-tegravir): absorption impaired by antacids c

Preferred: 2 NRTIs plus INSTI or NNRTI or PI + r/c c

Your patient is HLA positive. Which would you not use? Atripla Complera Stribild Triumeq d

What would be a potential option in a patient that is HLA positive and already has low bone density and bone marrow defects? LPV/r + 3TC DRV/r + 3TC ATV/c + RAL ATV/c + 3TC a

Efavirenz is the fav for TB but not pregnancy or CNS! Just a little trick! Efavirenz is the fav for TB but not pregnancy or CNS! a

More side effects and considerations… TDF: bone, kidney EFV: brain, methadone ABC, LPV/r: cardiac a