1. HIV Tutoring
By Alaina Darby

2. 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

3. 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

4. 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

5. 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

6. 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

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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

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

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

18. 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

19. 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

20. 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

21. 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

22. 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

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

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

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

26. 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

27. 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

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