Transcript HIV Tutoring

HIV Tutoring
By Alaina Darby
JD is a 22 yo WM who is suspected to have contracted HIV. Which of
the following tests would be most necessary?
a.
Genotype resistance testing
b. Plasma HIV RNA
c.
Complete blood count (CBC)
d. Fasting blood glucose
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?
a.
Reduce HIV-associated morbidity
b. Preserve immunologic function
c.
Prevent transmission
d. Minimize adverse effects
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?
a.
HIV viral load below detection limit
b. Lower CD4 count
c.
High potency ARV regimen
d. Low baseline viremia
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?
a.
Low CD4
b. Homosexual lifestyle
c.
High HIV load
d. All with HIV should start ART
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?
a.
Immune suppression
b. Quality of life
c.
Resistance development
d. Non-adherence
Which of the following medication classes is the backbone of ART?
a.
PI
b. NNRTI
c.
NRTI
d. INSTI
Which of the following medication classes is properly matched with
its drug?
a.
PI - EFV
b. NNRTI - ATV
c.
NRTI - ABC
d. INSTI - TDF
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?
a.
ABC/3Tc
b. FTC/TDF
c.
FTC/3Tc
d. ABC/TDF
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?
a.
LFTs
b. HLA-B
c.
Blood glucose
d. Serum lipids
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?
a.
ABC/3Tc
b. FTC/TDF
c.
FTC/3Tc
d. ABC/TDF
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?
a.
LFTs
b. HLA-B
c.
Blood glucose
d. Serum lipids
What would not be a reason to prescribe FTC/TDF over ABC/3Tc?
a.
History of adherence issues
b. Previous hematological problems
c.
Previous rash with carbamazepine
d. History of sleep disturbances
Labs:
HIV RNA: 80,000
CD4: 300
Na+: 138
Cl-: 105
K+: 5.2
HCO3: 25
FBG: 108
JD has a h/o neuropsychosis and kidney stones. Which of the
following adjunctive medications to TDF/FTC should he receive?
a.
ATV
b. DRV
c.
RPV
d. EFV
Which of the following should be taken on an empty stomach?
a.
ATV
b. DRV
c.
RPV
d. EFV
Which of the following would be least preferred for someone who is
also taking a PPI?
a.
ATV
b. DRV
c.
RPV
d. EFV
Which of the following would be best if a patient is taking
carbamazepine for seizures?
a.
ATV
b. DRV
c.
RPV
d. EFV
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?
a.
ATV
b. DRV
c.
LPV
d. NFV
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?
a.
DTG
b. EVG
c.
RAL
d. RTG
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?
a.
DTG
b. EVG
c.
RAL
d. RTG
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?
a.
Atripla
b. Complera
c.
Stribild
d. Triumeq
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
Drug class generalities:
 NRTIs: hepatomegaly, Cushing's
 NNRTIs (-vir-): resistance
 PIs (-vir): hyperglycemia, bleeding, hyperlipidemia
 INSTIs (-tegravir): absorption impaired by antacids
Preferred:
 2 NRTIs
plus
 INSTI or
 NNRTI or
 PI + r/c
Your patient is HLA positive. Which would you not use?
a.
Atripla
b. Complera
c.
Stribild
d. Triumeq
What would be a potential option in a patient that is HLA positive
and already has low bone density and bone marrow defects?
a.
LPV/r + 3TC
b. DRV/r + 3TC
c.
ATV/c + RAL
d. ATV/c + 3TC
Just a little trick!
 Efavirenz is the fav for TB but not pregnancy or CNS!
More side effects and considerations…
 TDF: bone, kidney
 EFV: brain, methadone
 ABC, LPV/r: cardiac