Podcast
Questions and Answers
Which class of antiretroviral drugs specifically includes PIs?
Which class of antiretroviral drugs specifically includes PIs?
- NRTIs
- Integrase Strand Transfer Inhibitors
- NNRTIs
- Protease Inhibitors (correct)
What is the mechanism of action primarily associated with NRTIs?
What is the mechanism of action primarily associated with NRTIs?
- Preventing virus integration into the host DNA
- Blocking viral entry
- Inhibiting viral reverse transcriptase (correct)
- Promoting viral replication
Which of the following drugs is a CCR5 antagonist?
Which of the following drugs is a CCR5 antagonist?
- Maraviroc (correct)
- Lamivudine
- Atazanavir
- Raltegravir
Which drug is NOT classified as a Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI)?
Which drug is NOT classified as a Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI)?
What role do pharmacokinetic enhancers play in antiretroviral therapy?
What role do pharmacokinetic enhancers play in antiretroviral therapy?
Which of the following is a major toxic effect associated with NRTIs?
Which of the following is a major toxic effect associated with NRTIs?
Which antiretroviral drug is available solely in co-formulations for HIV indication?
Which antiretroviral drug is available solely in co-formulations for HIV indication?
Which of these is classified under Entry Inhibitors?
Which of these is classified under Entry Inhibitors?
What is a significant consideration in selecting an appropriate ARV regimen?
What is a significant consideration in selecting an appropriate ARV regimen?
Which of the following pharmacokinetic enhancers can be used with various antiretroviral drugs?
Which of the following pharmacokinetic enhancers can be used with various antiretroviral drugs?
Which initial ART regimen should be avoided in patients with chronic kidney disease and an eGFR of 30 mL/min?
Which initial ART regimen should be avoided in patients with chronic kidney disease and an eGFR of 30 mL/min?
Which ART regimens are considered for patients with high cardiac risk?
Which ART regimens are considered for patients with high cardiac risk?
What is the recommendation regarding EFV-based regimens for patients with HAD?
What is the recommendation regarding EFV-based regimens for patients with HAD?
Which regimen is contraindicated for those with psychiatric illness due to the potential for exacerbating symptoms?
Which regimen is contraindicated for those with psychiatric illness due to the potential for exacerbating symptoms?
Which of the following ART regimens requires food for optimal absorption?
Which of the following ART regimens requires food for optimal absorption?
Which ART regimen is suggested if both ABC and TAF cannot be used?
Which ART regimen is suggested if both ABC and TAF cannot be used?
In patients on a stable dose of methadone, which ART regimen may induce opioid withdrawal when initiated?
In patients on a stable dose of methadone, which ART regimen may induce opioid withdrawal when initiated?
What should be taken into consideration when prescribing regimens for patients with high cardiac risk?
What should be taken into consideration when prescribing regimens for patients with high cardiac risk?
Which regimen is recommended for patients with HIV RNA >500,000 copies/mL?
Which regimen is recommended for patients with HIV RNA >500,000 copies/mL?
What factor is NOT considered when selecting an initial ART regimen?
What factor is NOT considered when selecting an initial ART regimen?
Which of the following conditions should be considered when selecting an initial ART regimen?
Which of the following conditions should be considered when selecting an initial ART regimen?
What is the recommendation for HIV patients with HLA-B*5701 positive status?
What is the recommendation for HIV patients with HLA-B*5701 positive status?
Which of the following ART regimens should be avoided if the CD4 count is 100,000?
Which of the following ART regimens should be avoided if the CD4 count is 100,000?
What is a consideration regarding drug interactions when selecting an ART regimen?
What is a consideration regarding drug interactions when selecting an ART regimen?
If a patient has comorbidities such as renal disease, which regimen characteristic is crucial?
If a patient has comorbidities such as renal disease, which regimen characteristic is crucial?
Which combination therapy is noted as a contraindication for patients needing immediate treatment?
Which combination therapy is noted as a contraindication for patients needing immediate treatment?
What is the recommended initial regimen for individuals without a history of long-acting cabotegravir use as PrEP?
What is the recommended initial regimen for individuals without a history of long-acting cabotegravir use as PrEP?
Under what condition is Dolutegravir-lamivudine not recommended for initial therapy?
Under what condition is Dolutegravir-lamivudine not recommended for initial therapy?
What type of testing should be performed prior to starting antiretroviral therapy for individuals with a history of long-acting cabotegravir as PrEP?
What type of testing should be performed prior to starting antiretroviral therapy for individuals with a history of long-acting cabotegravir as PrEP?
Which combination is part of a recommended regimen pending genotype test results for those with a history of cabotegravir as PrEP?
Which combination is part of a recommended regimen pending genotype test results for those with a history of cabotegravir as PrEP?
Which of the following is NOT listed as a recommended initial ART regimen?
Which of the following is NOT listed as a recommended initial ART regimen?
What components are included in the initial regimen involving Elvitegravir?
What components are included in the initial regimen involving Elvitegravir?
Which nucleotide reverse transcriptase inhibitor is included in the initial regimens when using a boosted protease inhibitor?
Which nucleotide reverse transcriptase inhibitor is included in the initial regimens when using a boosted protease inhibitor?
Which of the following regimens is recommended for the initial treatment of HIV in individuals without previous PrEP use?
Which of the following regimens is recommended for the initial treatment of HIV in individuals without previous PrEP use?
Which antiretroviral drug is associated with the highest weight gain upon initiation?
Which antiretroviral drug is associated with the highest weight gain upon initiation?
What significant population is disproportionately affected by ARV-associated weight gain?
What significant population is disproportionately affected by ARV-associated weight gain?
Which of the following combinations is not recommended for use due to high pill burden?
Which of the following combinations is not recommended for use due to high pill burden?
What adverse clinical event is commonly associated with HAART?
What adverse clinical event is commonly associated with HAART?
Which NRTI is linked to renal issues, particularly Fanconi Syndrome?
Which NRTI is linked to renal issues, particularly Fanconi Syndrome?
Which scenario warrants caution with the initiation of Nevirapine (NVP)?
Which scenario warrants caution with the initiation of Nevirapine (NVP)?
What condition can occur if specific NRTIs are discontinued in individuals with HBV?
What condition can occur if specific NRTIs are discontinued in individuals with HBV?
Which of the following NNRTIs is contraindicated with strong inducers?
Which of the following NNRTIs is contraindicated with strong inducers?
What hematologic toxicity is associated with Zidovudine?
What hematologic toxicity is associated with Zidovudine?
Which of the following treatments for HIV has shown psychiatric symptoms as a notable side effect?
Which of the following treatments for HIV has shown psychiatric symptoms as a notable side effect?
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Study Notes
Initial Regimens for Adults and Adolescents with HIV
- Recommended regimens for those without prior long-acting cabotegravir use: INSTI + 1 NRTI
- Dovato (Dolutegravir-lamivudine) is suitable except for individuals with HIV RNA >500,000 copies/mL, HBV coinfection, or when starting therapy before genotypic resistance testing results are available.
Recommendations for Individuals with PrEP History
- For individuals with previous long-acting cabotegravir use, integrase genotypic drug resistance testing is essential before starting antiretroviral therapy.
- If treatment starts before testing results, use a Boosted PI + 2 NRTIs regimen, specifically Darunavir (boosted with cobicistat or ritonavir) with tenofovir (either alafenamide or DF) plus emtricitabine or lamivudine.
Available Initial ART Regimens
- Examples include:
- Biktarvy: Bictegravir/TAF/FTC
- Triumeq: Dolutegravir/ABC/3TC
- Dovato: Dolutegravir/Lamivudine
- Truvada + Tivicay: TAF/FTC + Dolutegravir
Recommended Initial Regimens in Special Situations
- Regimens frequently used: INSTIs + 2 NRTIs such as:
- Elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine
- Raltegravir with either tenofovir DF/emtricitabine or tenofovir alafenamide/emtricitabine.
Factors Influencing Initial ART Regimen Selection
- Patient Factors: HIV RNA levels, CD4 counts, resistance test results, HLA-B*5701 status, patient preferences, and anticipated adherence.
- Comorbidities: Cardiovascular conditions, renal health, and any co-infections.
- Regimen Characteristics: Resistance potential, adverse effects, drug interactions, convenience, and cost.
Special Clinical Scenarios
- Do not use RPV-based ART for CD4 counts above 100,000 due to higher rates of virologic failure.
- For HLA-B*5701 positive individuals, avoid using abacavir due to hypersensitivity risk.
- Avoid NNRTI regimens and combination therapies that include ABC for urgent treatment before genotypic resistance test results are known.
Considerations for Food and Pharmacokinetics
- Some ARTs must be taken with food (e.g., Darunavir, Rilpivirine), while others must be taken on an empty stomach (e.g., Efavirenz).
- TDF usage is discouraged in chronic kidney disease patients; alternatives include ABC or TAF, and consider DTG plus 3TC for non-ABC/TAF candidates.
Antiretroviral Drugs Not Recommended
- Drugs lacking optimal potency or associated with side effects include:
- Delavirdine, Didanosine, Indinavir, Nelfinavir, Stavudine.
- Avoid monotherapy and specific combinations of NRTIs due to ineffectiveness.
Common Adverse Effects of ART
- Notable adverse clinical events associated with HAART include:
- Lactic acidosis, hyperglycemia, fat maldistribution, hyperlipidemia, and osteoporosis.
Important Clinical Pearls
- NRTIs are associated with lactic acidosis and hepatomegaly; Abacavir requires HLA-B*5701 testing.
- NNRTIs may cause hepatotoxicity and psychiatric effects, especially Efavirenz.
- Drug interactions are critical; NNRTIs can interact with CYP3A4 and must not be combined with strong inducers.
Key Recommendations for Diverse Patient Needs
- Individuals with psychiatric illnesses should avoid Efavirenz and Rilpivirine due to potential exacerbation of symptoms.
- Consider cardiovascular risks when prescribing ART, especially avoiding Abacavir or Lopinavir for patients with a high cardiac risk.
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