HIV Initial Treatment Regimens
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Questions and Answers

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?

  • 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?

  • Maraviroc (correct)
  • Lamivudine
  • Atazanavir
  • Raltegravir

    • Which drug is NOT classified as a Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI)?

    <p>Raltegravir</p> Signup and view all the answers

    What role do pharmacokinetic enhancers play in antiretroviral therapy?

    <p>They increase the absorption and bioavailability of other drugs.</p> Signup and view all the answers

    Which of the following is a major toxic effect associated with NRTIs?

    <p>Bone marrow suppression</p> Signup and view all the answers

    Which antiretroviral drug is available solely in co-formulations for HIV indication?

    <p>Tenofovir alafenamide (TAF)</p> Signup and view all the answers

    Which of these is classified under Entry Inhibitors?

    <p>Enfuvirtide</p> Signup and view all the answers

    What is a significant consideration in selecting an appropriate ARV regimen?

    <p>The patient's HIV strain and resistance profile</p> Signup and view all the answers

    Which of the following pharmacokinetic enhancers can be used with various antiretroviral drugs?

    <p>Cobicistat</p> Signup and view all the answers

    Which initial ART regimen should be avoided in patients with chronic kidney disease and an eGFR of 30 mL/min?

    <p>TDF</p> Signup and view all the answers

    Which ART regimens are considered for patients with high cardiac risk?

    <p>BIC- and RPV-based regimens</p> Signup and view all the answers

    What is the recommendation regarding EFV-based regimens for patients with HAD?

    <p>They should be avoided if possible.</p> Signup and view all the answers

    Which regimen is contraindicated for those with psychiatric illness due to the potential for exacerbating symptoms?

    <p>EFV</p> Signup and view all the answers

    Which of the following ART regimens requires food for optimal absorption?

    <p>ATV/r</p> Signup and view all the answers

    Which ART regimen is suggested if both ABC and TAF cannot be used?

    <p>DRV/r plus 3TC</p> Signup and view all the answers

    In patients on a stable dose of methadone, which ART regimen may induce opioid withdrawal when initiated?

    <p>EFV</p> Signup and view all the answers

    What should be taken into consideration when prescribing regimens for patients with high cardiac risk?

    <p>BIC- and RPV-based regimens are advisable.</p> Signup and view all the answers

    Which regimen is recommended for patients with HIV RNA >500,000 copies/mL?

    <p>None of the above</p> Signup and view all the answers

    What factor is NOT considered when selecting an initial ART regimen?

    <p>Patient's age</p> Signup and view all the answers

    Which of the following conditions should be considered when selecting an initial ART regimen?

    <p>Psychiatric illness</p> Signup and view all the answers

    What is the recommendation for HIV patients with HLA-B*5701 positive status?

    <p>Abacavir is contraindicated</p> Signup and view all the answers

    Which of the following ART regimens should be avoided if the CD4 count is 100,000?

    <p>RPV-based ART</p> Signup and view all the answers

    What is a consideration regarding drug interactions when selecting an ART regimen?

    <p>Concomitant medications</p> Signup and view all the answers

    If a patient has comorbidities such as renal disease, which regimen characteristic is crucial?

    <p>Potential adverse effects</p> Signup and view all the answers

    Which combination therapy is noted as a contraindication for patients needing immediate treatment?

    <p>NNRTI-based regimens</p> Signup and view all the answers

    What is the recommended initial regimen for individuals without a history of long-acting cabotegravir use as PrEP?

    <p>INSTI + 1 NRTI</p> Signup and view all the answers

    Under what condition is Dolutegravir-lamivudine not recommended for initial therapy?

    <p>In individuals with HBV coinfection</p> Signup and view all the answers

    What type of testing should be performed prior to starting antiretroviral therapy for individuals with a history of long-acting cabotegravir as PrEP?

    <p>Integrase genotypic drug resistance testing</p> Signup and view all the answers

    Which combination is part of a recommended regimen pending genotype test results for those with a history of cabotegravir as PrEP?

    <p>Darunavir + 2 NRTIs</p> Signup and view all the answers

    Which of the following is NOT listed as a recommended initial ART regimen?

    <p>Atripla</p> Signup and view all the answers

    What components are included in the initial regimen involving Elvitegravir?

    <p>Elvitegravir-cobicistat-tenofovir DF-emtricitabine</p> Signup and view all the answers

    Which nucleotide reverse transcriptase inhibitor is included in the initial regimens when using a boosted protease inhibitor?

    <p>Tenofovir DF</p> Signup and view all the answers

    Which of the following regimens is recommended for the initial treatment of HIV in individuals without previous PrEP use?

    <p>Dolutegravir-lamivudine</p> Signup and view all the answers

    Which antiretroviral drug is associated with the highest weight gain upon initiation?

    <p>Dolutegravir (DTG)</p> Signup and view all the answers

    What significant population is disproportionately affected by ARV-associated weight gain?

    <p>Women and Black and Hispanic people</p> Signup and view all the answers

    Which of the following combinations is not recommended for use due to high pill burden?

    <p>Didanosine plus Stavudine</p> Signup and view all the answers

    What adverse clinical event is commonly associated with HAART?

    <p>Fat maldistribution</p> Signup and view all the answers

    Which NRTI is linked to renal issues, particularly Fanconi Syndrome?

    <p>Tenofovir Disoproxil Fumarate (TDF)</p> Signup and view all the answers

    Which scenario warrants caution with the initiation of Nevirapine (NVP)?

    <p>Both A and B</p> Signup and view all the answers

    What condition can occur if specific NRTIs are discontinued in individuals with HBV?

    <p>Acute HBV exacerbation</p> Signup and view all the answers

    Which of the following NNRTIs is contraindicated with strong inducers?

    <p>Rilpivirine</p> Signup and view all the answers

    What hematologic toxicity is associated with Zidovudine?

    <p>Anemia</p> Signup and view all the answers

    Which of the following treatments for HIV has shown psychiatric symptoms as a notable side effect?

    <p>Efavirenz</p> Signup and view all the answers

    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
    • 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.
    • 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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    Description

    Explore the recommended initial regimens for adults and adolescents newly diagnosed with HIV. This quiz covers key considerations for those with and without prior long-acting cabotegravir use, as well as specific regimens and recommendations. Test your knowledge on the essential treatment protocols and their components.

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