HIV Initial Treatment Regimens

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)?

Raltegravir Signup and view all the answers

What role do pharmacokinetic enhancers play in antiretroviral therapy?

They increase the absorption and bioavailability of other drugs. Signup and view all the answers

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

Bone marrow suppression Signup and view all the answers

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

Tenofovir alafenamide (TAF) Signup and view all the answers

Which of these is classified under Entry Inhibitors?

Enfuvirtide Signup and view all the answers

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

The patient's HIV strain and resistance profile Signup and view all the answers

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

Cobicistat 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?

TDF Signup and view all the answers

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

BIC- and RPV-based regimens Signup and view all the answers

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

They should be avoided if possible. Signup and view all the answers

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

EFV Signup and view all the answers

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

ATV/r Signup and view all the answers

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

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

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

EFV Signup and view all the answers

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

BIC- and RPV-based regimens are advisable. Signup and view all the answers

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

None of the above Signup and view all the answers

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

Patient's age Signup and view all the answers

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

Psychiatric illness Signup and view all the answers

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

Abacavir is contraindicated Signup and view all the answers

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

RPV-based ART Signup and view all the answers

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

Concomitant medications Signup and view all the answers

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

Potential adverse effects Signup and view all the answers

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

NNRTI-based regimens Signup and view all the answers

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

INSTI + 1 NRTI Signup and view all the answers

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

In individuals with HBV coinfection 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?

Integrase genotypic drug resistance testing 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?

Darunavir + 2 NRTIs Signup and view all the answers

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

Atripla Signup and view all the answers

What components are included in the initial regimen involving Elvitegravir?

Elvitegravir-cobicistat-tenofovir DF-emtricitabine Signup and view all the answers

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

Tenofovir DF 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?

Dolutegravir-lamivudine Signup and view all the answers

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

Dolutegravir (DTG) Signup and view all the answers

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

Women and Black and Hispanic people Signup and view all the answers

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

Didanosine plus Stavudine Signup and view all the answers

What adverse clinical event is commonly associated with HAART?

Fat maldistribution Signup and view all the answers

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

Tenofovir Disoproxil Fumarate (TDF) Signup and view all the answers

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

Both A and B Signup and view all the answers

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

Acute HBV exacerbation Signup and view all the answers

Which of the following NNRTIs is contraindicated with strong inducers?

Rilpivirine Signup and view all the answers

What hematologic toxicity is associated with Zidovudine?

Anemia Signup and view all the answers

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

Efavirenz 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

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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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.