HIV Pharmacotherapy Review

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Questions and Answers

What is the primary treatment goal for patients with HIV-1 infection?

To achieve and sustain maximum suppression of HIV RNA (correct)

To ensure patients take medications at least twice a day

To increase the CD4 cell count to maximum levels

To reduce the total cholesterol levels

What does the abbreviation 'DTG' stand for in HIV pharmacotherapy?

Direct thrombin generation

Dolutegravir (correct)

Dexamethasone treatment guidelines

Dopamine transport group

Which of the following factors should be considered when choosing a treatment plan for an individual patient?

Resistance testing results (correct)

Patient's primary care physician's opinion

Patient's favorite brand of medication

Time of day the patient prefers to take medication

What does the term 'undetectable = untransmittable' refer to?

Patients with undetectable viral load cannot transmit HIV Signup and view all the answers

Which drug is represented by the abbreviation 'CAB-LA'?

Cabotegravir long-acting Signup and view all the answers

Which aspect is NOT typically included in baseline evaluation for HIV treatment?

Patient's social media activity Signup and view all the answers

What is the main goal of using 3TC (lamivudine) in HIV treatment?

To restore and maintain immune system function Signup and view all the answers

What is the significance of monitoring the CD4 cell count in HIV patients?

Assesses immune system health and progression of HIV Signup and view all the answers

Which screening test is critical to perform before prescribing ABC (abacavir)?

HLA-B*5701 screening Signup and view all the answers

What does a CD4 count ideally need to be to ensure better treatment outcomes?

Greater than 500 cells/mm3 Signup and view all the answers

Which of the following is NOT a factor to consider when choosing ART for HIV treatment?

A patient's favorite color Signup and view all the answers

The purpose of genotypic drug-resistance testing is to:

Identify the presence of drug-resistance mutations Signup and view all the answers

Which of the following is classified as a Protease Inhibitor (PI)?

DRV (darunavir) Signup and view all the answers

What is the aim of screening for opportunistic infections in HIV patients?

To minimize HIV-related health complications Signup and view all the answers

Which vaccines are particularly relevant in the health management of HIV patients?

Hepatitis A, B, and C Signup and view all the answers

What is the purpose of testing for G6PD deficiency in HIV treatment?

To avoid harmful reactions to certain medications Signup and view all the answers

Study Notes

HIV Pharmacotherapy Review

Treatment Goals: Achieve and maintain maximum HIV RNA suppression (undetectable), restore/maintain immune function (ideally CD4 count >500 cells/mm³), minimize complications, and prevent transmission.

Baseline Evaluation

Required tests: HIV RNA level (viral load), HIV antigen/antibody, CD4 cell count, HLA-B*5701 screening, G6PD deficiency screening, genotypic drug resistance testing, hepatitis A/B/C serologies, opportunistic infection screening, chemistry panel, urinalysis, STI screening, immunization history, pregnancy test, cancer screening.

Initial ART for Most Persons with HIV

Recommended regimens (for those without prior CAB-LA PrEP use): Biktarvy (BIC/FTC/TAF), Triumeq (DTG/ABC/3TC), Dovato (DTG/3TC), Dovato plus Viread (DTG/3TC plus TDF), Tivicay plus Truvada/Descovy/Cimduo(DTG plus TDF/FTC, or TAF/FTC, or TDF/3TC), Symtuza (DRV/COBI/TAF/FTC), Prezcobix plus Truvada/Descovy/Cimduo (DRV/COBI plus TDF/FTC, or TAF/FTC, or TDF/3TC).

Monitoring

CD4 Count:
- <300 cells/mm³: Every 3 months
- 300-500 cells/mm³: Every 6 months (first 2 years of ART), every 12 months after first 2 years with consistently suppressed viral load
- 500 cells/mm³: Every 6 months (first 2 years of ART), monitoring optional after first 2 years with consistently suppressed viral load
Viral Load:
- ≥50 copies/mL: Every 4-8 weeks
- <50 copies/mL: Every 3-6 months
BMP: Every 3-6 months

Prophylaxis Against Opportunistic Infections (OI)

Pneumocystis pneumonia (PCP): SMX-TMP DS 1 tab PO daily, Dapsone 100 mg PO daily, or Atovaquone 1500 mg PO daily - for CD4 count <200 cells/mm³.
Toxoplasma Gondii Encephalitis: SMX-TMP DS 1 tab PO daily, Dapsone 50 mg + pyrimethamine 50 mg and leucovorin 25 mg once weekly, or Atovaquone 1,500 PO daily - for CD4 count <100 cells/mm³ AND Toxoplasma IgG positive
Mycobacterium avium Complex (MAC) disease: Azithromycin 1200 mg PO once weekly or Clarithromycin 500 mg PO BID or Azithromycin 600 mg PO twice weekly - for CD4 count <50 cells/mm³.
Important Note: G6PD deficiency patients should not use SMX-TMP or dapsone due to hemolysis risk; atovaquone is an alternative.

Acquired Immunodeficiency Syndrome (AIDS)

AIDS is diagnosed when CD4 count drops below 200 cells/mm³ or when opportunistic infections (OIs) develop. Diagnosis is lifelong, even if CD4 count recovers above 200 cells/mm³.

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Description

This quiz covers the key aspects of HIV pharmacotherapy, focusing on treatment goals, necessary baseline evaluations, and recommended initial antiretroviral therapy (ART) regimens. Test your knowledge on strategies for maximizing HIV RNA suppression and maintaining immune function while minimizing complications.