Podcast
Questions and Answers
What is the primary treatment goal for patients with HIV-1 infection?
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?
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?
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?
What does the term 'undetectable = untransmittable' refer to?
Which drug is represented by the abbreviation 'CAB-LA'?
Which drug is represented by the abbreviation 'CAB-LA'?
Which aspect is NOT typically included in baseline evaluation for HIV treatment?
Which aspect is NOT typically included in baseline evaluation for HIV treatment?
What is the main goal of using 3TC (lamivudine) in HIV treatment?
What is the main goal of using 3TC (lamivudine) in HIV treatment?
What is the significance of monitoring the CD4 cell count in HIV patients?
What is the significance of monitoring the CD4 cell count in HIV patients?
Which screening test is critical to perform before prescribing ABC (abacavir)?
Which screening test is critical to perform before prescribing ABC (abacavir)?
What does a CD4 count ideally need to be to ensure better treatment outcomes?
What does a CD4 count ideally need to be to ensure better treatment outcomes?
Which of the following is NOT a factor to consider when choosing ART for HIV treatment?
Which of the following is NOT a factor to consider when choosing ART for HIV treatment?
The purpose of genotypic drug-resistance testing is to:
The purpose of genotypic drug-resistance testing is to:
Which of the following is classified as a Protease Inhibitor (PI)?
Which of the following is classified as a Protease Inhibitor (PI)?
What is the aim of screening for opportunistic infections in HIV patients?
What is the aim of screening for opportunistic infections in HIV patients?
Which vaccines are particularly relevant in the health management of HIV patients?
Which vaccines are particularly relevant in the health management of HIV patients?
What is the purpose of testing for G6PD deficiency in HIV treatment?
What is the purpose of testing for G6PD deficiency in HIV treatment?
Flashcards
HIV RNA Level (Viral Load)
HIV RNA Level (Viral Load)
The amount of HIV in the blood, measured in copies per milliliter.
CD4 Cell Count
CD4 Cell Count
A measure of the immune system's strength, indicating the number of CD4 cells per microliter of blood.
Undetectable = Untransmittable (U=U)
Undetectable = Untransmittable (U=U)
The goal of HIV treatment is to achieve and maintain undetectable levels of HIV in the blood.
Integrase Inhibitors (INSTIs)
Integrase Inhibitors (INSTIs)
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CAB-LA (Long-acting Cabotegravir)
CAB-LA (Long-acting Cabotegravir)
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Dolutegravir (DTG)
Dolutegravir (DTG)
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Baseline Evaluation
Baseline Evaluation
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Treatment Goals
Treatment Goals
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HLA-B*5701 screening
HLA-B*5701 screening
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CD4 count
CD4 count
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Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
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TDF: tenofovir disoproxil fumarate
TDF: tenofovir disoproxil fumarate
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Genotypic drug-resistance testing
Genotypic drug-resistance testing
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Protease Inhibitors (PIs)
Protease Inhibitors (PIs)
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DRV: darunavir
DRV: darunavir
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FTC: emtricitabine
FTC: emtricitabine
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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)
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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.
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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.
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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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