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What is the detection process for HIV?
- Screening with ELISA
- confirmation with Western Blot
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What does the ELISA test do?
detect presence of HIV ab in blood
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What to be cautious for when testing for HIV?
6 mo period
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What does the western blot do?
uses gel electrophoresis to detect specific proteins for HIV ag
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preferred way to test for drug resistance and why
- genotypic assay
- cheaper, get results faster, better sensitivity
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what is the CD4 count a measure of?
- indicator of immunodeficiency
- predicts disease progression and survival
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when should the CD4 be monitored and what does it determine with therapy?
- q3-4 months
- when to start therapy
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what is the goal in CD4 monitoring?
inc of 50-150 cells per year until SS reached
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what does the viral load indicate?
response to antiviral therapy
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when is the viral load monitored?
2-8 wks after the start or change of therapy
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what is the viral load treatmetn goal?
undetectable <50
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when is a pt defined as having aids?
- cd4 <200
- or an aids defining illness
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what are the big AIDS defining illnesses?
- candidiasis
- PCP
- Toxoplasmosis
- MAC
- Cytomegalovirus
- TB
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Emtricitabine drug class
NRTI
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lamivudine drug class
NRTI
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tenofovir drug class
NRTI
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stavudine drug class
NRTI
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zidovuidine drug class
NRTI
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didanosine drug class
NRTI
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what are the agents active against hep b
- emtricitabine
- lamivudine
- tenofovir
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NRTI elimination
- renal elimination
- except: abacavir (alcohol dehydrogenase) and zidovudine (glucoronidation)
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which NRTIs don't go through renal elimination?
- abacavir - alcohol dehydrogenase metab
- zidovudine - glucoronidation
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NRTI AEs
- lactic acidosis
- hepatic statosis
- lipodystrophy
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what causes bone marrow suppression?
zidovudine
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what causes hypersensitivity?
abacavir
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which drug classes have no cyp drug interactions?
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etravirine drug class
NNRTI
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NRTI AEs
- hepatotoxicity
- hypersensitivity
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efavirenz AEs
- vivd dreams
- confusion
- euphoria
-
efavirenz preg category
D
-
NNRTI DDIs
Cyp 3A4 inducer
-
-
-
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PI AEs
- hyperlipidemia
- insulin resistance, DM
- lipodystrophy
- elevated LFTs
- DIARRHEA
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PI DDIs
CYP 3A4 inhibitors
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drugs to avoid with PIs
- simvastatin
- lovastatin
- St. John's Wort
- Rifampin
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which drug should be taken with PPIs
atazanavir
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raltegravir cyp interactions?
none
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enfuviritide drug class
fusion inhibitor (binds to gp41)
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maraviroc drug class
CCR5 inhibitor
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raltegravir drug class
INSTI
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what is the only injectable med?
enfuviritide
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Preferred/alternative NRTI backbone
- Pre: emtricitabine/tenofovir
- Alt: lamuvadine/abacavir
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pre/alt NNRTI option
- Pre: efavirenz
- alt: etravirine
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pre/alt PI option
- pre: atazanavir/ritonavir
- alt: darunavir/ritonavir
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INSTI options
- pre: raltegravir
- alt: cobistat/elvitegravir
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what is the preferred treatment in pregnancy
- lopinavir/ritonavir AND
- zidovudine/lamivudine
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pre/alt treatment for thrush
- primary: clotrimazole, nystatin, fluconazole
- alt: itraconazole, AmB, caspofungin
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Pref/alt proph for PCP
- pre: bactrim DS
- alt: pentamidine, dapsone/trimethoprim, atovaquone
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when to use proph for PCP
CD4<200 or thrush
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tox proph (pre/alt)
- pre: bactrim
- alt: atovaquone, primethamine/leucovorin
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MAC proph
- azithromycin
- clarithromycin
alt: rifabutin
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when to use proph fro tox
CD4 <100
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when to use proph for MAC
CD4 <50
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when to d/c proph for mac?
CD4 >100 x 3 mo
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when to use proph for TB
positive test or close contact
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pre/alt proph for TB
- pre: isoniazide/pyridoxine x 9 mo
- alt: rifampin x 4 mo
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indication for cyt proph
primary proph not indicated, but can use valganciclvir in cd4 <50
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