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HIV Tutoring By Alaina Darby JD is a 22 yo WM who is suspected to have contracted HIV. Which of the following tests would be most necessary? a. Genotype resistance testing b. Plasma HIV RNA c. Complete blood count (CBC) d. Fasting blood glucose JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Which of the following would not be a primary goal for treating his HIV? a. Reduce HIV-associated morbidity b. Preserve immunologic function c. Prevent transmission d. Minimize adverse effects JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Which of the following would not predict therapeutic success? a. HIV viral load below detection limit b. Lower CD4 count c. High potency ARV regimen d. Low baseline viremia JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Weighing the concerns of starting ART, which of the following would indicate the need to start ART? a. Low CD4 b. Homosexual lifestyle c. High HIV load d. All with HIV should start ART JD is a 22 yo WM who is suspected to have contracted HIV. He has now been diagnosed. Which of the following would not be a concern with him taking ART? a. Immune suppression b. Quality of life c. Resistance development d. Non-adherence Which of the following medication classes is the backbone of ART? a. PI b. NNRTI c. NRTI d. INSTI Which of the following medication classes is properly matched with its drug? a. PI - EFV b. NNRTI - ATV c. NRTI - ABC d. INSTI - TDF Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. Which of the following NRTI backbones should she most likely receive? a. ABC/3Tc b. FTC/TDF c. FTC/3Tc d. ABC/TDF Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. You decide to start her on ABC/3Tc. What should you test before starting this NRTI combination as opposed to another NRTI combo? a. LFTs b. HLA-B c. Blood glucose d. Serum lipids Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. You find that she has a history of night terrors. What is your recommendation now? a. ABC/3Tc b. FTC/TDF c. FTC/3Tc d. ABC/TDF Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 BR is a 44 yo WF who is starting ART. Her labs are listed on the left. You find that she has a history of night terrors. You start her on FTC/TDF. What is a lab value that you would need to recheck based on ADR’s for both of these drugs? a. LFTs b. HLA-B c. Blood glucose d. Serum lipids What would not be a reason to prescribe FTC/TDF over ABC/3Tc? a. History of adherence issues b. Previous hematological problems c. Previous rash with carbamazepine d. History of sleep disturbances Labs: HIV RNA: 80,000 CD4: 300 Na+: 138 Cl-: 105 K+: 5.2 HCO3: 25 FBG: 108 JD has a h/o neuropsychosis and kidney stones. Which of the following adjunctive medications to TDF/FTC should he receive? a. ATV b. DRV c. RPV d. EFV Which of the following should be taken on an empty stomach? a. ATV b. DRV c. RPV d. EFV Which of the following would be least preferred for someone who is also taking a PPI? a. ATV b. DRV c. RPV d. EFV Which of the following would be best if a patient is taking carbamazepine for seizures? a. ATV b. DRV c. RPV d. EFV RP has a history of STEMI and adherence issues. He is currently taking omeprazole. Which of the following would be the preferred PI for him? a. ATV b. DRV c. LPV d. NFV The doctor wants to start JW on a statin but is worried about the increased risk of rhabdo given his current ART therapy. What agent is he likely taking? a. DTG b. EVG c. RAL d. RTG The doctor wants to start JW on a statin but is worried about the increased risk of rhabdo given his current ART therapy. What agent is he likely taking? a. DTG b. EVG c. RAL d. RTG Labs: HIV RNA: 75,000 CD4: 450 LFT: WNL CrCl: 38 Remember her? BR is a 44 yo WF who is starting ART. Her labs are listed on the left. Which of the following should not be used in her? a. Atripla b. Complera c. Stribild d. Triumeq ADRs/contraindications to remember: ABC: hypersensitivity rash (HLA testing), sleep d/o FTC/3Tc/TDF: HBV exacerbation TDF: bone marrow issues, bone density EFV: neuropsych d/o RPV: not for high RNA/low CD4 LPV: heart issues RAL: rhabdo Drug class generalities: NRTIs: hepatomegaly, Cushing's NNRTIs (-vir-): resistance PIs (-vir): hyperglycemia, bleeding, hyperlipidemia INSTIs (-tegravir): absorption impaired by antacids Preferred: 2 NRTIs plus INSTI or NNRTI or PI + r/c Your patient is HLA positive. Which would you not use? a. Atripla b. Complera c. Stribild d. Triumeq What would be a potential option in a patient that is HLA positive and already has low bone density and bone marrow defects? a. LPV/r + 3TC b. DRV/r + 3TC c. ATV/c + RAL d. ATV/c + 3TC Just a little trick! Efavirenz is the fav for TB but not pregnancy or CNS! More side effects and considerations… TDF: bone, kidney EFV: brain, methadone ABC, LPV/r: cardiac