Download 5-7-2016 PPT

PHARMACOKINETICS:
HIV DRUGS
ALLIE PUNKE ([email protected])
RENAL FUNCTION
• Patients with HIV are at an increased risk of having
nephropathy that can lead to ESRD
• DJ is a Caucasian female who was just diagnosed
with HIV. When/should you recommend for her to
be screened for renal function?
• What are you specifically screening for when
performing renal function tests?
RENAL FUNCTION
• CG is a HIV+ (diagnosed about a year ago) African
American male. At your appointment with him
today, he tells you he sometimes forgets to take his
medications for HIV. The CD4 and HIV RNA count
today is 150 and 900, respectively. His renal function
was stable when he was diagnosed with HIV.
Should we check his renal function today?
RENAL FUNCTION
• When to screen patients for renal function:
• Screen ALL patients when they are diagnosed with HIV
• Yearly screening if patients are at high risk
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African American
CD4<200
HIV RNA>400
Family history of renal problems
HEPATIC FUNCTION
• What makes HIV + patients at increased risk for liver
function abnormalities?
HEPATIC FUNCTION
• GP is a 28 YO AA male who was just diagnosed with
HIV. How often should we monitor his hepatic
function?
DOSE ADJUSTMENTS
• Patients with renal or hepatic issues will most likely:
• Not be able to take medications that are _________.
• Will often require _________ doses
• Will be advised to take medications _________ HD session.
• Will or will not require trough concentrations.
DOSE ADJUSTMENTS
• Generally speaking…. Dose adjustments
(hepatic/renal) should be made for the following
drugs:
• 1. INST
• 2. NNRTI
DOSE ADJUSTMENTS
• 3. PI
• 4. NRTI
DOSE ADJUSTMENTS
• AB is a 45 YO African American HIV + male. His renal
function has been gradually declining, and now he
is requiring dialysis on M, W, F. His medications
include: efavirenz, maraviroc, enfuvirtide, tenofovir,
atorvastatin, amlodipine. Which medication only
needs to be given once a week?
• When should the other HIV medications be dosed?
DOSE ADJUSTMENTS
• In general, patients with renal/hepatic issues should
avoid co-formulated products; however, there is
one combination medication which has lower renal
cut-off that patients may be on until renal
dysfunction becomes worse:
DOSE ADJUSTMENTS
• T/F: Emtricitabine is a member of the NNRTI class,
which generally does not require renal dose
adjustment.
• T/F: Atripla does not require dose adjustment for
patients with decreased renal function.
• T/F: Stribild can be recommended without testing
renal function when initiating, but yearly renal
function screening is recommended.
DRUG MONITORING
• T/F: Most patients with HIV receiving antiretroviral
medication should have their medications
monitored through the use of drug concentrations
• T/F: Patients who do have their HIV medications
monitored experience quicker time to
undetectable RNA load and less side effects
• T/F: Monitoring HIV medications is recommended in
HIV guidelines due to clinical trials showing that
monitoring improves clinical outcomes
DOSE ADJUSTMENTS
• A patient who was recently diagnosed with HIV has
been on anti-retroviral therapy for the past 3
months. She reports being extremely adherent (the
pill counts also show she has been adherent).
However, her CD4 count is still very low and her RNA
is quite high. What can we consider doing?
PRE-EXPOSURE PROPHYLAXIS
• A 23 YO Caucasian female with history of IV drug
abuse asks if there’s any medication to reduce her
chances of acquiring HIV. What medication would
you want to tell her about?
• If you give her the medication, when would you
want to schedule a follow up visit?
PRE-EXPOSURE PROPHYLAXIS
• What are some things to monitor for a patient
receiving pre-exposure prophylaxis?
• If a patient becomes HIV + while on prophylaxis
(and the diagnosis is confirmed and CD4 count is
ordered), what should we do?
PRE-EXPOSURE PROPHYLAXIS
• For all groups (MSM, heterosexuals, IVDU)…what
must we make sure they do NOT have before
initiating HIV pre-exposure prophylaxis?
PRE-EXPOSURE PROPHYLAXIS
• Should we initiate it in these patients?
• 1. Gay male who was diagnosed with gonorrhea 5 months
ago.
• 2. IV drug abuser who sometimes shares needles with her
friend who was just diagnosed with HIV
• 3. Heterosexual male who thinks he may be having
symptoms of HIV after a previous partner informed him that
she is HIV+
PRE-EXPOSURE PROPHYLAXIS
SUMMARY
• Recognize the need to monitor for renal and
hepatic function in HIV + patients
• Recognize the classes of medications as well as the
combination products that generally need to be
adjusted for renal or hepatic function
• Know the drug used for pre-exposure prophylaxis
• Know which patients are eligible for pre-exposure
prophylaxis
QUESTIONS ABOUT THIS OR
PREVIOUS SESSION?
GOOD LUCK!