HIV drugs
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| CCR5 antagonist (MOA), | Maraviroc,
CCR5 antagonist prevent the co-receptor to bind with HIV to help facilitate the fusion of HIV RNA.
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| Maraviroc (Rights) ADR | CCR5 antagonist,
Rash, SJS, GI, Hepatotoxicity, URTI, Drug interactions as CYP 3a4 inhibitor
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| Fusion inhibitor (enfuvirtide) | SC BID (painful),
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| enfuvirtide ADR | injection site painful rxn 98%, hypersensitivity rxn, increase in bacterial pneumoniae, nodule formation at the injection site
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| NRTI meds (know class ADR: Lactic acidosis, hepatic steatosis & lipodystrophY) | ZELTA (Zidovudine, Tenofovir, Abacavir, Lamivudine, Emtricitabine)
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| NRTI MOA | prevent conversion of RNA to DNA (reverse transcriptase)
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| Abacavir ADR | NRTI: life threatening hypersensitivity (FARMS N/V)
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| Tenofovir ADR | GI intolerance, renal impairment
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| Zidovudine ADR | HA, bone marrow suppresion
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| Lamivudine and Emtricitabine | minimal toxicity
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| Integrase inhibitor (MOA) | it will prevent the integration of viral DNA into cellular DNA.
raltegravir, elvitegravir, stribild
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| Integrase inhibitor ADR of Raltegravir | CHIMP N/D (CPK elevation, Nausea, diarrhea, pyrexia, headache, myocardial infraction)
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| Integrase inhibitor Stribild, Elvitegravir (cobicistat) | one tablet a day with food, don't use if CrCl < 70 or with other ART,
Cobcistat is booster.
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| Stribild | N/D, renal impairment, decrease bone mineral density
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| Prevention: what can you do? Sexual | Practice CDC's ABC.
Latex condom and water-based lubricant.
Early ART, do TRUVADA for prophylaxis.
Male circumcision
Dental dams
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| Prevention: what can you do? parenteral | testing/treatment for accidental needlestick.
universal precautions.
screening of donated blood/organs etc.
clean needle programs.
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| Perinatal: what can you do? perinatal | treat during pregnancy (don't use efavirenz). RNA count less than 1000. Elective C-section. avoid breastfeeding if safe alternative exists.
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| Efavirenz Strength | NNRTI. well tolerated, low pill burden, PI option reserved for future use
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| Efavirenz Weakness | CNS symptoms, possible teratogenicty,DI, rash, hepatotoxicity, resistance single mutation
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| PCP prophylaxis Primary | Bactrim 1 ds, if sulfa allergy then dapsone.
Start if CD4 < 200, stop if CD4 > 200 for > 3 months.
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| PCP prophylaxis secondary | same as primary, only this time don't stop treatment if CD4 >200
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| Toxoplasma gondii | start bactrim ds qd if CD4 < 100
stop when CD4 > 200 for 3 months
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| MAC (mycobaterium avium complex) | start azithromycin 1200 mg po qwk if CD4 < 50
Stop when CD4 > 100 for 3 months
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| DI ART | CASHEW-G (contraceptive, antimicrobial (rifampin), antifungal, anticonvulsant, statins, herbals, ED, Gastric acid suppressant)
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| Four vaccine u need to avoid | Varicella, Zostavax, MMR, live attenuated influenza vaccine
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| Four vaccine u need to get | Pneumovax (at any CD4 above 200), inactive influenza (annually), Hep b (anti-HBc negative), Hep A (at risk plus negative anti-HAV)
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