Term
abacavir - ABC (Ziagen);
also in combo products: Trizivir, Epzicom |
|
Definition
NRTI;
Take without regard to meals;
Dose Adjustments:
- NO Renal adjustments necessary;
- HEPATIC dose adjustment REQUIRED;
ADEs:
- Fatal Hypersensitivity Rxn: Screen for HLA-B*5701 (Sx: fever, rash, N/V, malaise, decreased appetite, respiratory Sx);
- Cardiovascular Toxicity & Decrease Efficacy with HIGH VL (>100,000 copies/ml) |
|
|
Term
| Nucleoside Reverse Transcriptase Inhibitors (NRTIs) |
|
Definition
abacavir (ABC; Ziagen);
didanosine (ddI; Videx EC & solution);
emtricitabine (FTC; Emtriva);
lamivudine (3TC; Epivir);
stavudine (d4T; Zerit);
tenofivir disoproxil fumarate (TDF; Viread);
zidovudine (AZT, ZDV; Retrovir) |
|
|
Term
| didanosine - ddI (Videx EC & solution) |
|
Definition
NRTI;
Weight-based dosing;
- reduced dose with TDF (tenofivir) combo;
**TAKE 1/2 HR BEFORE OR 2 HRs AFTER MEAL** - levels decrease by 55% with food;
Dosage Adjustments:
- RENAL adjustments required;
ADEs:
- pancreatitis, peripheral neuropathy, retinal changes, N/V, lactic acidosis, risk of MI, insulin resistance/DM; |
|
|
Term
emtricitabine - FTC (Emtriva);
also found in combo products: Truvada, Atripla |
|
Definition
NRTI;
Take without regard to meals;
Renal dose adjustements required;
MINIMAL TOXICITY |
|
|
Term
| didanosine - ddI (Videx Ec & Suspension) |
|
Definition
| only NRTI that CANNOT be taken with or without food: TAKE 1/2 HR BEFORE or 2 HRs AFTER MEAL - levels decrease 55% with food; |
|
|
Term
| Trizivir (ABC + ZDV + 3TC) |
|
Definition
| abacavir + zidovudine + lamivudine combo product (3 NRTIs) |
|
|
Term
|
Definition
abacavir + lamivudine combo product
(2 NRTIs)
**ALTERNATE Dual NRTI Therapy**
- used if unable to use tenofovir
- must screen HLA-B*5701 when starting ABC |
|
|
Term
|
Definition
emtricitabine + tenofivir combo product
(2 NRTIs)
** PREFERRED Dual NRTI**
- potent virologic suppression
- convenient dosing (QD)
- little toxicity
- less emergence of mutations |
|
|
Term
| Atripla (EFV + TDF + FTC) |
|
Definition
efavirenz + tenofivir + emtricitabine combo product (2 NRTIs + 1 NNRTI)
**1st fixed NNRTI-based regimen;
- may be used alone OR in combo with other ART (tx-experienced pt) |
|
|
Term
| Alternative Dual NRTIs Used |
|
Definition
lamivudine (3TC) + abacavir (ABC) [TRUVADA]
OR
lamividuine (3TC) + zidovudine (ZDV) [Combivir] |
|
|
Term
lamivudine - 3TC (Epivir);
also in Combo Products: Combivir, Epizicom, Trizivir |
|
Definition
NRTI;
Take without regard to meals;
*Typcially part of a combo as the "backbone";
Renal adjustments required;
MINIMAL TOXICITY - very effective when used in combo; |
|
|
Term
|
Definition
NRTI - old drug;
Wt-based dosing;
**RARELY selected as 1st line agent;
Take without regard to meals;
Renal adjustments required;
SIGNIFICANT ADRs:
- peripheral neuropathy, lipodystrophy, pancreatitis, lactic acidosis, hyperlipidemia, insulin resistance/DM; |
|
|
Term
tenofovir disoproxil fumarate - TDF (Viread);
also in Combo Products: Truvada, Atripla |
|
Definition
NRTI - newest;
Take without regard to meals;
Renal adjustments required;
ADEs:
- RENAL INSUFFICIENCY (Falconi Syndrome - monitor SCr, electrolytes, U/A);
- potential decrease in bone mineral density; |
|
|
Term
| NRTIs with Hepatits B Virus Activity |
|
Definition
| lamivudine (3TC, Epivir), emtricitabine (FTC, Emtriva), & tenofovir (TDF, Viread) |
|
|
Term
tenofovir (TDF) + emtricitabine (FTC) [TRUVADA]
OR
tenofovir (TDF, Viread) + lamivudine (3TC, Epivir) |
|
Definition
Recommended Tx if HIV & HBV co-infected;
- use both active agents to reduce risk of resistance compared to monotherapy; |
|
|
Term
| zidovudine (ZDV), didanosine (ddI), stavudine (d4T) |
|
Definition
oldest NRTIs;
More severe ADRs;
Rarely used for tx-naive pts;
Added on to regimens in pts w/ resistance issues; |
|
|
Term
zidovudine - AZT, ZDV (Retrovir);
Also in Combo Products: Combivir, Trizivir |
|
Definition
Capsules, 10 mg/mL IV soln, & 10 mg/mL oral soln;
Take without regard to meals;
Renal adjustments required;
ADEs:
- BONE MARROW SUPPRESSION: macrocytic anemia & neutropenia |
|
|
Term
| Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) |
|
Definition
| efavirenz (EFV, Sustiva), nevirapine (NVP, Viramune), etravirine (TMC-125, Intelence) |
|
|
Term
efavirenz - EFV (Sustiva);
also in Combo Products: Atripla |
|
Definition
**MOST STUDIED ART today - superior virologic response;
Give dose AT BEDTIME (SEs);
Take on an EMPTY STOMACH;
POTENT 3A4 mixed INDUCER > INHIBITOR;
ADRs:
- RASH
- CENTRAL NERVOUS SYSTEM SX: dizziness, insomnia, abnormal dreams, confusion, abnormal thinking, impaired concentration, amnesia, depersonalization, hallucinations, euphoria;
- INCREASED TRANSAMINASE LEVELS;
- HYPERLIPIDEMIA;
- TERATOGENIC |
|
|
Term
| nevirapine - NVP (Viramune) |
|
Definition
NNRTI - alternative agent;
Dose:
- 200 mg daily x 14 days ("Lead-in Period"), then 200 mg PO BID;
Take without regard to meals;
CYP3A4/2B6 INDUCER;
ADRs:
- RASH (highest NNRTI);
- Symptomatic Hepatitis --> FATAL HEPATIC NECROSIS: AVOID if CD4+ >250 (F) or >400 (M) if Tx-Naive |
|
|
Term
| etravirine - TMC-125 (Intelence) |
|
Definition
NNRTI;
**CANNOT USE in Tx-NAIVE Pts**
Take FOLLOWING a MEAL;
Metabolized by CYP3A4, 2C9, & 2C19;
3A4 INDUCER, 2C9 & 2C19 INHIBITOR;
**SIGNIFICANT DRUG-DRUG INTERACTIONS**
ADEs:
- RASH (SJS);
NOTES:
- 2nd generation NNRTI (newest);
- used for NNRTI-resistant variants of HIV;
- FOR TX-EXPERIENCED PTs (used in combo w/ at least 2 other ART) |
|
|
Term
| Advantage of NNRTI-based Combo ART |
|
Definition
| EFV: superior virologic response |
|
|
Term
| Disadvantages of NNRTI-based Combo ART |
|
Definition
Risk of resistance: single mutation, CROSS RESISTANCE (wipes out entire class) --> Genetic Testing RECOMMENDED;
Rash;
Increased Transaminases;
CYP450 Drug interactions;
CNS toxicity/teratogenicity (EFV);
Heptatitis (NVP) |
|
|
Term
| Preferred NNRTI-based Combo ART |
|
Definition
efavirenz (EFV) + 2 NRTIs (i.e. Atripla);
- superior virologic response;
- low pill burden;
- AVOID if: pregnant (1st trim), women planning to conceive, use of ineeffective/inconsistent contraception, Preg. Cat. D;
- CNS Side Effects |
|
|
Term
| Alternative NNRTI-based ART Combo |
|
Definition
Nevirapine (NVP, Viramune) + 2 NRTIs;
- higher cases of ADRs in tx-naive pts;
- SYMPTOMATIC, severe HEPATIC EVENTs (increased LFTs);
- SKIN RASH (needs lead-in period) |
|
|
Term
|
Definition
| atazanavir (ATV; Reyataz), darunavir (DRV; Prezista), fosamprenavir (f-APV; Lexiva), indinavir (Crixivan), lopinavir + ritonavir (LPV/r; Kaletra), nelfinavir (NFV; Viracept), ritonavir (RTV; Norvir), saquinavir (SQV; Invirase), tipranavir (TPV; Aptivus) |
|
|
Term
| atazanavir - ATV (Reyataz) |
|
Definition
PI PREFERRED in Guidelines;
Take with food;
Needs acidic environment for absorption: AVOID antacids, H2RAs, PPIs;
CYP3A4 INHIBITOR;
ADEs:
- Indirect hyperbilirubinemia;
- prolonged PR interval - asymptomatic 1st degree AV Block;
- Metabolic side effects seen in ALL PIs |
|
|
Term
| Metabolic Side Effects seen in ALL Protease Inhibitors (PIs) |
|
Definition
Transaminase Elevation;
Lipodystrophy;
Insulin resistance;
Hyperlipidemia |
|
|
Term
| Advantages of PI-based Combo ART |
|
Definition
Higher genetic barrier to resistance;
Slow to develop resistance even AFTER virologic failure;
Less cross-resistance within the class; |
|
|
Term
| Disadvantages of PI-based Combo ART |
|
Definition
Metabolic abnormalities can lead to CV events - Transaminase elevation, lipodystrophy, insulin resistance, hyperlipidemia;
More GI SEs;
Most CYP3A4 substrate, Most INHIBITORS: more pronounced w/ RTV-boosed drugs;
Increased risk of bleeding in hemophiliacs; |
|
|
Term
| atazanavir-based regimen - PREFERRED: atazanavir + ritonavir (ATV/r) |
|
Definition
Preferred PI-based ART;
MAJOR SE: indirect hyperbilirubinemia;
Preferred b/c:
- superior/noninferior virologic efficacy to other PI-based regimens;
- requires no more than 100 mg RTV/day;
- Qdaily dosing: less pill ct;
- Tolerable
Needs acidic environment: AVOID acid reducers, TAKE with food; |
|
|
Term
| darunavir - DRV (Prezista) |
|
Definition
PI also PREFERRED in Guidelines over other regimens;
- recommended to be BOOSTED with RTV;
TAKE with FOOD;
CYP3A4 INHIBITOR & substrate;
ADEs:
- Rash (SJS/erythema multiforme); CAUTION: Sulfonamide moiety - SULFA Allergies!!!
- diarrhea, nausea;
- Metabolic SEs |
|
|
Term
| darunavir-based PI regimen - PREFERRED: darunavir + ritonavir (DRV/r) |
|
Definition
PREFERRED PI-based ART regimen;
- 2nd gen. PI
- boosted with RTV;
SE: SULFA Allergy!!!
Preferred b/c:
- superior/noninferior virologic efficacy to other PI-based regimens;
- requires no more than 100 mg RTV/day;
- Qdaily dosing: less pill ct;
- Tolerable |
|
|
Term
| fosamprenavir - f-APV (Lexiva) |
|
Definition
ALTERNATIVE PI-based regimen behind ATV/r & DRV/r regimens;
Tablets: Take WITHOUT regard to meals (if not boosted with RTV);
- FPV + RTV: Take WITH meals;
- Suspension: Take WITHOUT regard to meals;
CYP3A4 INHIBITOR, INDUCER, SUBSTRATE;
ADRs:
- skin rash: SULFA ALLERGY!!!
- diarrhea, N/V;
- Metabolic SEs |
|
|
Term
| fosamprenavir (f-APV)-based PI regimen - ALTERNATIVE: f-APV + RTV recommended |
|
Definition
alternative PI-based regimen to ATV/r & DRV/r;
BID dosing more efficacious;
MAJOR SE: skin rash;
Controversial Risk: MIs & STROKE |
|
|
Term
|
Definition
- very old PI, back-up to other more preferred regimens;
Boosted regimen recommended for Tx-Naive Pts;
Unboosted regimen NOT recommended for Tx-Naive pts;
Unboosted: May take with SKIM MILK or LOW-FAT MEAL;
Boosted: Take WITHOUT regard to meals;
ADRs:
- NEPHROLITHIASIS --> hydrate w/ 1.5 L of fluid/day;
- NAUSEA;
- hepatitis;
- indirect hyperbilirubinemia;
- Metabolic SEs |
|
|
Term
| lopinavir + ritonavir - LPV/r (Kaletra) |
|
Definition
Only CO-FORMULATED PI;
May be taken with EVF or NVP: PI-naive OR experienced pts;
Refrigerate ORAL SOLUTION: stable @ room temp. for 2 months;
Tablets: Take without regard to meals;
Oral Soln: Take WITH food;
CYP3A4 INHIBITOR;
ADRs:
- GI intolerance (N/V/D; higher incidence w/ QD dosing than BID dosing);
- Metabolis SEs |
|
|
Term
| nelfinavir - NFV (Viracept) |
|
Definition
older PI - inferior viroligic efficacy;
Take WITH food;
CYP3A4 Inhibitor;
ADRs:
- DIARRHEA**
- Metabolic SEs |
|
|
Term
|
Definition
PI that is no longer used alone: PK booster for other PIs;
Take WITH food;
POTENT 3A4/2D6 INHIBITOR;
ADRs:
- GI intolerance (N/V/D);
- Paresthesias;
- Hepatitis;
- Metabolic SEs
Low-dose given w/ other PIs as a "PK Booster":
- increases drug exposure;
- prolongs serum half-life of active PI;
- reduces dosing frequency & pill burden; |
|
|
Term
| saquinavir tabs & hard gel caps - SQV (Invirase) |
|
Definition
PI - not 1st line: inferior virologic efficacy;
Unboosted: NOT RECOMMENDED;
Boosted: required if used;
Refrigerate CAPS: stable at room temp for 60 days;
Tabs: Take w/ RTV & WITH FOOD;
3A4 INDUCER & substrate;
ADRs:
- GI intolerance (N/D)
- Metabolic SEs
- PR/QT Prolongation |
|
|
Term
| tipranavir - TPV (Aptivus) |
|
Definition
PI - 2nd generation;
Tx of Tx-Experienced pts (evidence of viral replication & have HIV-1 strains resistance to multiple PIs;
Unboosted: NOT recommended;
Boosted: RECOMMENDED;
Refrigerate caps, stable @ room temp for 60 days;
Tabs: Take WITH FOOD;
CYP3A4 INDUCER & substrate;
Net effect w/ RTV: INHIBITOR;
ADRs:
- hepatotoxicity: clinical hepatitis, monitor closely;
- skin rash: SULFA Allergy;
- rare fatal & nonfatal intracranial hemorrhages;
- Metabolic SEs |
|
|
Term
| raltegravir - RAL (Isentress) |
|
Definition
Integrase Inhibitor;
Take PO BID;
Take without regard to meals;
NO CYP INTERACTIONS!!!
Minor ADRs (new drug): N, HA, D; |
|
|
Term
| maraviroc - MVC (Selzentry) |
|
Definition
CCR5 Inhibitor - ACCEPTABLE alternative to Integrase Inhibitor-based regimen;
**Co-receptor tropism assay should be performed when CCR5 inhibitor is being considered OR concerncs of virologic failure w/ CCR5 inhibitor;
Dosing:
- 150 mg BID w/ Strong 3A4 inhibitors (including PIs);
- 300 mg BID when given with NRTIs, T20, TPV/r, NVP, RAL, or weaker 3A4 inhibitors/inducers;
- 600 mg BID when given w/ 3A4 Inducers (EFV, TMC-125, rifampin);
Take with or without food;
3A4 substrate;
Minor ADRs: abd pain, cough, dizziness; |
|
|
Term
| INSTI-based regimen: raltegravir (RAL) + tenofovir/emtricitabine (TDF/FTC) |
|
Definition
PREFERRED over CCR5 inhibitor-based regimen;
- Unique MOA;
- Indicated for Tx-Experienced Adults AND for Tx-naive pts;
- Minimal ADRs, DDIs, & food-drug interactions;
Limitations:
- low genetic barrier
- BID dosing
- limited use with other NRTI dual backbone |
|
|
Term
| CCR5 inhibitor-based regimen: maraviroc (MVC) + zidovudine/lamivudine (ZDV/3TC) |
|
Definition
ACCEPTABLE Tx regimen (behind INSTI-based regimen);
- unique MOA;
- Tx-experienced pts & Tx-Naive pts
Limitations:
- Dosing depends on co-administered HIV meds due to DDIs
- MUST obtain viral tropism test (to verify CCR5 tropism) before use - EXPENSIVE;
- BID Dosing;
- Limited use w/ other NRTI dual backbone |
|
|
Term
| enfuviritide - T20 (Fuzeon) |
|
Definition
Fusion inhibitor - ONLY injectable product!!!
Indications: Tx-Experienced Pts
Dosing: SC BID
ADRs:
- local injection site reactions
- increased rate of bacterial pneumonia
- hypersensitivity rxns; |
|
|
Term
| Human Immunodeficiency Virus (HIV) |
|
Definition
envelope RNA retrovirus;
long interval between initial infection & onset of serious symptoms;
Escapes host antibodies & killer T-cells (CD8+);
Inhibits productoin of a vaccine;
Transmission: most commonly sexual intercourse (vagina, vulva, penis, or rectum), contact w/ infected blood (needle sticks, blood transfusion, vertical [mother-to-infant via birth & breastfeeding]); |
|
|
Term
| No evidence of transmission of HIV |
|
Definition
|
|
Term
|
Definition
Spreads rapidly thru lymphatic system;
Infects large # of CD4+ T-cells & replicates rapidly;
Flu-like Sx: starts 2-4 wks after exposure (highly infectious):
- fever, adenopathy, pharyngitis, rash, myalgia, diarrhea, HA, N/V, hepatosplenomegaly, weight loss, thrush, neurologic sx;
Immune system fights back: killer T-cells (CD8+ T-cells) & B-cell-produced antibodies:
- 6-8 wks after exposure
- reduced viral load (VL)
- Sx free for yrs despite replication |
|
|
Term
|
Definition
Sx can occur ~10 yrs after 1st exposure in ADT-naive pts;
S/Sx:
- enlarged lymph nodes >3 months;
- lack of energy;
- weight loss;
- frequent fevers & sweats;
- peristent yeast infections;
- persistent skin rashes or flaky skin;
- PID;
- short-term memory loss;
- herpes flare |
|
|
Term
|
Definition
most advanced stage of HIV infection;
prone to developing aggressive cancers & opportunistic infections;
- ultimately what kills pts |
|
|
Term
|
Definition
CD4 cells >500 cells/mm^3: Asymptomatic or Acute HIV infection, Sypmtomatic;
CD4 Cells: 200-499 cells/mm^3: Asymptomaitc or Acute HIV infection, Symptomatic |
|
|
Term
|
Definition
CD4 Cell: >500 - AIDS-indicator condition;
CD4 Cell: 200-499 - AIDS indicator Condition;
CD4 Cell <200 - Asymptomitic or acute HIV infection, Symptomatic, AIDS-indicator condition |
|
|
Term
| AIDS-Indicator Conditions |
|
Definition
candidiasis (lung, esophagus);
CMV disease, retinitis;
Coccidiomycosis;
HSV: chonic ulcers;
Histoplasmosis;
Kaposi's sarcoma;
MAC (Mycobacterium avium complex);
Mycobacterium TB;
PCP (Pneumocystis jiroveci pneumonia);
Recurrent pneumonia;
Toxoplasmosis of brain |
|
|
Term
| Natural History & Classification of HIV-1 |
|
Definition
| Viral transmission (2-3 wks) --> acute retroviral syndrome (2-3 wks) --> recovery + seroconversion (2-4 wks) --> asymptomatic chronic HIV-1 infection (~8 yrs) --> symptomatic HIV-1 infection/AIDS (~1.3 yrs) --> death |
|
|
Term
|
Definition
2 repeated ELISA tests: if either are positive, follow with a confirmatoryy Western Blot (WB)
(+) WB --> HIV + |
|
|
Term
| ELISA - Enzyme-linked Immunosorbent Assay |
|
Definition
1st screening tool;
Inexpensive & very sensitive;
Must take 2 tests, if either is (+), must take Western Blot (WB) to confirm HIV |
|
|
Term
|
Definition
confirmatory test for HIV;
only performed if ELISA is positive;
detects Abs to HIV-1 proteins;
Positive: reactive to gp120/160 PLUS either gp41 or gp24 |
|
|
Term
|
Definition
plasma HIV-1 RNA;
**MOST IMPORTANT MARKER of THERAPEUTIC RESPONSE**
Goal: 20-75 copies/mL (<50) - want to achieve after 12-24 wks of intiial therapy;
Plasma HIV-1 RNA PCR: high sensitivity & specificity;
Predictor of clinical progression: rising # --> CD4 T-cell decline;
Diagnosis of acute HIV infections if used prior to seroconversion;
Accuracy: best if used during time of clinical stability |
|
|
Term
|
Definition
Normal Range: 800-1050 cells/mm^3
Normal Percent: 32-68%;
Indications:
**MOST IMPORTANT indicator of IMMUNE FUNCTION**
Strongest predictor of disease progression & survival;
Most important consideration in decisions to intiate ART & prophylaxis for Opportunistic Infections (OIs) |
|
|
Term
|
Definition
Before treatment:
- Baseline, then q3-6 months;
Initiation (or switch) of Therapy:
- start of therapy
- recheck q3-6 months after tx initiation: expect increase by 50-150 cells/mm^3 each year (accelerated in 1st 3 months);
- Counts plateau after 4-6 yrs of tx
- assesses immunologic response to ART
- assesses need to start or stop chemophrophylaxis for OIs
Stable ARV Regimen:
- monitor q3-6 months
- can go to q6-12 months if count is well above threshold of OI risk (>200 cells/mm^3) |
|
|
Term
|
Definition
Guides selection of ARV regimen:
- performed when HIV pt enters into care regardless of whether therapy will start immediately or not;
- if therapy is deferred, repeat testing at start of therapy |
|
|
Term
|
Definition
| ONLY with initiation of CCR5 antagonist |
|
|
Term
|
Definition
| ONLY with initiation of abacavir (ABC; Ziagen) |
|
|
Term
| Goals for Treatment of HIV-1 |
|
Definition
reduce HIV-1 related morbidity & prolong duration & quality of survival;
Restore & preserve immmunologic function;
Maximally & durably suppress VL;
Prevent vertical HIV transmission |
|
|
Term
| Long-term Virologic Success of ART |
|
Definition
potency: at least 2, preferably 3, active drugs from 2 or more drug classes;
Adherence to treatment & resistant patterns;
Low baseline VL (<50);
Higher baseline CD4+ T-cell count (>200)
How rapid VL responds to treatment; |
|
|
Term
| When To Treat Tx-NAIVE Pts with HIV |
|
Definition
ART should be INITIATED in ALL Pts with:
- AIDS-defining illness or CD4+ <350;
- **CD4+ 350-500**
- HIV-associated nephropathy (HIVAN) & Hep B virus (HBV) co-infection when tx of HBV is indicated, regardless of CD4+ count;
- pregnant women;
- willingness to start therpy;
- knowledge of benefits & risks of starting therapy (SEs, DDIs, Adherence) |
|
|
Term
| Factors to Consider when to Start ART |
|
Definition
co-morbid conditions;
Adverse drug effects;
DDIs;
pregnancy/pregnancy potential;
Results of genotypic drug-resistance testing;
Gender & pretreatment CD4+ count (NVP use);
HLA-B*5701 testing (ABC use);
Co-receptor tropism assay (MVC use);
Patient adherence;
Convenience (pill burden, dosing frequency, food/fluid considerations) |
|
|
Term
| PREFERRED Combo ART regimens for Tx-NAIVE Pts |
|
Definition
NNRTI-based (NNRTI + 2 NRTIs)
PI-based (PI + 2 NRTIs)
INSTI-based (RAL + 2 NRTIs) |
|
|
Term
| Acceptable (but not Preferred) Combo ART Regimen for Tx-NAIVE Pts |
|
Definition
| CCR5 antagonist-based: MVC + 2 NRTIs |
|
|
Term
| Preferred NNRTI-Based ART Regimen |
|
Definition
| efavirenz (EFV) + tenofivir (TDF) + emtricitabine (FTC) --1 combo pill called ATRIPLA |
|
|
Term
| Preferred PI-based ART Regimens |
|
Definition
1) atazanivir + ritonavir (ATV/r; Reyataz/Norvir) PLUS tenofovir (TDF; Viread) PLUS emtricitabine (FTC; Emtriva)
FTC/TDF combo product: TRUVADA
OR
2) darunavir + ritonavir (DRV/r; Prezista/Viread) PLUS tenofovir (TDF) PLUS emtricitabine (FTC)
-- TDF/FTC combo product: TRUVADA |
|
|
Term
| Preferred INSTI-based ART regimen |
|
Definition
| raltegravir (RAL; Isentress) + tenofovir + emtricitabine (TDF/FTC; TRUVADA) |
|
|
Term
| Alternative ART Regimens --> CCR5 Antagonist-based |
|
Definition
1) maraviroc (MVC; Selzentry) + zidovudine (ZDV; Retrovir) + lamivudine (3TC; Epivir)
- ZDV/3TC combo product: COMBIVIR;
OR
2) maraviroc (MVC; Selzentry) + tenofovir/emtricitabine (TRUVADA) OR abacavir/lamivudine (Epizicom) |
|
|
Term
|
Definition
nonadherence;
adverse drug reactions;
drug-drug interactions (ALL PIs & NNRTIs are metabolized by CYP450 isoenzymes [CYP3A4]);
Drug Resistance |
|
|
Term
| Common Drugs with potential Drug-Drug Interactions w/ ART Drugs |
|
Definition
statins;
CCBs;
immunosuppressants (cyclosporine/tacrolimus);
anticonvulsants;
rifamycins;
azole antifungals;
macrolides;
St. John's Wort |
|
|
Term
|
Definition
preferrred drug resistance testing for Tx-Naive pts;
- detects drug resistance mutations & cross-resistance within that class;
Rapid results (1-2 wks) |
|
|
Term
|
Definition
| inability to achieve or maintain suppression of viral replication (to an HIV RNA level <200 copies/mL) |
|
|
Term
| Management of Virologic Failure |
|
Definition
| New ARV regimen should contain AT LEAST TWO, and preferably THREE, fully active drugs (different classes/MOAs) |
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