Which 2 agents should you be cautious with starting for viral loads>100000 copies/ml?
Abacavir and rilpivirine
What are the creatinine clearance limits for tenofovir?
CrCl <70 for TDF, <30 for TAF
If starting treatment, and cannot use TDF, TAF or ABC, what is recommended?
Darunavir/ritonavir and Raltegravir
In which 2 populations and 3 clinical scenarios should therapeutic drug monitoring be considered?
Children, pregnancy
malabsorption, drug interactions, suspected non adherence
If stopping treatment NRTI with NNRTI, what should it be switched to?
Darunavir/ritonavir for 4 weeks
If previous NRTI resistance, what agent should be switched to?
Protease inhibitor
What is a virological blip, low-level viraemia, incomplete virological response and virological failure?
1) blip- VL 50-200 followed by undetectable result
2) low-level viraemia- multiple blips
3) incomplete virological response VL>200 but never undetectable
4) failure- VL>200 after being undetectable
Virological failure- what should the switch be for:
1) on 1st line ART and wild type?
2) on 1st line PI +2 NRTI with limited major PI mutation?
3) Extensive drug resistance?
1) switch to PI based combination
2) switch to active PI and 1-2 agents with novel mechanism
3) 2 or more fully active agents with at least 1 PI and 1 novel agent (INI, MVC or enfurvitide) with Etravirine an option
HIV/TB co-infection, when should ART start if:
1) CD4 <50
2) CD4>50?
1) within 2 weeks
2) delay 8-12 weeks
What is the 1st line ART for HIV/TB coinfection?
Tenofovir DF, emtricitabine and efavirenz
HIV/TB- when should rifabutin be used instead of rifampicin?
If using ritonavir, cobicistat or nevirapine
HIV/TB- what are the issues with rifampicin and:
1) efavirenz
2) raltegravir
3) dolutegravir?
1) use same dose regardless of weight
2) cautious due to reduced levels
3) can use but 50mg BD, frequent viral load monitoring
Which are the AIDS defining cancers?
Kaposi’s sarcoma
Non hodgkin’s lymphoma (Burkitt’s, primary effusion lymphoma, DLBCL etc)
Cervical cancer
What should be considered with chemotherapy and HIV?
1) drug interactions ,especially cytochrome P450 with ritonavir/cobicistat
2) prophylaxis if previous Hep B
3) prophylaxis if previous HSV
In cardiovascular disease, which is the preferred PI?
Atazanavir/ritonavir
In cardiovascular disease, what is 1st line ART?
tenofovir DF, lamivudine or emtricitabine and dolutegravir or raltegravir or rilpivirine (<100000)
In cardiovascular disease, which agents should be avoided?
abacavir, maraviroc, lopinavir/ritonavir and fosamepravir
What are the 4 issues with rilpivirine?
Can’t give initially if VL>100,000, need to take with food, prolongs QT interval, interacts with PPI
In which 3 scenarios regarding bone health would you avoid TDF?
1) >40 yrs with osteoporosis
2) history of fragility fracture
3) FRAX score >20%
In which 4 scenarios would you expedite treatment for primary HIV infection?
1) Neurological involvement
2) CD4< 350
3) AIDS defining illness
4) diagnosed within 12 weeks of previous negative HIV test
In suspected TB meningitis in HIV patients, what is the WHO preferred test on CSF for diagnosis?
Xpert MTB/Rif
In patients with TB pleuritis and HIV why should respiratory samples be obtained in the absence of lung parenchymal involvement?
Because sputum culture diagnosis approaches 55%
What urinary test has a high sensitivity for TB and is best at what CD4 counts?
LF- liparabinomannan, CD4<100
Why are corticosteroids not advised in HIV patients with TB pericarditis despite shorterning resolution of effusions/thickening?
Increased risk of Kaposi’s Sarcoma and CMV disease, no effect on mortality or respiratory function.
