Master the board step 3

Master the Boards: USMLE Step 3
HIV/AIDS
Following are the “must know” facts about HIV:
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Adverse effects of medications
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Needle-stick injury management
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Pregnancy/perinatal HIV management
When to start therapy?
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CD4 count < 500 without exception
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Symptomatic patients with any CD4 count or viral load
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Pregnant women: All of them, any stage of pregnancy, any CD4
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Needle-stick scenario, where patient is known to be HIV-positive
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Optional at any CD4 count, even > 500
Monotherapy with AZT
alone is never the right
answer for anyone.
Start triple highly active antiretroviral therapy (HAART), which is one of
the following:
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Tenofovir and emtricitabine and efavirenz (single combination pill with all
of these)
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Tenofovir and emtricitabine and atazanavir (or darunavir)
When a protease inhibitor such as atazanavir or darunavir is used in combination
with tenofovir and emtricitabine, you should add a small amount of
ritonavir to boost the level of the other protease inhibitors.
Raltegravir is an integrase inhibitor that is used with two nucleosides, such as
tenofovir and emtricitabine. This three-drug combination is considered equivalent
to the combination with efavirenz or a protease inhibitor.
The precise combination is not as important as knowing the adverse effects of
the medications.
Class
Nucleoside Reverse
Transcriptase Inhibitors
Protease Inhibitors
Nonnucleoside
Reverse Transcriptase
Inhibitors
Adverse effects of
the class
Lactic acidosis
Hyperglycemia
Hyperlipidemia
Drowsiness (efavirenz)
Individual
medications
Zidovudine: Anemia
Didanosine: Pancreatitis and
peripheral neuropathy
Indinavir: Kidney stones
Ritonavir
Lopinavir
Efavirenz
Nevirapine
Etravirine
Stavudine: Pancreatitis and
neuropathy
Lamivudine: None
Abacavir: Rash
Nelfinavir
Saquinavir
Darunavir
Tipranavir
Rilpivirine
Emtricitabine
Amprenavir
Tenofovir: Renal toxicity
Atazanavir
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