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Chapter 87. Human Immunodeficiency Virus Infection

Student Questions

ML is a 56-year-old man who returns to clinic for a discussion of initiating antiretroviral treatment after being recently diagnosed. HIV RNA (125,000 copies/mL [125 × 106 copies/L]) and CD4+ T-cell count (390 cells/mm3 [390 × 106/L]) were obtained 2 weeks ago. The baseline HIV genotype shows NNRTI resistance. He is 6 feet tall (183 cm) and weighs 176 lbs (80 kg). Today, his laboratory test results reveal a serum creatinine of 1.43 mg/dL (126 μmol/L). He is HLA-B*5701 negative. His current medications include simvastatin 40 mg daily, hydrochlorothiazide 25 mg daily, omeprazole 20 mg daily, and sildenafil 50 mg daily 1 hour prior to sexual activity. He states that he prefers a regimen that requires the "least number of pills per day." Which regimen would be the best for this antiretroviral-naïve patient?

A. Tenofovir disoproxil fumarate + emtricitabine + atazanavir + ritonavir

B. Tenofovir disoproxil fumarate + emtricitabine + rilpivirine

C. Tenofovir alafenamide + emtricitabine + elvitegravir + cobicistat

D. Abacavir + lamivudine + dolutegravir

Answer: D

Option A: Incorrect. Tenofovir disoproxil fumarate + emtricitabine + atazanavir + ritonavir have multiple drug-drug interactions with his current home medications. Additionally, given his elevated SCr, tenofovir disoproxil fumarate is less than ideal.

Option B: Incorrect. Tenofovir disoproxil fumarate + emtricitabine + rilpivirine are one-pill, once daily options but represent NNRTI-based regimens to which this patient's genotype shows resistance. Additionally, given his elevated SCr, tenofovir disoproxil fumarate is less than ideal.

Option C: Incorrect. Tenofovir alafenamide + emtricitabine + elvitegravir + cobicistat have multiple drug-drug interactions with his current home medications.

Option D: Correct. Abacavir + lamivudine + dolutegravir represents the best option for this patient because it is a one-pill, once daily option that does not interact with his current medications.

Which of the following is true regarding cobicistat?

A. Cobicistat is a pharmacokinetic enhancer that is available co-formulated with darunavir.

B. Cobicistat is an integrase inhibitor with potent antiviral activity.

C. Cobicistat is a pharmacokinetic enhancer that is available co-formulated with raltegravir.

D. Cobicistat has very low potential for drug interactions.

Answer: A

Options A: Correct, cobicistat is available co-formulated with darunavir.

Option B: Incorrect. Cobicistat does not have any antiviral activity nor does it belong to the integrase inhibitor class.

Option C: Incorrect. Raltegravir does ...

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