217.2 📚 國考版

217.2.0.1 必背 — Universal ART Start

  • ALL HIV+ regardless of CD4
  • ASAP after diagnosis
  • “Rapid start” or “same-day” programs

217.2.0.2 必背 — First-Line Regimens (DHHS 2024)

Regimen Note
Biktarvy (BIC/TAF/FTC) Most adults preferred, STR
DTG + TDF/FTC Pregnancy preferred
Dovato (DTG/3TC) 2-drug alternative
Cabenuva (CAB/RPV) LA injectable for virally suppressed

217.2.0.3 必背 — Drug Classes

Class Examples
NRTIs TAF, TDF, FTC, 3TC, ABC
NNRTIs Doravirine, rilpivirine, efavirenz
PIs (boosted) Darunavir, atazanavir
InSTIs Dolutegravir, bictegravir, raltegravir, cabotegravir
Entry inhibitors Maraviroc (CCR5), ibalizumab (CD4), fostemsavir (gp120)
Capsid Lenacapavir

217.2.0.4 必背 — Monitoring

  • HIV RNA + CD4 baseline + 4-8 wk + 24 wk + q3-6 mo
  • Resistance test at diagnosis + virologic failure

217.2.0.5 必背 — Resistance Mutations

  • M184V (3TC/FTC R)
  • K65R (TDF/ABC R)
  • K103N (NNRTI cross-R)

217.2.0.6 必背 — Pregnancy

  • All HIV+ pregnant → ART
  • DTG + TDF/FTC preferred new start
  • Biktarvy alternative
  • Infant prophylaxis 4-6 wk post-delivery
  • Cesarean if VL > 1000 at delivery
  • < 2% vertical with PMTCT

217.2.0.7 必背 — HBV Co-Infection

  • HBV-active ART (TDF/TAF + FTC/3TC)
  • Single regimen treats both

217.2.0.8 必背 — PrEP

  • Truvada / Descovy oral daily
  • Cabotegravir LA (Apretude) IM every 2 months
  • Lenacapavir LA SC every 6 months (2025+ expected)
  • 2-1-1 dosing (event-based) for MSM

217.2.0.9 必背 — PEP

  • Within 72 hr of exposure
  • 3-drug ART × 28 days
  • TDF/FTC + raltegravir or dolutegravir

217.2.0.10 必背 — IRIS

  • 10-30% with low CD4 baseline
  • Paradoxical OI worsening / new presentation
  • TB, cryptococcal, KS, MAC, PML
  • Treatment: continue ART + treat OI + steroid for severe

217.2.0.11 必背 — Drug Interactions

  • InSTIs + polyvalent cations (separate)
  • PIs / cobicistat = CYP3A4 inhibitor (many)
  • Rifampin = inducer (incompatible with PIs; alt rifabutin)
  • Atazanavir + acid reducer (avoid)

217.2.0.12 必背 — Lenacapavir

  • Capsid inhibitor
  • SC every 6 months
  • Salvage + emerging PrEP
  • PURPOSE trials 100% prevention