Anti-Retroviral

Question 1

Who to treat with anti-retroviral

Answer 1

everybody with HIV regardless of CD4 count

Question 2

Standard of care for HIV

Answer 2

3 drugs from 2 different classes

Preferred therapy - 2 NRTI + 1 PI or 1 INSTI

Question 3

AE NRTI

Answer 3

inhibitors affect cellular DNA causing mitochondrial damage

Hepatic stenosis, lactic acidosis, neuropathy, pancreatitis

Question 4

Indications for Lamivudine

Answer 4

preferred treatment for anti-retroviral therapy and HBV

Question 5

Emtricitabine

Answer 5

fluorinated analog of Lamivudine

Question 6

AE Abacavir

Answer 6

Fatal hypersensitivity - associated with HLA B5701 - screen beforehand **

Question 7

AE Tenofovir Disoproxil Fumarate

Answer 7

renal toxicity, Fanconi syndrome, hyperPO4, decreased bone density/fetal growth

Question 8

Indications for Tenofovir DF

Answer 8

HIV, HBV

Contraindicated in renal impairment

Question 9

NRTI Drugs

Answer 9

Lamivudine
Emtricitabine
Abacavir
Tenofovir DF
Tenofovir A

Question 10

MOA of Protease Inhibitors

Answer 10

“NAVIR”

Target HIV protease; block maturation after budding

Question 11

Protease Inhibitor Drugs

Answer 11

RAD - NAVIR
Ritonavir
Darunavir
Atazanavir

Question 12

AE Ritonavir

Answer 12

hepatitis, lipodystrophy

Potent cytochrome inhibitor = large plasma content of drugs *****

Question 13

Alternative PI for HIV treatment

Answer 13

Atazanavir

Question 14

Integrase Strand Transfer Inhibitor (ISTI)

Answer 14

“GRAVIR”

Prevent integration of proviral DNA into host chromosome

Question 15

ISTI drugs

Answer 15

RED - GRAVIR
Raltegravir
Elvitegravir
Dolutegravir

Question 16

Resistant to Raltegravir, Elvitegravir?

Answer 16

Dolutegravir

Question 17

Non-Nucleoside Reverse Transcriptase Inhibitors

Answer 17

Alternative Regimen
Bind different site on reverse transcriptase
No phosphorylation needed
Not active against HIV-2; highly susceptible to resistance

Question 18

NNRTI drugs

Answer 18

Efavirenz

Rilpivirine

Question 19

Maraviroc

Answer 19

Treatment resistant HIV
CCR5 Receptor antagonist - inhibits attachment
AE - postural hypotension, allergic rxn, hepatotoxicity
Screen for CCR5 tropism

Question 20

Enfuvirtide

Answer 20

Treatment resistant HIV
Fusion inhibitor - inhibits fusion protein gp41
Twice daily subcutaneous injection**

Question 21

Pre-exposure Prophylaxis

Answer 21

Tenofovir DF and Emtricitibine - high risk

Question 22

Post-exposure Prophylaxis

Answer 22

within 72h of exposure - 28d treatment
Similar 3 drug treatment as preferred
Do not use Abacavir - delayed treatment required for screening