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Pharmacology > Anti-retroviral Therapy > Flashcards

Anti-retroviral Therapy Flashcards

1
Q

What is the virus that causes HIV infection?

A

Human immunodeficiency virus (HIV)

HIV causes acquired immunodeficiency syndrome (AIDS), the most advanced stage of HIV infection.

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2
Q

How is HIV spread?

A

Through blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, or breast milk

HIV is transmitted from a person with HIV.

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3
Q

What cells does HIV attack?

A

CD4 cells (CD4 T lymphocytes)

These cells play a major role in protecting the body from infection.

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4
Q

What is the HIV life cycle?

A

The process HIV uses to multiply and spread, consisting of seven stages

HIV medicines protect the immune system by blocking HIV at different stages.

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5
Q

What happens during the primary infection stage of HIV?

A

CD4+ cell count decreases and HIV RNA rises significantly

30% to 60% of individuals may experience clinical manifestations of acute HIV infection.

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6
Q

How long can asymptomatic clinical latency last in adults after HIV infection?

A

2 to 10 years

During this period, HIV is produced and removed by the immune system.

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7
Q

What are the three stages of a typical HIV infection?

A

Primary infection, asymptomatic infection, symptomatic infection including AIDS

Each stage has distinct characteristics and clinical implications.

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8
Q

What is the effect of pregnancy on HIV-infected women?

A

Increased likelihood of early pregnancy complications

Complications include bacterial pneumonia, urinary tract infections, and higher stillbirth rates.

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9
Q

How does HIV progression differ in children compared to adults?

A

More rapid disease progression and shorter duration for each stage

This is due to a child’s immature immune system.

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10
Q

What are the categories of HIV progression in children under 5 years?

A

Category 1: Rapid progressors
* Category 2: Early symptoms with rapid deterioration
* Category 3: Long-term survivors

Categories are based on age of symptom development and survival rates.

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11
Q

What is antiretroviral therapy (ART)?

A

The use of HIV medicines to treat HIV infection

Involves taking a combination of HIV medicines daily.

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12
Q

What is the main goal of HIV treatment?

A

Reduce a person’s viral load to an undetectable level

An undetectable viral load means the level of HIV in the blood is too low to be detected.

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13
Q

What are NRTIs and their function?

A

Nucleoside reverse transcriptase inhibitors, block step 4 of the HIV life cycle

They prevent HIV from replicating.

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14
Q

List some examples of NRTIs.

A
  • Lamivudine (Epivir)
  • Abacavir (Ziagen)
  • Tenofovir DF (Viread)
  • Emtricitabine (Emtriva)

These drugs are used in HIV treatment.

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15
Q

What is the role of protease inhibitors (PIs)?

A

Block step 10 of the HIV life cycle

They prevent new (immature) HIV from becoming a mature virus.

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16
Q

What is a combination therapy in ART?

A

Using combinations of 3 or more drugs from more than 1 class

Helps prevent drug resistance.

17
Q

What is HIV treatment failure?

A

Sub-optimal treatment outcomes following the initiation of ART

It can be classified as virologic, immunologic, or clinical failure.

18
Q

What is defined as virologic treatment failure?

A

A viral load (VL) above 1000 copies/ml based on two consecutive VL measurements

This is after an adherence intervention.

19
Q

What should be done if a patient has a non-suppressed VL result?

A

Undergo Enhanced Adherence Counseling (EAC) sessions

A VL test should be repeated in 3 months after EAC.

20
Q

What is the preferred ARV drug for second-line ART?

A

Protease inhibitor-based regimen

DTG may be used as an alternative if intolerant to LPV/r.

21
Q

Fill in the blank: ART should be initiated in all children with HIV, regardless of _______.

A

[WHO clinical stage]

This includes any CD4+ cell count.

22
Q

What is treatment failure in the context of ART?

A

Treatment failure refers to the inability to achieve viral suppression or clinical improvement despite adherence to the prescribed ART regimen.

This may necessitate switching to a different drug class or regimen.

23
Q

What is switching in ART?

A

Switching refers to changing a patient from a first-line regimen to a second-line regimen or from a second-line regimen to a third-line or salvage regimen.

This is often done due to treatment failure.

24
Q

What is the preferred ARV drug for second-line ART among adults, adolescents, and children?

A

Protease inhibitor-based regimen is recommended as the preferred ARV drug for second-line ART.

DTG may be used as an alternative if certain conditions are met.

25
Q

When may DTG be used as an alternative second-line regimen?

A

DTG may be used if an individual is intolerant of LPV/r, has a contraindication to ATV/r, or if the first-line regimen does not contain DTG.

This provides flexibility in treatment options.

26
Q

What is the recommended second-line ART regimen for neonates weighing less than 3 kg?

A

AZT + 3TC + DTG or RAL; AZT + 3TC + LPV/r.

This regimen is specifically for neonates under 1 month of age.

27
Q

What is the preferred second-line regimen for children aged 6-10 years weighing more than 30 kg?

A

TDF + 3TC (or FTC) + DTG.

TAF is used for children weighing more than 25 kg.

28
Q

What are the criteria for switching to third-line ART?

A

Criteria include confirmation of failure on first-line and second-line ART, a viral load suggestive of treatment failure, adherence assessment, and HIV drug resistance testing.

These criteria ensure appropriate and effective treatment adjustments.

29
Q

What is the definition of third-line therapy in ART?

A

Third-line therapy refers to the ART offered to PLHIV in response to the failure of second-line treatment.

This is a critical step for managing treatment-resistant cases.

30
Q

What are common non-communicable diseases (NCDs) that affect ART outcomes?

A

Common NCDs include kidney impairment, cardiomyopathy, and osteoporosis.

These conditions may require dose adjustments to limit complications.

31
Q

What is Highly Active Antiretroviral Therapy (HAART)?

A

HAART is a combination therapy known for involving 2 Nucleoside reverse transcriptase inhibitors with either a non-nucleoside reverse transcriptase inhibitor or one or two protease inhibitors.

This approach significantly improves patient outcomes.

32
Q

True or False: HAART prolongs patient survival.

A

True.

HAART has been shown to prolong survival in HIV patients.

33
Q

What are the potential downsides of HAART?

A

HAART has many unwanted effects and interactions.

These can complicate treatment and affect patient adherence.

Pharmacology (18 decks)

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