Anti-retroviral Therapy Flashcards
What is the virus that causes HIV infection?
Human immunodeficiency virus (HIV)
HIV causes acquired immunodeficiency syndrome (AIDS), the most advanced stage of HIV infection.
How is HIV spread?
Through blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, or breast milk
HIV is transmitted from a person with HIV.
What cells does HIV attack?
CD4 cells (CD4 T lymphocytes)
These cells play a major role in protecting the body from infection.
What is the HIV life cycle?
The process HIV uses to multiply and spread, consisting of seven stages
HIV medicines protect the immune system by blocking HIV at different stages.
What happens during the primary infection stage of HIV?
CD4+ cell count decreases and HIV RNA rises significantly
30% to 60% of individuals may experience clinical manifestations of acute HIV infection.
How long can asymptomatic clinical latency last in adults after HIV infection?
2 to 10 years
During this period, HIV is produced and removed by the immune system.
What are the three stages of a typical HIV infection?
Primary infection, asymptomatic infection, symptomatic infection including AIDS
Each stage has distinct characteristics and clinical implications.
What is the effect of pregnancy on HIV-infected women?
Increased likelihood of early pregnancy complications
Complications include bacterial pneumonia, urinary tract infections, and higher stillbirth rates.
How does HIV progression differ in children compared to adults?
More rapid disease progression and shorter duration for each stage
This is due to a child’s immature immune system.
What are the categories of HIV progression in children under 5 years?
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.
What is antiretroviral therapy (ART)?
The use of HIV medicines to treat HIV infection
Involves taking a combination of HIV medicines daily.
What is the main goal of HIV treatment?
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.
What are NRTIs and their function?
Nucleoside reverse transcriptase inhibitors, block step 4 of the HIV life cycle
They prevent HIV from replicating.
List some examples of NRTIs.
- Lamivudine (Epivir)
- Abacavir (Ziagen)
- Tenofovir DF (Viread)
- Emtricitabine (Emtriva)
These drugs are used in HIV treatment.
What is the role of protease inhibitors (PIs)?
Block step 10 of the HIV life cycle
They prevent new (immature) HIV from becoming a mature virus.
What is a combination therapy in ART?
Using combinations of 3 or more drugs from more than 1 class
Helps prevent drug resistance.
What is HIV treatment failure?
Sub-optimal treatment outcomes following the initiation of ART
It can be classified as virologic, immunologic, or clinical failure.
What is defined as virologic treatment failure?
A viral load (VL) above 1000 copies/ml based on two consecutive VL measurements
This is after an adherence intervention.
What should be done if a patient has a non-suppressed VL result?
Undergo Enhanced Adherence Counseling (EAC) sessions
A VL test should be repeated in 3 months after EAC.
What is the preferred ARV drug for second-line ART?
Protease inhibitor-based regimen
DTG may be used as an alternative if intolerant to LPV/r.
Fill in the blank: ART should be initiated in all children with HIV, regardless of _______.
[WHO clinical stage]
This includes any CD4+ cell count.
What is treatment failure in the context of ART?
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.
What is switching in ART?
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.
What is the preferred ARV drug for second-line ART among adults, adolescents, and children?
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.
When may DTG be used as an alternative second-line regimen?
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.
What is the recommended second-line ART regimen for neonates weighing less than 3 kg?
AZT + 3TC + DTG or RAL; AZT + 3TC + LPV/r.
This regimen is specifically for neonates under 1 month of age.
What is the preferred second-line regimen for children aged 6-10 years weighing more than 30 kg?
TDF + 3TC (or FTC) + DTG.
TAF is used for children weighing more than 25 kg.
What are the criteria for switching to third-line ART?
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.
What is the definition of third-line therapy in ART?
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.
What are common non-communicable diseases (NCDs) that affect ART outcomes?
Common NCDs include kidney impairment, cardiomyopathy, and osteoporosis.
These conditions may require dose adjustments to limit complications.
What is Highly Active Antiretroviral Therapy (HAART)?
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.
True or False: HAART prolongs patient survival.
True.
HAART has been shown to prolong survival in HIV patients.
What are the potential downsides of HAART?
HAART has many unwanted effects and interactions.
These can complicate treatment and affect patient adherence.
