Anti-Retrovirals Part II

Question 1

Describe the mechanism of action of NNRTIs?

Answer 1

They are not nucleosides or nucleotides. They bind to the reverse transcriptase enzyme and deactivate it.

Question 2

Name 2 NNRTIs to which HIV rapidly develops resistance.

Answer 2

Nevirapine

Efavirenz

Question 3

Name 3 NNRTIs, known as second generation NNRTIs, to which HIV doesn’t develop resistance as quickly.

Answer 3

Doravirine
Rilpivirine
Etravirine

Question 4

What is the mechanism of action of fusion inhibitors?

Answer 4

Blocks the CD4 receptor

Question 5

Name a fusion inhibitor that is not used often and state how it is administered.

Answer 5

Enfuvirtide - Injected BID. Used as a drug of last resort.

Question 6

What is the mechanism of action of Maraviroc?

Answer 6

R5 receptor blocker - no effects on X4

Question 7

What lab is drawn before administering maraviroc and why?

Answer 7

Trophic Assay that tells you which co-receptor the patient’s HIV primarily uses.

Question 8

What is the mechanism of action of integrase inhibitors?

Answer 8

Block integrase preventing entry of viral DNA into the cell nucleus and thus preventing integration of viral DNA with host cell DNA

Question 9

What is the hottest class of HIV drugs in 2021?

Answer 9

Integrase inhibitors

Question 10

List 3 integrase inhibitors.

Answer 10

Raltegravir
Elvitegravir
Dolutegravir

Question 11

What is unique about the drug Fostemsavir?

Answer 11

• It blocks the CD4 receptor but at a different attachment point than enfuvirtide
• It is administered PO (enfuvitride is injected)

Question 12

Name a pure potent CP450 inhibitor that can be used as a booster and list its advantages.

Answer 12

Cobicistat. No GI side effects. Doesn’t contribute to resistance as you would when using ritonavir

Question 13

What are the three standard recipes used when administering drugs to treat HIV?

Answer 13

2 NRTIs and 1 NNRTI
2 NRTIs and 1 Protease Inhibitor
2 NRTIs and 1 Integrase Inhibitor –> hottest

Question 14

What is a hot method for administration of HIV drug cocktails?

Answer 14

STR –> single tablet regimen, IE, all three drugs in one pill.

Question 15

T/F: There is no way to test a patient’s resistance to HIV medications.

Answer 15

False –> resistance testing exists

Question 16

What percent of new HIV patients are resistant to at least 1 medication at baseline?

Answer 16

15% have resistance at baseline

Question 17

Describe when resistance testing is repeated in HIV patients?

Answer 17

When treatment fails with failure defined as detectable viral load.

Question 18

What are the primary and secondary goals in HIV treatment?

Answer 18

Primary: undetectable viral load
Secondary: CD4 count increase

Question 19

List the 4 anti-retrovirals that also cover Hepatitis B.

Answer 19

Lamivudine, Emtricitabine, Tenofovir (TDF), and Tenofovir Alfenamide (TAF)

Question 20

List the anti-retrovirals that also cover Hepatitis C.

Answer 20

No HIV drugs cover Hep C

Question 21

What other diseases are HIV patients screened for?

Answer 21

Hep A, B, and C, chlamydia, gonorrhea, syphilis

Question 22

Describe and differentiate between PEP, NPEP, PREP, and TasP.

Answer 22

• PEP: post exposure prohylaxis –> 3 drugs x 30 days within 48-72 hours
• NPEP: non-occupational PEP –> same as PEP if high risk exposure
• PREP: Pre-Exposure Prophylaxis –> people at high risk for HIV get 2 drugs QD
• TasP: Treatment as Prevention –> undetectable = untransmittable

Question 23

What are two drug combinations given for PREP?

Answer 23

Truvada: Tenofovir (TDF) and Emtricitabine
Descovy: Tenofovir Alfenamide (TAF) and Emtricitabine

Question 24

T/F: Oral sex is considered high risk exposure for HIV.

Answer 24

F: almost impossible to transmit HIV orally

Question 25

What new HIV drug regimen was just approved by the FDA?

Answer 25

Once a month injectable antiretroviral combination