Antiretrovirals

Question 1

drugs for viral entry

Answer 1

attachment inhibitors
chemokine receptor antagonists
fusion inhibitors

Question 2

what are attachment inhibitors

Answer 2

• blocks hiv from binding to ccr5 and cxr4 coreceptors

- ibalizumab

Question 3

what are chemokine receptor antagonists

Answer 3

• maraviroc
• binds a hydrophobic transmembrane cavity of ccr5

Mag Antagonize ng Receptors

Question 4

what are fusion inhibitors

Answer 4

• blocks formation of gp41 helix bundle
• efuvirtide

eFUSION-virtide

Question 5

drugs for reverse transcription

Answer 5

nucleoside-analog reverse transcriptase inhibitors (nrti) and non-nucleoside reverse transcriptase inhibitors (nnrtis)

Question 6

what are nrtis

Answer 6

• competitive inhibitors of hiv reverse transcriptase
• lack of 3’-oh group = termination of growing viral dna chain
• abacavir, emtricitabine (ftc), lamivudine (3tc), zidovudine (azt), tdf

Question 7

what are nnrtis

Answer 7

• bind directly to reverse transcriptase

- “vir” = efavirenz (efv), nevirapine (nvp)

Question 8

what are integrase strand transfer inhibitors

Answer 8

• raltegravir (ral)
• dolutegravir (dtg)
• elvitegravir (evg)
• interacts with integrase and viral dna

“tegravir”

Question 9

what are protease inhibitors

Answer 9

• prevent cleavage of gag-pol polyprotein = immature, noninfectious viral particles
• “navir”

Question 10

multidrug combinations:

Answer 10

#1: 2 nrti + 1 nnrti
- efavirenz, emtricitabine, tdf

#2: 2 nrti + 1 nnrti
- emtricitabine, rilpivirine, tdf

#3: pi + pharmacokinetic enhancer
- atazanafir sulfate and cobicistat

Question 11

first line reginment

Answer 11

• for adults and adolescents
• 2 nrtis + 1 insti/nnrti
• azt/tdf + 3tc/ftc
• tdf + 3tc + insti

Question 12

can pregnant women get art

Answer 12

yes they should

Question 13

hiv clinical staging

Answer 13

read

Question 14

hiv staging based on cd4 count

Answer 14

1: > 500-600
2: 350-500
3: 200-350
4: <200

Question 15

new recommended first line regimen

Answer 15

dolutegravir

Question 16

post exposure prophylaxis

Answer 16

• tdf + 3tc/ftc = adults and adolescence
• azt + 3tc = children
• abc + 3tc or tdf + 3tc = children alternative

Question 17

infant prophylaxis

Answer 17

• azt twice daily and nvp once daily for first 6 weeks

Question 18

monitoring

Answer 18

• 6 mos, 12 mos, then every 12 mos
• stable on art: art for 1 yr, no current illness/pregnancy, good understanding of lifelong adherence, evidence of success