Antiretrovirals (Only ARVs)

Question 1

When should someone start ARV treatment?

Answer 1

As soon as they are diagnosed, except few cases(ART deferral)

Question 2

Describe ART Deferral

there’s four reasons for ART deferral

Answer 2

1. Drug-sensitive TB
   (CD4<50 cells per muL- initiate ART 2 weeks after TB treatment)
   (CD4>=50 cells- initiate ART 8 weeks after TB treatment)
2. Cryptococcal Meningitis (defer ART until 4-6 weks of antifungal treatment is complete)
3. 4. TB meningitis (Defer ART until 4-8 weeks of TB treatment)
4. Pneumocystis Jirovecci Pneumonia (Defer ART for 1-2 weeks after commencing treatment for the infenction)

Question 3

ARV classes

1.Name all NRTIs
2. Describe MOA and Adverse Effects of NRTIs.

there’s 5 drugs that are NRTIs.

Answer 3

1. (Z-LATE) Zidovudine, Lamivudine, Abacavir, Tenofovir, Emtricitabine.
2. MOA- Competrd with Nucleoside Triphosphate

Adverse Effects- Nucleoside Analogues(Nausea, headach, lactic acidosis…) and Nucleotide Analogues(Nephrotoxicity, Fanconi syndrome and Bone Mineralization disorder)

Question 4

ARV classes

1.List all NNRTIs
2.Describe the MOA and Side Effects of NNRTIs.

Answer 4

1. (RENE)- Rilpvirine, Efavirenz, Nevarapine and Etravirine.
2. MOA- Inhibit the HIV reverse transcriptase
   A/E-
   (EFV)Abnormal dreams, Psychosis(lost contact with reality), Gynaecomastia, Maculopapular rash.
   (NVP)-Rash and Hepatitis
   (FTR)-Rash and Triglyceridaemia (presence of too many glycerides(fats) in bloodstream, Increasing risk of heart disease and atherosclerosis)

Question 5

ARV classes

Describe side effects of each drug under Protein Inhibitors.

There are 4 drugs under PIs.

(LADS) for PIs

Answer 5

1. Lopinavir (Hyperglycemia, Diarrhea, Dyslipidemia, Atherosclerosis)
2. Atazanavir (Used if Lopinavir is not well tolerated, A/E: Jaundice and Abdominal Pain)
3. Darunavir( A/E: Abdominal Pain, Fatigue, Headache)
4. Saquinavir (A/E: Prolonged QT and PR intervals–Alters heart rhythm)

all these drugs are taken with RITONAVIR

[lads] for PIs

Question 6

ARV classes

Name all 3 drugs under Integrase Inhibitors.
[Focus on Dolutegravir and Raltegravir] Describe their DI, A/E

Answer 6

[Carbotegravir, Dolutegravir, Raltegravir]
1.Dolutegravir
DI- Rifampicin
A/E- well tolerated though (Headache, Nausea, Fatigue, Myopathy and Rhabdomyolysis)

rhbdomyolysis occurs when damaged muscle tissue releases its proteins

Question 7

NRTIs Pharmacokinetics

Name CI, DI and AE of Abacavir

Answer 7

CI- hypersensitivity and sever liver impairment
DI- Nothing significant
AE- Fatal Hypersensitivity, Hepatitis

Question 8

NRTIs

Describe CI, DI and AE for Lamivudine

Answer 8

CI- Anemia and Neutropenia(abnormal low count of WBCs)
DI- Nothing significant
AE- Peripheral Neuropathy, Pancreatitis.

Question 9

NRTIs

Describe CI, DI and AE for Emtricitabine

Answer 9

CI- Renal Failure
DI- Nothing significant
AE- Headache, Diarrhoea, Rash

Question 10

NRTIs

Describe CI, DI and AE for Tenofovir

Answer 10

CI- Renal Failure
DI- Increases levels of ddl
AE- Nephrotoxicity

Question 11

NRTIs

Describe CI, AE and DI for Zidovudine

Answer 11

CI- Anaemia and Neutropenia
DI-
AE- Anemia and Myelosuppression

Question 12

NNRIs

Describe CI, DI and AE for Efavirenz

Answer 12

CI- Severe Liver disease
DI-
AE- CNS effects(its a psychoactive drug), Gynecomastia

Question 13

NNRTIs

Describe CI, DI and AE Nevirapine

Answer 13

CI- Caution in liver insufficiency
DI- Oral Contraceptives reducued efficacy and with Rifampicin
AE- Rash and Hepatitis

Question 14

Antiretroviral Regimens

Pre-Exposure Prophylaxis (PrEP)
which drugs(ARVs) does it have?

Answer 14

2 NRTIs
(Tenofovir/Emtricitabine) or (Tenofovir/Emtricitabine)

Question 15

Antiretroviral Regimen

Which ARVs do PEP have and when must they be given?

Answer 15

Must be given to HIV negative patients 72 hours(at latest) after possible exposure to HIV.

3ARV

Question 16

PMTCT

Categorise the infant risk based on mother’s viral load results.

don’t confuse viral load with CD4 count,

Answer 16

VL<1000c/ml=low risk
VL>1000c/ml=high risk
No VL results is interpreted as high risk

Question 17

How is HIV treated?

Describe what drug classes Highly Active Antiretroviral Therapy entails, and describe the drugs in the first and seocnd line regimens.

Answer 17

HAART= 2NRTIs+1NNRTI or 1InSTI

First Line Regimens
Tenofovir(TDF)+ Emtricitabine(FTC)+Lamivudine(3TC)+Efacirenz(EFV)
or replace EFV with DTG
or use ABC+3TC(when there is renal imparement)

Second Line Regimens
(NRTI combinations)
Zidovudine(AZT)+ 3TC OR Tenofovir(TDF)+ Emtricitabine(FTC)

Question 18

PEP Drugs

What drugs does HIV PEP have?

Answer 18

TDF+3TC+DTG

OR

AZT instead of DTG