ANTIVIRAL AGENTS And Anti-retroviral Agent Flashcards by Iseoluwa Ojo

Viruses are the smallest living microorganism measuring ____-___nm (30 x 10-9M)in size and cannot reproduce outside their host cells which are usually larger including ______ and _____ cells.

20 – 30

bacteria and human

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A _______ is the free-living virus particle outside the host cells.

virion

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A virion is the free-living virus particle (inside or outside?) the host cells.

Outside

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Virion consists of nuclear material (RNA or DNA) enclosed in a _____ coat known as _____ which may also be surrounded by an external ________ envelope.

protein; capsid

lipoprotein

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The capsid together with the RNA/DNA => ___________

nucleocapsid

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The capsid is made up of (symmetrical or asymmetrical?) repeating structural units called ___________ .

symmetrical

capsomeres

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Some viruses also contain enzymes that initiate their replication in the host cell.

T/F

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DNA viruses )-

___________ (warts)

________(Shingles, cold sores, glandular fever)

_________ virus (mononucleosis or kissing disease)

_______ virus (chicken pox)

_________(smallpox)

Hepatitis B virus

_________(sore throat, conjunctivitis)

__________(retinitis).

Papillomavirus

Herpesviruses

Epstein-Barr

Varicella zoster

Poxviruses

Adenovirus

cytomegalovirus

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DNA viruses (PHEVPHAC)-

Papillomavirus (______)

Herpesviruses (_______,_______ , glandular fever)

Epstein-Barr virus (________ or ____ disease)

Varicella zoster virus (_______)

Poxviruses (smallpox)

Hepatitis B virus

Adenovirus (______ ,_______)

cytomegalovirus (_______).

warts

Shingles, cold sores

mononucleosis; kissing

chicken pox

sore throat, conjunctivitis

retinitis

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RNA viruses (RHOEPARPARC)-

_________ (HIV/AIDS, T- cell leukamia)

Hepatitis C virus

_______(influenza A, B and C)

_______(myocarditis)

_________(measles, mumps, respiratory tract infections)

Arboviruses (Yellow fever)

________(rabies)

_________(poliomyelitis)

_______ (meningitis, lassa fever)

_______(German measles) and Coronaviruses (RTI).

Retroviruses; Orthomyxovirus

enterovirus; Paramyxovirus

Rhabdoviruses; Picornaviruses

Arenavirus; Rubella virus

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HPV is a (DNA or RNA?) virus which affects human _____ and the _______ that line the body (throat, mouth, feet, fingers, nails, anus and cervix).

DNA

skin; moist membranes

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HPV

There are over _____ types, of which ____ can affect the genital area.

Transmission: _____________ with infected person.

Symptoms: Asymptomatic or ________

100; 40

skin to skin sexual contact

appearance of warts.

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HPV

Prevention:_______,_______, condoms, reduction of _______

Treatment: _____,________ ,________.

Vaccination, abstinence

sexual partners

cryotherapy, electrodessication, laser surgery

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Mention 2 Effective drugs for papilloma virus infection

No effective drugs.

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Viral REPLICATION

_______->_______->TRANSLATION- >_______ ->__________

ENTRY

TRANSCRIPTION; ASSEMBLY

BUDDING/RELEASE

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Viral Replication : DNA Viruses

Viral DNA enters the host cell ______,
where transcription into ______ occurs catalyzed by the (host or viral?) cell _________.

nucleus; mRNA

host; RNA polymerase

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Viral replication: DNA viruses

Translation of the ____ into _____- specific ______ then takes place.

Some of these proteins are enzymes (DNA polymerase) that _____________, as well as proteins comprising the _____ and ______

mRNA; virus; proteins

synthesize more viral DNA

viral coat and envelope.

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Viral replication: DNA viruses

After assembly of coat proteins around the viral DNA, complete virions are released by ______ or after _________

budding

host cell lysis.

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Viral replication: RNA viruses

Enzymes (____dependent ____ polymerase) within the (virion or host ?) synthesize its _____ from the ____ RNA
template, or sometimes the viral RNA serves as its own mRNA.

RNA; RNA

Virion; mRNA; viral

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Viral replication: RNA viruses

mRNA, is translated by the (host or virion?) cell into various enzymes, including ____ polymerase (which directs the synthesis of more viral RNA), and also into structural proteins of the virion.

Host ; RNA

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Viral replication: RNA viruses

The viral structural proteins are arranged around the newly formed viral RNA to form new virions which escape by ______ or ______ .

budding or cell lysis

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The nucleus is usually not involved in RNA viral replication except for ___________.

orthomyxoviruses

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Viral replication

Retroviruses: contain _____——- enzyme (virus ____-dependent ____ polymerase), which makes a ____ copy of the viral RNA.

This new copy is integrated into the genome of the host cell by ____ enzyme to form a ____virus which is transcribed into both ___________ and ________.

The latter is translated into (active or inactive?) proteins which are broken down by the _______ enzymes into structural proteins followed by assembly.

reverse transcriptase

RNA; DNA; DNA

integrase; provirus

new viral RNA & mRNA; inactive

protease

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The ability of several viruses to remain dormant and be replicated together with, the host genome is responsible for the _________________ , such as those caused by __________ (cold sores) or the _______ (chickenpox) virus, which recur when _________ is reactivated when the immune system is compromised.

periodic nature of some viral diseases

herpes labialis

varicella zoster ; replication

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Some RNA retroviruses can transform normal cells into malignant cells T/F

T Eg T-cell leukamia

herpes labialis Aka ??

Cold sores

Host defenses against viruses 1)______ skin: can not be penetrated by most viruses unlike sites of ______ and _____

Intact wounds and insect bites.

Host defenses against viruses Innate and adaptive immune response: ____-lymphocytes killed viral infected cells which it recognises by the complex (formed from ______ and ______ ) presented on the surface of the infected cells.

T; viral peptide and major histocompatibility complex

Host defenses against viruses Natural killer cells: kill viruses (which escape the initial _______-lymphocytes effect) using _________ strategy

cytotoxic T- mother Turkey

Host defenses against viruses Gene silencing: An attempt by the _____ to use the ______’s translational/transcriptional machinery causes the _______ for the _______ to be ________, probably by ___________, thereby interrupting with viral replication.

virus; host; gene coding viral RNA; switched off DNA phosphorylation

Antiviral drugs are used for treating viral infections. Unlike most antifungals and antibacterial, they ________________ rather than ___________.

inhibit the development or reproduction of viruses destroying them

Antiviral drugs are the same as viricides T/F

F Antiviral drugs are different from viricides

viricides are chemicals that ____________ They are not ___________.

destroy virus particles medication!

viricides Examples: ______, sodium _______, ___________ chloride, essential oils (e.g. ________ oil).

Lysol hypochlorite; benzalkonium eucalyptus

Classification of non-retroviral Antiviral drugs 1)Viral ________ Inhibitors 2) Viral ________ Inhibitors 3) Viral __________ Inhibitors 4) _____________ inhibitors

DNA Polymerase neuraminidase coat disassembly NSE protease

Viral DNA polymerase inhibitors Examples : aci_____, famci______, ganci_____, penci____ valaci_____, valganci_____, ____ ,_______,_______,______

clovir x 6 foscarnet, idoxuridine, ribavirin, and cidofovir

Viral DNA polymerase inhibitors Uses for the treatment of _____ infections. In addition, cidofovir, valaciclovir, ganciclovir and valganciclovir are also used for the treatment of ______ infections Ribavirin is used for the treatment of ______,______, and ______

herpes cytomegalovirus respiratory syncitial infections, lassa fever and hepatitis c

Viral DNA polymerase inhibitors is used for ______ and _______ infections And ribavirin_____,______, and _______

CMV HERPES respiratory syncitial infections, lassa fever and hepatitis c

Ribavarin is used to treat _______,______,______

respiratory syncitial infections, lassa fever and hepatitis c

Viral DNA polymerase inhibitors Mechanism of action- they inhibit the viral DNA polymerase in different ways. Aciclovir, valaciclovir and penciclovir are __________ that are first converted to the ________ by viral ________ more rapidly by the (viral or host?) enzyme but this can also be done by the (viral or host?) enzyme.

guanosine analogue; monophosphate thymidine kinase Viral; host

Viral DNA polymerase inhibitors Mechanism of action- After Aciclovir, valaciclovir and penciclovir are converted to the mono phosphates , They are then converted by the (viral or host?) kinases to their _____ which _____________________ for ________________ by the enzyme viral DNA polymerase. This leads to chain _________ and _________ of viral DNA replication.

Host; triphosphates compete with host natural guanosine triphosphate incorporation into viral DNA chain termination and suppression

Ribavirin is a synthetic (nucleoside or non-nucleoside ?) analogue that is thought to act by altering the ______________ or by interfering with the _________

nucleoside viral nucleotide pool synthesis of viral mRNA.

Foscarnet is a (nucleoside or non nucleoside?) analogue of ______ which inhibit viral DNA polymerase by binding to the _________ binding site.

Non-nucleoside; pyrophosphate pyrophosphate

Inhibitors of viral neuraminidase Examples: oselta ______, zana_______, lanina_____ & pera_____. n protein

mivir x4

Inhibitors of viral neuraminidase Uses: are for treament of _____ and ________ infections and they are only effective in the ______ stage of the infections.

influenza A and influenza B viral early

Inhibitors of viral neuraminidase Mechanism of action: the neuraminidase inhibitors prevent the ____________________________________ by inhibiting the viral neuraminidase which is an protein enzyme on the surface of the virion that is responsible for __________________________

escape of the newly replicated viruses severing the bond between the viral coat and the host sialic acid (neuraminic acid).

Neuraminidase is responsible for ______________ between the _________ and ____________

severing the bond viral coat and the host sialic acid

sialic acid Aka ??

neuraminic acid

Inhibitors of viral neuraminidase Side effects: GIT symptoms such as nausea, vomiting, _______ and diarrhoea.

dyspepsia

Inhibitors of viral coat disassembly Examples: Amantadine & rimantadine Uses: only for the treatment of influenza A • viral infection. No action on influenza B virus. • Mechanism of action: (i) Amantadine acts by blocking the M2 ion channel which is another protein through which an influx of H+ occurs

Inhibitors of viral coat disassembly Examples: Aman______ & riman______

tadine tadine

Inhibitors of viral coat disassembly Uses: only for the treatment of __________ infection. No action on _________

influenza A viral influenza B virus.

Inhibitors of viral coat disassembly Mechanism of action: (i) Amantadine acts by blocking the ___________ which is another protein through which an influx of _____ occurs to _____ the viral particle in the host cell cytoplasm thereby —————— so that the viral RNA genome can be released into __________ for ________

M2 ion channel H+; acidify enhancing its dissassembly the host cell for replication.

Inhibitors of viral coat disassembly Side effects: most common:> dizziness, _________ and _______

slurred speech and insomnia.

NS3 protease inhibitors Examples: Asuna______, boce________, grazo_____, parita______, sime_____ and tela_______

previr previr previr previr previr previr PaST BaGrA

NS3 protease inhibitors Uses:to treat _______

Hepatitis C

NS3 protease inhibitors Mechanism of action: Inhibits viral NSE protease enzyme which converts _____________ to ________________

large inactive protein/polypetide (formed after translation from mRNA) smaller active functional and structural protein.

________ and _______ can be used to treat hepatitis C

Viral DNA polymerase inhibitors (ribavirin) NS3 protease inhibitor(asunaprevir)

Antiretroviral agents: drugs for the treatment of infection caused by ________.

retroviruses

A retrovirus is an RNA virus which possesses _________ enzyme with which it produces _____ copy of its _____ genome.

reverse transcriptase DNA RNA

A retrovirus Examples:______________ (HIV),___________ and _____________ (HTLV-1

Human immune deficiency virus Simian immunodeficiency virus (SIV) Human T-cell lymphotropic virus type 1

Structure of HIV-1 HIV-1: (Small or large?) in size (~___ nm). Consists of 2 single stranded RNA (___ genes) tightly bound to the viral enzymes (______,_____,_______, and ________) and surrounded by a protein coat (capsid).

Small 120; 9 Reverse transcriptase , integrase, protease, & ribonuclease

Structure of HIV-1 HIV-1: Capsid made of repeated units (______) and surrounded by _____ of viral proteins which in turn is surrounded by a ________ envelope

capsomere; matrix lipoproprotein

Structure of HIV-1 HIV-1: a lipoproprotein envelope made of mainly _____ & protein from _______ and also few copies of viral protein [gp _____ (___) + gp ____ (___)].

lipid bilayer; human host 120; cap 41; stem

Structure of HIV-1 HIV-1: The stem are of ____ molecules

In HIV gp 120 is the ________ gp 41 is the ______

cap Stem

Life cycle of HIV Step 1: Binding- the virus binds to molecules on the surface of the _____ cell: first a ____ receptor and then either a ______ or ______ coreceptor.

CD4 CD4 CCR5 or CXCR4

Life cycle of HIV Step 1: Binding- the virus binds to molecules on the surface of the ______ cell: first a ____ receptor and then either a ______ or _____ coreceptor.

CD4 CD4 CCR5 or CXCR4

Life cycle of HIV Step 2: Fusion- HIV _________ fuses with the CD4 ___________ which allows HIV to enter the CD4 cell and releases HIV RNA & HIV enzymes into the cell.

Viral envelope cell membrane

Life cycle of HIV Step 3: Reverse transcription- HIV releases and uses __________ to convert its genetic material—HIV _____—into HIV _____ which allows HIV to enter the CD4 ___________

reverse transcriptase RNA; DNA cell nucleus

Life cycle of HIV Step 4: Integration- Once inside the host CD4 cell nucleus, HIV releases ______ enzyme. HIV uses HIV this enzyme to _____________________________________ to form a ______

integrase insert its viral DNA into the DNA of the host cell Provirus

Life cycle of HIV Step 5: Replication- After integration. The _______ DNA is transcribed into _____________________. The latter is translated into ———

provirus both new viral genome RNA as well as mRNA inactive proteins.

Life cycle of HIV Step 7: Assembly- new HIV RNA and HIV proteins made by the host CD4 cell move to the _____ of the cell and assemble into (mature or immature?) (infectious or noninfectious?) new virions.

surface Immature noninfectious

Life cycle of HIV Step 8: Budding- immature virions ((can or can't?) infect another CD4 cell) pushes themselves out of the host CD4 cell. Once outside the CD4 cell, the new HIV releases HIV ______ enzyme which break up the (short or long?) (active or inactive?) protein chains to form (smaller or larger?) HIV active proteins that combine to form (mature or immature?) , (non-infectious or infectious ?) HIV.

Can’t ; protease Long; inactive Smaller Mature ; infectious

Classification of Antiretroviral agents 1.___________ inhibitors (NRTIs) 2. ___________ inhibitors 3. ___________ inhibitors 4. _________ inhibitors 5. ________/______ inhibitors 6. ________ inhibitors 7. ________ inhibitors

Nucleoside/nucleotide reverse transcriptase Non-nucleoside reverse transcriptase Protease Fusion; Entry/CCR5 Integrase; Maturation

(1)Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Examples: ______ (ABC), _______ (TDF) [nucleotide], ______ (DDC), _________ (FTC), _________, ________ (3TC), ______ (D4T) & ___________ (AZT).

abacavir; tenofovir; didanosine emtricitabine; zalcitabine lamivudine; stavudine zidovudine

(1)Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Mechanism of action: initial _________ of the NRTI’S by the ____ cell enzymes (kinase) to their ___________ derivatives. These then compete with their corresponding _________ and act as __________ to the viral reverse transcriptase enzyme in the synthesis of the proviral DNA. The incorporation of the ________ into the growing viral DNA chain eventually results in chain _________.

phosphorylation; host 5’ triphosphate; host cellular triphosphates false substrate ; 5’-triphospate termination

(1)Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Mechanism of action: The mammalian ________ –DNA polymerase is (susceptible or resistant?) to the effect of the NRTI’s. However the ______-DNA polymerase in their host cell _______ is fairly (sensitive or resistant ?) and this may account for the ____________

alpha relatively resistant gamma; mitochondria; sensitive unwanted effects of the NRTI’s.

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Uses: mainly for _____ with other ARVs. But Lamivudine, adefovir and tenofovir are also used for ___________

HIV hepatitis B.

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Uses: ________,________, and _______ are also used for hepatitis B.

Lamivudine ,adefovir and tenofovir

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Adverse effects: Class adverse effects: ______ which involves the building up of _____ in the blood due to _________ which results in production of ______ as a bye product of energy formation.

Lactic acidosis ; lactic acid mitochondria toxicity; lactic acid

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Adverse effects: ______ adverse effects _______ adverse effects

Class Specific

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Adverse effects: Specific adverse effects: Zidovudine ( ________ ) Stavudine (_________ and ________ ) Abacavir (———- reaction) tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF).

anaemia peripheral neuropathy & lipodystrophy allergic

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Adverse effects: Specific adverse effects: ________ (anaemia) _________ (peripheral neuropathy & lipodystrophy) ________ (allergic reaction) tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF).

Zidovudine Stavudine Abacavir

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) Specific adverse effects: (TAF or TDF?) has better effects on bones and kidney and is preferable in patients with underlying bone or kidney disease than (TAF or TDF?) . However the latter also have better _________ effects .

TAF; TDF lipid lowering

Why is TDF better than TAF in lowering lipids levels

This is because TDF produce higher level of tenofovir which lowers lipid.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Examples 1st generation: _______,________,_______ 2nd generation: ———,——-,———-

efavirenz (EFV), nevirapine (NVP) & delavirdine daravirine, etravirine and rilpivirine

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Uses: for _____ in combination with other ARVs. ________ (resistant case in tmt exp pt only), ______ (tmt naïve pt)

HIV Etravirine Rilpivirine

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Mechanism of action: NNRTIs bind to the ————— near its ______ site and _____ it.

reverse transcriptase enzyme catalytic; denature

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Class adverse effects: ______ Specific adverse effects: Efavirenz: _____ toxicity Nevirapine: ______toxicity Etravirine: _____ reaction Delavirdine: ______ reaction, fever, _____ vision,stuffy nose.

rash CNS hepa allergic ; allergic; blurred

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Class adverse effects: rash Specific adverse effects: __________: CNS toxicity ___________: hepatoxicity __________: allergic reaction __________: allergic reaction, fever, blurred vision, stuffy nose.

Efavirenz Nevirapine Etravirine Delavirdine

HIV PROTEASE INHIBITORS Ends with??

Navir

HIV PROTEASE INHIBITORS Mechanism of action:- protease inhibitors bind to the site where _____ normally occur. This prevent the viral specific protease from ____________________________ into various viral structural and functional proteins

cleavage breaking down the inert polyproteins at the appropriate cleavage positions

HIV PROTEASE INHIBITORS Uses: for ______ infection in combination with other antiretroviral drugs of different classes

HIV

HIV PROTEASE INHIBITORS Class adverse effects: __________, ____________ , myalgia, lipodystrophy, hyperglycemia.

paraesthesia rhabdomyolysis

HIV PROTEASE INHIBITORS Specificic adverse effects: Atazanavir causes ___________________ but has less effects on _________ and __________

raised bilirubin levels lipodystrophy and hyperglycemia.

Inhibitors of HIV fusion Example: __________,_________

enfuvirtide, ibalizumab

Inhibitors of HIV fusion Mechanism of action: Enfuvirtide: binds to ______ to inhibit fusion of HIV with host cells CD4 molecules. It is usually given by ________ injection. Ibalizumab: binds to _________ and prevent fusion with HIV

GP41 ; subcutaneous CD4 molecules

Inhibitors of HIV fusion Uses: used in treatment of HIV in combination with other ARV drugs when ———————————- or ___________________________

resistance becomes a problem or when there is intolerance to other antiretroviral drugs.

Inhibitors of HIV fusion Side effects: Enfuvirtide:______ symptoms and __________ reactions.

flu-like hypersensitivity

HIV Integrase Strand Transfer inhibitors (ISTIs) Examples: • – 1st generation: ralte________ and elvite_____. • – 2nd generation: dolute_______ and bicte______

gravir; gravir gravir; gravir we aRE BaD

HIV Integrase Strand Transfer inhibitors (ISTIs) cont’d Side effects of raltegravir: – Common: headache, nausea, diarrhoea, weakness,insomnia. – Rare: _______ ,________,_______ , pyrexia, diaphoresis, rashes, _____ failure, nephrolithiasis, depression, _____ behaviours, anxiety and paranoia.

hepatitis, thrombocytopenia, rhabdomyolysis renal; suicidal

HIV Integrase Strand Transfer inhibitors (ISTIs) Mechanism of action:- they inhibit the __________ enzyme which is responsible for integration of the viral DNA with the infected cell DNA. Uses: HIV/AIDS infection (with other ARVs)

viral integrase

Entry Inhibitors or CCR5 antagonists Examples: mara____, apla______ and vicri______.

viroc viroc viroc

Entry Inhibitors or CCR5 antagonists Mechanism of action- maraviroc binds to ______ and blocks its association with the HIV gp _____ thereby preventing _____________ However some HIV can also enter the host cell through _________. Therefore hiv ___________ is essential for efficacy.

CCR5 ; 120; entry into the host cell. CXCR4 tropism test

Maturation Inhibitors Examples: __________ and __________

vivecon and bevirimat

Maturation Inhibitors Mechanism of action- they inhibit the conversion of ________ to _________ leading to formation of (infective or non infective ?) virions with ________

viral polyprotein mature capsid non infective defective core.

Maturation Inhibitors Examples: vivecon and bevirimat Uses: HIV/AIDS in combination with other ARV drugs T/F

Pharmacotherapy of antiretroviral Principles involved: – start treatment as soon as __________ – use combination of at least _________ different antiretroviral drugs (______) – monitoring of _________ and _________ – change treatment regimen if viral plasma concentration persists or increases.

HIV is diagnosed three; HAART plasma viral load and cd4+ cells count

At present, HIV infection has no cure. T/F

However, the virus can be reduced to an ___________ level in the blood with ___________.

undetectable HAART

ART FOR TREATMENT NAÏVE PATIENTS (2014 GUIDELINES) 1. Tenofovir/emtricitabine + _______/______ 2. Tenofovir + emtricitabine + _______ 3. Tenofovir/emtricitabine + ______/______ 4. Tenofovir/emtricitabine + ________ 5. Tenofovir/emtricitabine +________/cobicistat 6. Tenofovir/emtricitabine + _______ 7. Abacavir/lamivudine + dolutegravir in (HLA*B-5701 negative) _____________ could be used to replace emtricitabine in all the regimen.

darunavir; ritonavir efavirenz atazanavir; ritonavir raltegravir Elvitegravir dolutegravir Lamivudine

Prevention of mother to child transmission of HIV (PMTCT) Mother to child transmission happens when HIV, the virus that causes AIDS, is passed from a mother to her unborn baby during ________,_______, or ________.

pregnancy, labour, childbirth or during breastfeeding

Prevention of mother to child transmission of HIV (PMTCT) The main aim in treating pregnant women with antiretroviral drugs is to ____________ and to ________________.

avoid damage to the fetus prevent mother to child transmission of HIV

Scheduled caesarean delivery can not prevent MTCT of HIV. T/F

F Scheduled caesarean delivery could also prevent MTCT of HIV.

PMTCT Breastfeeding mother Mother: continue _____ being used from ________________________________ and thereafter. Infant: ______ started within _____ of birth till ______ after ___________

HAART ; before conception throughout pregnancy, breastfeeding nevirapine; 6-72hrs one week; stoppage of breastfeeding.

PMTCT Non-breastfeeding mother: mother: same as above Infant: ______ started within ______ after birth for _________

nevirapine 6-72hrs 6 weeks.

HIV post exposure prophylaxis WHO recommendations are administration of a)_______/_________+ _______/______for ____ days OR (b) ________ /________ + ______/ ————-for _____ days _________ could replace emtricitabine in either case. And patient should avoid unprotected sex during this period.

TENOVOFIR; EMTRICITABINE LOPINAVIR; RITONAVIR ; 28 TENOFOVIR ; EMTRICITABINE ATAZANAVIR; RITONAVIR; 28 Lamivudine TELl R or TEAm R

________ ARV has been controversially said to be teratogenic

efavirenz

No ARV has been clearly stated to be teratogenic T/F

No ARV has been clearly stated to be teratogenic except efavirenz controversially.

efavirenz should be avoided in pregnant and child-bearing age women T/F