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Multisystem 1st Half > ART therapy for HIV patients (anti-retroviral therapy) > Flashcards

ART therapy for HIV patients (anti-retroviral therapy) Flashcards

1
Q

average number of years to be lived at age 25 after starting ART is about

A

40-50 years

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2
Q

what indicates extent of HIV induced damage already suffered

A

CD4 count

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3
Q

major indicator of immune function and predictor of disease progression is…?

A

CD4 count

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4
Q

adequate response to ART is….

A

CD4 increase 50-150 cells/microliter per year

and

HIV RNA below detection (

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5
Q

CD4 monitoring procedure

A

check baseline twice

then atleast every 3-6 months

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6
Q

ART …usually monotherapy or combo?

A

mono is NOT standard of care

combo is used.

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7
Q

goals of ART

A

maximum suppression of viral replication
preserve or restore effective immune response against HIV
delay progressive immune dysfunction
prevent HIV transmission
improve quality of life and overall survival

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8
Q

regardless of viral load, there is a low risk of progression if CD4 count is …

A

greater or equal to 350

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9
Q

regardless of CD4 count, ART initiation is recommended for 6 conditions:

A 
1 history of AIDs defining illness
2 pregnant women
3 HIV associated nephropathy
4 HepB coinfection, when HBV treatment is indicated
5 acute opportunistic infections
6 age >50 yo
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10
Q

when to start ART based on CD4 count?

A

exact is unknown BUT evidence supports starting ART at higher counts

currently –> ART for all

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11
Q

ART is strongly recommended for all ________ individuals

A

HIV infected

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12
Q

A1 recommendation for ART

A

means strong recommendation with high quality evidence (1+ randomized control trials)

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13
Q

3 reasons for deferral of ART?

A
  • huge barriers to adherence
  • if co-morbidities complicate or prohibit ART
  • elite controllers and long-term non-progressors
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14
Q

early ART may prevent ____

A

HIV related end organ damage

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15
Q

ART in relation to HIV sexual transmission

A

has been shows to prevent transmission to a sexual partner

should be considered in patients who are at risk of transmitting HIV to sexual partner

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16
Q

combo therapy blocks HIV replication ______

A

at multiple different steps

if virus cant replicate, it cant mutate –> less resistance

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17
Q

HIV lifecycle

A

binding and fusion - HIV enters CD4 cells with binding to CD4R and co-receptor (either CCR5 or CXCR4) and releases RNA into cell

reverse transcription - HIV RNA is changed to DNA by HIV RT

integration - new HIV DNA enters CD4 nucleus and HIV integrase combines the HIV DNA and the CD4 DNA

transcription - virus integrated into CD4 cell and commands it to make new HIV proteins

assembly - HIV protease cuts proteins and those piece merge with HIV RNA = new viruses

budding - buds out of CD4 cell to infect other cells

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18
Q

what kind of inhibitor is maraviroc ?

A

entry inhibitor (CCR5 antagonist)

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19
Q

what kind of inhibitor is fuzeon

A

fusion inhibitor

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20
Q

what kind of inhibitor is AZT?

A

RT inhibitor

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21
Q

what kind of inhibitor is raltegravir?

A

integrase inhibitor

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22
Q

what kind of inhibitor is indinavir?

A

protease inhibitor

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23
Q

what does it mean that HIV is a retrovirus?

A

that means that its genetic info is stored on single stranded RNA instead of dsDNA and to replicate HIV uses reverse transcriptase to convert RNA to DNA

24
Q

NRTIs and NNRTIs both exert effect over

A

reverse transcriptase

25
Q

NRTIs and NNRTIs

A 
NRTIs = Z-LASTED
NNRTIs = N-DEER
zidovudine
lamivudine
abacavir
stavudine
tenofovir
emtricitabine
didanosine
nevirapine
delavirdine
efavirenz
etravirine
rilpivirine
26
Q

integrase inhibitors

A

end in -gravir
raltegravir
elvitegravir
dolutegravir

27
Q

what kind of inhibitor is enfuvirtide

A

a fusion inhibitor

28
Q

ART combinations

A

2 NRTIs and 1 PI
2NRTIs and 1 II
1 NNRTI and 2 NRTIs

29
Q

what 3 NRTIs also have activity against hepB

A

lamivudine
emtricitabine
tenofovir

30
Q

what NRTI causes lactic acidosis

A

stavudine

31
Q

which NRTI causes neuropathy and pancreatitis

A

zalcitabine

32
Q

which NRTI is the safest?

A

lamivudine

33
Q

what drug should NOT be used with HLAB5701

A

abacavir

since it causes anaphylaxis hyppersensitivity

34
Q

what drug is the 1 nucleotide RT inhibitior?

A

tenofovir

—the others are nucleoside RT inhibitors

35
Q

which ART drug can cause fanconi’s syndrome?

A

tenofovir

this syndrome is renal tubular dysfunction = phosphaturia and glucosuria

36
Q

what combo is used in PrEP

A

pre exposure prophylaxis is made of emtricitibine + tenofovir

37
Q

k103N mutation

A

confers resistance to efavirez and other NNRTIs

38
Q

efavirenz

A

NNRTI that is backbone to ART (combine with tenofovir and emtricitabine)

crosses BBB - nightmares and teratogen

39
Q

common triple ART combo

A

tenofovir + emtricitibine + efavirenz = ATRIPLA

40
Q

etravirine

A

NNRTI that doesnt have same mutation resistance KN103 as efavirenz
and no vivid dreams
not as potent
cannot be used with 2 NRTIs

41
Q

why are protease inhibitors so toxic?

A

because our cellular proteases are also blocked

and interacts with cytp450

42
Q

all protease inhibitors can cause….

A

insulin resistance, hyperglycemia, and diabetes

dyslipidemia and fat redistribution

increased risk for MI

43
Q

protease inhibitors

A 
ritonavir
indinavir
atazanavir
lopinavir 
darunavir
44
Q

RTV boost

A

ritonavir (protease inhibitor) used at low doses with other protease inhibitors

45
Q

indinavir

A

protease inhibitor that has effects on kidney (nephrolithiasis, sterile pyuria)

so drink lots of water on this drug

46
Q

fusion inhibitors

A

T20 or enfuvirtide

subcutaneous injection
blocks HR1 region of Gp41 so that HIV cannot bind and enter the Cd4 cell

prevents HR1 and HR2 interaction

47
Q

maraviroc

A

ccr5 chemokine receptor antagonist

inhibits HIV binding to ccr5 receptor and inhibits entry

some patients lack ccr5 so not always effective

48
Q

co receptor tropism

A

HIV may use either ccr5 or cxcr4 to enter the host cell

can be dual or mixed
R5 virus
X4 virus
d/M virus

49
Q

raltegravir

A

targets the HIV1 integrase so cannot integrate into host dna

50
Q

WHICH combo is better?

atripla (tenofovir, emtricitabine + efavirenz) or dolutegravir/abacavir/3TC?

A

dolutegravir + 3TC/abacavir

better tolerated and suppresses HIV faster
FIRST LINE recommended as of 2015

51
Q

elvitegravir

A

new HIV integrase stand transfer inhibitor

52
Q

cobicistat

A

no activity against HIV but it does act as a pharmacokinetic enhancer of elvitegravir

53
Q

OI prophylaxis can stop for the following at what CD4 level?

1) MAC
2) CMV
3) PCP

A

1 ) >100

2) >150
3) >200

54
Q

HIV ART therapy is recommended for all ____

A

preganant women regardless of cd4 and viral loads

55
Q

if viral load is >1000 at delivery …

A

do a C section

56
Q

what agent should you NOT use with pregnanct women

A

efavirenz (teratogen)

any “d” drugs = lactic acidosis and hepatosteatosis

Multisystem 1st Half (23 decks)

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