EXAM 5 HIV THANOS Flashcards
Pathogenesis of HIV infection
Glycoprotein 120 (gp120) binds CD4 receptors on T cells/macrophages/dendritic cells
Primary target of HIV is CD4 T helper/inducer lymphocyte
Infected CD4 cells have impaired function and used in viral replication
Once seeded into the cell, they become latent. That is why HIV is not curable
State the three routes of transmission of HIV
Exposure to mucous membrane or damaged tissue to infected body fluids: blood, semen, pre-seminal fluid, vaginal secretions, breast milk
Blood stream exposure to infected body fluids
Mother-to-child
Describe the methods of HIV diagnosis
Diagnosis requires:
Positive test from a multitest algorithm: initial + supplement test must be different.
Positive virological test: viral load + qualitative HIV NAT
counsel a patient on an at-home HIV test
Reactive results (preliminary results): seek out medical provider for confirmatory testing
Non-reactive results: has a seroconversion window of 3 months
Repeat test if exposure was in the 3 month window
two surrogate markers used in assessing the progression of a patient’s infection
CD4 T lymphocytes cell count: marker for immunocompontence used before therapy initiation.
HIV RNA PCR (viral load): used to assess the effectiveness of therapy and useful after therapy initiation. Higher baseline is predictive of faster disease progression.
Differentiate between HIV infection and AIDS.
Chronic HIV infection: asymptomatic
AIDS: acquired immunodeficiency syndrome, symptomatic
NRTIs (nucleoside reverse transcriptase inhibitor) drugs
Adenosine: tenofovir,
Cytidine: lamivudine, emtricitabine
Thymidine: and zidovudine
Guanosine: abacavir
NRTIs (nucleoside reverse transcriptase inhibitor) MOA + ADE
MOA: synthetic purine and pyrimidine analogs, which result in elongation termination of growing proviral DNA chain
ADE: mitochondrial toxicity and lactic acidosis
NNRTI (non- nucleoside reverse transcriptase inhibitor) agents
-VIR
examples:
Efavirenz
Rilpivirine
NNRTI (non- nucleoside reverse transcriptase inhibitor) MOA + ADE
MOA: bind allosteric site of reverse transcriptase to impair function
ADE: rash
Protease inhibitors agents
-navir
Atazananir
Darunavir
rotinavir
Protease inhibitors MOA + ADE
MOA: inhibit viral protease preventing assembly, maturation, release of new virons
ADE: GI upset, insulin resistance, lipodystrophy
Ritonavir and cobicistat are “boosters” bc of potent CYP3A4 inhibition
Integrase Strand Transfer Inhibitors (INSTIs) agents
-tegravir
Dolutegravir
bictegravir
Integrase Strand Transfer Inhibitors (INSTIs) MOA + ADE
MOA: inhibits HIV integrase, preventing proviral DNA integration into host cell genome
ADE: weight gain
Attachment inhibitor MOA
MOA: fostemsavir is a prodrug of temsavir.
Temsavir binds GP120 on surface of HIV, blocking attachment to CD4 T cell co-receptor
Precautions: CI in with strong CYP3A4 inducers bc it decreases serum concentration
Post-attachment inhibitors MOA + Agent
MOA: binds D2 of CD4 T-cell co-receptor and interrupts post attachment required for entry HIV into host cell
Agent: Ibalizumab
Chemokine Coreceptor 5 antagonist MOA + Agent
MOA: binds CCR5 on CD4 and blocks binding to GP120, which prevents HIV entry into host cell
Agent: Maraviroc
Capsid inhibitor MOA + Agent
MOA: binds to capsid protein (p24) subunits and interferes with steps in viral lifecycle:
Uptake of proviral DNA, virus assembly and release, capsid core formation
Agent: Lenacapavir
State the FDA-approved adult doses of dolutegravir
In naïve patients: 50mg QD
In non-naïve patients: 50mg BID
Efavirenz special administration
take on empty stomach at bedtime
Nevirapine special administration
dose titration over 14 days
Etravirine, Rilpivirine, Atazanavir, Elvitegravir special administration
take with food
Ibalizumab special administration
IV
Lenacapavir special administration
subcutaneous administration
