Hiv

Question 1

What are the strongest indications for initiating antiretroviral therapy (ART)?

Answer 1

• AIDS-defining illness
• Low CD4+ cell count (< 500 cells/mm3)
• High viral load

Question 2

What is the typical regimen for antiretroviral therapy (ART)?

Answer 2

• 3 drugs to prevent resistance:
  
  • 2 NRTIs (Nucleoside Reverse Transcriptase Inhibitors)
  • Preferably an integrase inhibitor
• Most ARTs active against HIV-1 and HIV-2

Question 3

What drugs are used in pre-exposure prophylaxis (PrEP)?

Answer 3

Tenofovir + Emtricitabine

Question 4

Name some NRTIs used in HIV treatment.

Answer 4

• Abacavir (ABC)
• Emtricitabine (FTC)
• Lamivudine (3TC)
• Tenofovir (TDF)
• Zidovudine (ZDV; formerly AZT)

Question 5

What is the mechanism of action for NRTIs?

Answer 5

• Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain
• Tenofovir is a nucleotide; others are nucleosides requiring phosphorylation to be active

Question 6

What mnemonic can help remember NRTIs?

Answer 6

Have you dined (vudine) with my nuclear (nucleosides) family?

Question 7

What are some adverse effects of NRTIs?

Answer 7

• Myelosuppression
• Nephrotoxicity
• Abacavir: Contraindicated in patients with HLA-B*5701 mutation

Question 8

Name some NNRTIs used in HIV treatment.

Answer 8

• Doravirine
• Efavirenz
• Rilpivirine

Question 9

What is the mechanism of action for NNRTIs?

Answer 9

• Bind to reverse transcriptase at a site different from NRTIs
• Do not require phosphorylation to be active or compete with nucleotides

Question 10

What are common adverse effects of NNRTIs?

Answer 10

• Rash
• Hepatotoxicity
• Efavirenz: Vivid dreams, CNS symptoms

Question 11

Name some drugs classified as Integrase Strand Transfer Inhibitors.

Answer 11

• Bictegravir
• Dolutegravir

Question 12

What is the mechanism of action for Integrase Strand Transfer Inhibitors?

Answer 12

Inhibit HIV genome integration into the host cell chromosome by reversibly inhibiting HIV integrase

Question 13

Name some Protease Inhibitors used in HIV treatment.

Answer 13

• Atazanavir
• Darunavir
• Lopinavir
• Ritonavir

Question 14

What is the mechanism of action for Protease Inhibitors?

Answer 14

• Prevent maturation of new virions by inhibiting HIV-1 protease
• Protease cleaves polypeptide products of HIV mRNA into functional parts

Question 15

What are the boosting agents for Protease Inhibitors?

Answer 15

• Ritonavir
• Cobicistat

Question 16

What are some adverse effects of Protease Inhibitors?

Answer 16

• Hyperglycemia
• GI intolerance (nausea, diarrhea)

Question 17

What drugs are classified as Entry Inhibitors?

Answer 17

• Enfuvirtide
• Maraviroc

Question 18

What is the mechanism of action for Enfuvirtide?

Answer 18

Binds gp41, inhibiting viral entry by blocking fusion

Question 19

What is the mechanism of action for Maraviroc?

Answer 19

Binds CCR-5 on the surface of T cells/monocytes, inhibiting interaction with gp120

Question 20

What are the adverse effects associated with Enfuvirtide?

Answer 20

Skin reaction at injection sites

Question 21

True or False: Maraviroc is generally well tolerated.

Answer 21

True