HIV 2

Question 1

purpose for anti retroviral therapy

Answer 1

reduce viral load to undetectable
restore immunocompetence
reduce morbidity and mortality
minimise toxicity

Question 2

what is the definition of HAART

Answer 2

combination of 3 drugs from at least two drug classes

Question 3

examples of three drugs and their drug classes

how are they given

Answer 3

Tenofovir (NtRTI)
Emtricitabine (NRTI)
Efavirenz (NNTRI)

one tablet taken daily once

Question 4

preventing drug resistance

Answer 4

adherence 
lifestyle 
tolerability 
pharmacokinetics
drug-drug interactions
treatment interruptions

Question 5

HAART side effects

Answer 5

GI - protease inhibitors
Skin - rash, hs, SJS for abacavir, nevi rapine
CNS - mood, psychosis - efacirenz
Renal toxicity - proximal renal tubulopathies - tenofovir, atazanavir
Bone - osteomalacia - tenofovir
CVS - increased MI risk - abacavir, lopinavir, maraviroc
Haem - anaemia - zidovudine
GI - transaminitis, fulminant hep - nevi rapine, and most other

Question 6

Drug classes of HAART

Answer 6

reverse transcripterase
Integrase
Protease
Entry - fusion, CCR5 receptor

Question 7

drug - drug interactions

Answer 7

protease inhibitors generally potent liver enzyme inhibitors
NNRTIs are generally potent liver enzyme inducers

Question 8

Prevention of onward HIV transmission

Answer 8

sexual: condom use, HIV treatment, STI screening and treatment, sero adaptive sexual behaviours, disclosure, post exposure prophylaxis, pre exposure prophylaxis

Question 9

conception options for px with HIV

Answer 9

both have HIV - times unprotected sex with HAART, treatment as prevention

HIV + female and HIV - male - self insemination, timed unprotected sex with HAART, treatment as prevention

Question 10

prevention of MTCT

Answer 10

HAART during preg
vaginal delivery if load undetectable 
C section if detected viral load
4/52 PEP for neonate 
exclusive formula feeding