HIV Flashcards
HIV 1 / HIV 2
- HIV 1 is the main cause of AIDS
- HIV 2 can cause AIDS but it is less virulent, less transmissible and less prevalent
What are the purposes of ART?
- Suppress HIV replication
- Delay the onset of AIDS
- Reverse HIV associated immunologic deficits
- Prolong survival
How is HIV transmitted
- Infected needle prick
- Used needles
- Receive HIV infected blood products
- HIV infected organ donation
- Perinatal infection
- Sexual intercourse
What two surrogate markers are used to diagnose HIV?
- CD4 cell count
- Viral load
At what CD4 count should you initiate therapy?
<350 cells/mm3
What are the goals of therapy?
- Reduce HIV-associated morbidity and prolong the duration and quality of survival
- Restore and preserve immunologic function,
- Maximally and durably suppress plasma HIV viral load
- Prevent HIV transmission
What are the 4 therapy classes?
- Entry inhibitors
- Reverse transcriptase inhibitors
- Integrase strand transfer inhibitors
- HIV protease inhibitors
What are the two subtypes of Reverse Transcrpitase Inhibitors?
- Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
- Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
What do NRTIs require for activation?
Phosphorylation
NRTI toxicities
- Peripheral neuropathy
- pancreatitis
- lipoatrophy
- myopathy
- anemia
- lactic acidosis w/ fatty liver (rare)
What three NRTIs are preffered over Stavudine and didanosine?
- Emtricitabine
- Lamivudine
- Tenofovir
Do NNRTIs require intracellular activation?
No
Can you effectively use NNRTIs with NRTIs?
Yes
Name the NNRTIs (4)
- Efavirenz (EFV)
- Delavirdine (DLV)
- Nevirapine (NVP)
- Etravirine (ETR)
What are NNRTIs associated with?
Rash and elevated Liver Function tests
What do all Protease Inhibitors end with?
-vir
Name the Protease Inhibitors (PIs) (10)
- amprenavir (APV)
- fosamprenavir (FPV) (prodrug of amprenavir)
- atazanavir (ATV)
- darunavir (DRV)
- indinavir (IDV)
- lopinavir (LPV)
- nelfinavir (NFV)
- ritonavir (RTV)
- saquinavir (SQV)
- tipranavir (TPV)
PIs MOA
competitively inhibit the cleavage of the gag-pol polyprotein (stops viral replication)
What are PIs associated with?
GI distress and metabolic changes
What are PI mostly given with and why?
Ritonavir (CYP3A inhibitor)–> Enhances plasma concentration of the PI
What are the two types of Entry Inhibitors?
- Fusion inhibitors
- CCR5 inhibitors
What is the one fusion inhibitor?
Enfuvirtide
Enfuvirtide MOA
Inhibits fusion of HIV with the target cell
What is the preferred route of administration of enfuvirtide?
SQ
Oral route is impossible to do its peptide nature
Side Effects of enfuvirtide
Injection site reaction
How is enfuvirtide cleared?
- protein catabolism
- amino acid recycling
What is the one CCR5 inhibitor?
Maraviroc
MOA of Maraviroc
Antagonist that blocks human receptors
Potential Side Effects of Maraviroc
Drug to drug interactions because it is a substrate of P-glycoprotien
MOA of Integrase Inhibitors (InSTIs)
Binds to HIV integrase at a certain time which therefore prevents the HIV viral DNA from getting into the human genome. Cellular components then break down the unincorporated viral DNA.
What are the two Integrase Inhibitors (InSTIs)?
- Raltegravir
- Elvitegravir
What is Elvitegravir susceptible to?
Drug interactions with CYP3A drugs. (its metabolized by CYP3A drugs)
What should Elvitegravir be coadministered with?
Ritonavir. It increases plasma concentrations.
What is the drug combination for Atripla?
Efavirenz (EFV) +
Tenofovir (TDF) +
Emtricitabine (FTC)
What is the drug combination for Stribild?
Elvitgravir +
Cobicistat +
Tenofovir +
Emtricitabine
What is the drug combination for Complera?
Rilpivirine +
Tenofovir +
Emtricitabine
What is the drug combination for Truvada?
Tenofovir +
Emtricitabine
What is the drug combination for Combivir?
Lamivudine +
Zidovudine
What is the drug combination for Kaletra?
Lopinavir +
Ritonavir
When should stribild be used?
In patients with pre treatment creatinine clearance of >70ml/min
When should you do HLA-B 5701 screening?
Before starting patients on an abacavir containing regimen to reduce the risk of hypersensitivity reactions
When should you do Coreceptor tropism assays?
- Whenever using a CCR5 inhibitor
- May be considered in patients who exhibit virologic failure on a CCR5 inhibitor
What lab tests can be done for HIV?
- CD 4 T cell count
- Plasma HIV RNA Testing
- Drug resistance testing
- HLA-B 5701 screening
- Coreceptor Tropism Assay
What is the combination for Epzicom?
Abacavir +
Lamivudine
What is the combination for Trizivir?
Abacavir +
Lamivudine +
Zidovudine
