HIV

Question 1

What is the initial therapy regime for treatment naïve?

Answer 1

2 NRTI + either 1

• NNRTI
• integrase inhibitor
• PI

Question 2

NRTI block RNA dependent DNA synthesis. Examples

Answer 2

Abacavir - screen for HLAB*5701 -> hypersensitivity reaction
Emtricitabine
Lamivudine
Tenofovir
Zidovudine - LIPODYSTROPHY, takes 10 years to recover fat

Question 3

NNRTI
Examples
Class effects

Answer 3

Efavirenz - difficult to use. Replaced.
Nevirapine - lots of patients on this. Older drug, well tolerated, been around since 1996 with undetectable viral load 20 years later.

Class effects: N, rash (SJS and LFTs more frequent with nevirapine)

Question 4

Protease inhibitors - inhibit HIV protease which lyses viral proteins into their active form following translation.
Examples
Class effects

Answer 4

Atazanavir - most common 
Lopinavir
Darunavir - most common 
Fosamprenavir
Indinavir
Saquinavir
Tipranavir

Class effects:
N/D
HYPERLIPIDAEMIA, LIPODYSTROPHY, HYPERGLYCAEMIA
possible risk of bleeding in pts with haemophilia A or B

Question 5

HIV entry inhibitor. MOA, examples. Indications?

Answer 5

CCR5 inhibitors preventing binding of the R5 tropic virus

Examples:
Maraviroc
Enfuvirtide

Indications:
Add to optimised Tx in patient with R5 virus on a BG of sustained HIV levels despite Tx with 3 classes

Question 6

If patients have undetectable viral load and getting side effects from drugs. Next step?

Answer 6

Can do single drug swap to help with side effects.

Can switch therapy if virological failure.

Switching therapy does not work if you have immunological therapy

Question 7

Fixed dose combinations e.g. atripla consist of?

Answer 7

Tenofavir (NRTI) + emtricitabine (NRTI)and efavirenz (NNRTI)

Question 8

Which protease inhibitor is a potent cyp inhibitor?

Answer 8

Ritonavir most potent

All PIs inhibit cyp

Question 9

Which NNRT induces cyp?

Answer 9

Nevirapine

AE: severe hepatotoxicity

Question 10

Which medications are absolute CI in ART therapy?

Answer 10

Cisaparide -> Long QT
Lovastatin -> rhabdomyolysis. Use pravastatin instead.
Midazolam -> prolonged sedation. Use propafol

Question 11

Which NNRTI affects methadone metabolism?

Answer 11

Nevirapine induces cyp -> withdrawal

Stopping results in overdose!

Question 12

What are the specific reactions of PI with

• PPI
• warfarin
• Rivatoxaban
• TCA
• Clarithromycin
• Hormone replacement

Answer 12

• PPI, reduces PI dose
• Warfarin - increases, decreases dose
• Rivaroxiban - PI increases dose
• TCA increases
• Clarithromycin increases
• Rifampin decreases PI concentration

Question 13

Malignancy is increasing in HIV patients. T/F

Answer 13

True