HIV/AIDS

Question 1

GOALS OF HIV THERAPY

Answer 1

• Viral suppression
• Immune reconstitution
• Reduce Transmission
• Treat and Prevent Opportunistic infections • Improve quality of life

Question 2

Currently Available Drugs

Answer 2

NRTIs
Tenofovir Abacavir Lamivudine Emtricibine Zidovudine

NNRTIs
Etravirine
Nevirapine (for eMTCT)

PIs
Lopinavir-r
Darunavir-r 450mg
Darunavir-r 600mg

INSTIs
Dolutagravir Cabotagravir (Prep)

Question 3

PRINCIPLE OF TREATING HIV

Answer 3

• Combination of a Minimum of 3 drugs
• Atleast from 2 different classes
• NRTI back bone for 1st and 2nd line
• INSTI back bone for 3rd line with Etravirine and DRV 600mg
• i.e 2NRTIs + 1INSTI or 1NNRTI
1 PI

Question 4

PREFERED AND ALTERNATIVE REGIMENS

Answer 4

1st Line Regimens
TDF -300mg + 3TC -300mg + DTG-50mg (TLD)
TAF-25mg +FTC -200mg + DTG-50mg (TafED)
ABC-300mg bd +3TC (renally adjusted) + DTG-50mg
ABC IS NO LONGER AVAILABLE IN OUR CURRENT GUIDELINES. SEEK EXPERT OPINION FOR SUCH CASES

• 2nd Line regimens
AZT/3TC/DRV-r (800mg) (or LPV-r)
Note; The presence of even 1 2nd line drug in the regimen makes the regimen 2nd line.
e.g- TDF/3TC/DRV-r AZT/3TC/DTG

• 3rd Line regimens
DRV-R (600mg bd)
ETV (200mg bd) High genetic barrier to Resistance
DTG
Note; Selection of 3rd Line drugs depends of Genotypic resistance testing;
e.g TDF/3TC/DTG/DRV-R AZT/3TC/DRV-R/ETV TafED/DRV-R/ETV

Question 5

TDF

Answer 5

TDF-300mg od Nephrotoxicity
Bone Demineralization (reduced BMD)

Question 6

TAF

Answer 6

TAF-25mg od
Reduced renal and bone toxicities

Question 7

ABC

Answer 7

ABC-300mg bd
Hypersensitivity (Maculopopular rush) Gene associated (HLA-B*57)
6% Caucasians
2-3% African Americans

Question 8

TAF ELIGIBILITY

Answer 8

TAF ELIGIBILITY
• Renally impaired
Creatinine clearance > 30mls/min Contraindicated if < 30mls/min
• Age (due to reduced levels of Oestrogen and declining renal function) Females above 45years old
Males above 50years old

Question 9

AZT

Answer 9

AZT-300mg bd
Bone marrow suppression
Anemia Neutropenia Thrombocytopenia

Question 10

3TC Dosage adjustments

Answer 10

• Creatinine clearance Concroft-Goult equation
> 50ml/min – 300mg od (150mg od)

30ml/min – 49ml/min – 150mg od

15ml/min – 29ml/min – 75mg od

5ml/min – 14ml/min – 50mg od

< 5ml/min – 25mg od

Question 11

DTG

Answer 11

DTG-50mg od Insomia
Headache

Question 12

PIs

Answer 12

PIs
Hyperglyceamia
Deranged lipid profile
Nausea, Vommitting and Diarrhoea

Question 13

LPV-r

Answer 13

LPV-r
More NVDs
Can be co-administered with Rifampicin
will be needed for Patients on ATT

Question 14

ATV-r

Answer 14

ATV-r
Hyperbilirubinemia
Not active against HIV-2
Cannot be co-administered with Rifampicin Low bsrrier to resistance
High rates of discontinuation

Question 15

DRV-r

Answer 15

DRV-r
Lesser ADRS
High barrier to resistance Effective against both HIV 1 and 2

Question 16

PRE-EXPOSURE PROPHYLAXIS

Answer 16

ORAL PREP
HIV PREVENTION MEASURES
PRE-EXPOSURE PROPHYLAXIS
Must be taken 7 days before exposure in both men and women TDF/3TC or Taf/FTc
Continue for 7 days from last day of exposure before discontinuing

2. CAB-LA
   Long acting cabotagravir (IM)
   600mg- 2nd dose must be 4 weeks from 1st dose
   then 8 weeks (2 monthly) apart there after.
   Oral cabotagravir- if client wont return for CAB-LA injection for more than 7 days- 30mg daily for 2 months to replace 1 missed inj dose. Start Inj on or within 3 days

Question 17

TUBERCULOSIS

Answer 17

TUBERCULOSIS
INH 300mg od for 6 months Pyridoxine 50mg od
INH-900mg + RIFAPENTINE-900mg once weekly for 3 months (3 tablets once a week)
Pyridoxine 50mg for each 300mg of INH or 50mg od for 3 months