HIV AIDS Flashcards
acute HIV infection clinical presentation
flu like illness
swollen lymph nodes
fever malaise rash
2-3 wks
HIV AIDS persistent generalised lympjadenopathy
persistent unexplained lymph node enlargement in neck, underarms, groin for > 3 months
AIDS related conditions
- succumb to infection by unusual organism that uninfected person can resist
- lungs, eyes, GI, nervous system, skin
- fever, unexplained weight loss, diarrhoea
- rare cancer, candidiasis
monitoring parameters for HIV antiviral therapy
1) CD4
- healthy 500-1200 cell/mm^3
- baseline, every 3-6 months, every 12 months after adequate response (increase by 50-100 cells in first year)
2) viral load
- before initiation
- within 2-4 wks after initiation/modification
- 4-8 wks until viral load suppressed
- 3-6 months after viral load suppression
- ideally viral suppression by 8-24 weeks
nucleoside reverse transcriptase inhibitors (NRTI) for HIV
tenofovir, emtricitabine, abacavir, lamivudine, zidovudine
AE for NRTI for HIV
1) Lamivudine
- N/V/D
2) emtricitabine
- hyperpigmentation, N/D
3) tenofovir
- N/V/D
- renal impairment
- decrease bone mineral density
4) abacavir
- N/V/D
- hypersensitivity for pt with HLA-B*5701
- X use if high cardiovascular risk cuz risk of MI
5) zidovudine
- N/V/D
- myopathy
- bone marrow suppression -> anaemia, neutropenia (monitor FBC)
- AE related to mitochondrial toxicity
**lactic acidosis and hepatic steatosis
** lipoatrophy
** zidovudine higher risk - need dose adjust for renal impairment except abacavir
non-nucleoside reverse transcriptase inhibitors (NNRTIS) for HIV
efavirenz, rilpivirine
NNRTIs for HIV AE
- skin rash, SJS
- evfavirenz
** rash, hyperlipidaemia
** neuropsych
** increaes LDL-C and TG
** hepatox - rilpivirine
**depression, headache
NNRTI for HIV caution
- potential for CYP450 DI
- efavirenz: CYP3A4 substrate, CYP3B6 and CYP2C19 inducer
- rilpivirine: CYP34A substrate, oral absorption reduced with increased gastric pH
- QTc prolongation
integrase inhibitor (INSTI) for HIV
bictegravir, dolutegravir, raltegravir, elvitegravir
INSTI for HIV ae
- weight gain, N/D, headache
- bictegravir, dolutegravir: inhibit tubular secretion -> increase serum creatinine
- Raltegravir: pyrexia, creatine kinase elevation (rhabdo)
INSTI FOR HIV DDI
F lowered by concurrent polyvalent cations
B, D, E, CYP3A4 substrates
treatment regimens for HIV
1) 2 NRTI + 1 INSTI
- tenofovir + emtricitabine + bictegravir
- tenofovir + emtricitabine + dolutegravir
- abacvair + lamivudine + dolutegravir
2) 1 NRTI + 1 INSTI
- emtricitabine + dolutegravir
