HIV - Antiretroviral Treatment

Question 1

What is the general treatment concept for HIV? (what is the usual combination)

Answer 1

NRTI + NRTI + INSTI/NNRTI/PI

Nuke backbone plus different class

Question 2

What is WHO preferred first line antiviral therapy for HIV-1?

Answer 2

NRTI +NRTI +Insti
Tenofovir + Lamivudine or Emitriciatibine + Dolutegravir

One pill a day

Question 3

Name 4 NRTIs?

Answer 3

TENOFOVIR (TDF/TAF)
Lamivudine (3TC)
Emtricitabine (FTC)
Abacavir (ABC)

Ziovudine (AZT) - Dallas buyers club

Question 4

In addition to HIV, what do Tenofovir, Lamivudine and Emtricitabine also have action against?

Answer 4

Hep B

Question 5

What are the most important side effects of Tenofovir? (2)

Answer 5

Nephrotoxic - tubular damage

Reduction in bone mineral density

Question 6

Explain why febrile hypersensitivity reaction in Caucasian person taking Abacavir (ABC)?

Answer 6

HLA b5701

Very rare in Africans

Question 7

What is the main use of ABC in HIV?

Answer 7

Infants and children (ABC +3TC = backbone)

Adults if other regimens fail/not tolerated

Question 8

What is the main issue with AZT (ziovudine)?

Answer 8

Macrocytic anaemia particularly in Africa

Also BD dosing

Question 9

What is the main use of AZT in HIV treatment today?

Answer 9

Infant prophylaxis

Question 10

Name two intergrase (strand transfer) inhibitors?

Answer 10

DOUTEGRAVIR (DTG)
Raltergravir

Question 11

List some of the advantages of using Dolutegravir?

Answer 11

RAPID VIRAL SUPRESSION
Low interactions
Low cost
Safe and effective in TB co-infected patients

Safe in kids
Affective against HIV-2

Question 12

What are the side effects of Dolutegravir (DTG)?

Answer 12

Weight gain
Sleep disturbances
Dizziness
Paraesthesias
Hyperglycaemia

NTD ?? informed decision making

Question 13

Name 2 NNRTIs?

Answer 13

Nevirapine
Efavirenz

Question 14

A patient starts on ART and develops gynaecomastia - what drug are they likely on?

Answer 14

Efavirenz

Question 15

What are the two most important side effects of Nevirapine?

Answer 15

Rash - Stevens Johnsons Syndrome
Hepatotoxicity

Question 16

Name 3 protease inhibitors?

Answer 16

Darunavir-r
Atazanavir-r
Lopinavir-r

Question 17

What are the main issues with PI and why they are no longer commonly used as first line?

Answer 17

1. High pill burden
2. Side effects - including lipodystrophy
3. Multiple interactions - CYP450

Question 18

According to WHO how long after commencement of treatment should someone be undetectable?

Answer 18

6 months

Question 19

What is the viral copies/ml to be undetectable?

Answer 19

50 copies per ml

Question 20

What is the reasoning behind cotrimoxazole preventative therapy? (5)

Answer 20

Prophylaxis from
1. PJP
2. Cerebral toxoplasmosis
3. Intestinal Protozoa
4. Gram -ve sepsis (invasive non typhoidal salmonella)
5. Malaria (partial protection)

Question 21

Define IRS and types

Answer 21

immune reconstitution inflammatory syndrome

Unmasking IRIS - west undetected OI starts manifesting after starting ART

Paradoxical IRIS - known OI (on treatment) deteriorates after ART start

Question 22

What is PREP?

Answer 22

Pre exposure prophylaxis of HIV (taken by negative patients)

Question 23

What is oral PrEP composed of?

Answer 23

Usually 2 ARVs usually TDF/FTC - usually Truvada

Question 24

What is Cabotegravir and its relationship with PREP?

Answer 24

long acting injectable intergrade inhibitor - injection every 8 week

Question 25

Prevention of mother to child transmission of HIV?

Answer 25

1. Mum on ART
2. C section*
3. Infant prophylaxis
4. avoid breastfeeding*

Not used in most African countries - debated elsewhere especially if undetectable

Question 26

Treatment for high risk infant prophylaxis in HIV

Answer 26

AZT and NVP for 6 weeks, if breastfed for another 6 weeks

Question 27

Treament for prophylaxis low risk kids (mum on ART)

Answer 27

6 weeks of NVP