HIV - Antiretroviral Treatment Flashcards
Specific drug classes/mechanisms of action and combination therapy
What is the general treatment concept for HIV? (what is the usual combination)
NRTI + NRTI + INSTI/NNRTI/PI
Nuke backbone plus different class
What is WHO preferred first line antiviral therapy for HIV-1?
NRTI +NRTI +Insti
Tenofovir + Lamivudine or Emitriciatibine + Dolutegravir
One pill a day
Name 4 NRTIs?
TENOFOVIR (TDF/TAF)
Lamivudine (3TC)
Emtricitabine (FTC)
Abacavir (ABC)
Ziovudine (AZT) - Dallas buyers club
In addition to HIV, what do Tenofovir, Lamivudine and Emtricitabine also have action against?
Hep B
What are the most important side effects of Tenofovir? (2)
Nephrotoxic - tubular damage
Reduction in bone mineral density
Explain why febrile hypersensitivity reaction in Caucasian person taking Abacavir (ABC)?
HLA b5701
Very rare in Africans
What is the main use of ABC in HIV?
Infants and children (ABC +3TC = backbone)
Adults if other regimens fail/not tolerated
What is the main issue with AZT (ziovudine)?
Macrocytic anaemia particularly in Africa
Also BD dosing
What is the main use of AZT in HIV treatment today?
Infant prophylaxis
Name two intergrase (strand transfer) inhibitors?
DOUTEGRAVIR (DTG)
Raltergravir
List some of the advantages of using Dolutegravir?
RAPID VIRAL SUPRESSION
Low interactions
Low cost
Safe and effective in TB co-infected patients
Safe in kids
Affective against HIV-2
What are the side effects of Dolutegravir (DTG)?
Weight gain
Sleep disturbances
Dizziness
Paraesthesias
Hyperglycaemia
NTD ?? informed decision making
Name 2 NNRTIs?
Nevirapine
Efavirenz
A patient starts on ART and develops gynaecomastia - what drug are they likely on?
Efavirenz
What are the two most important side effects of Nevirapine?
Rash - Stevens Johnsons Syndrome
Hepatotoxicity
Name 3 protease inhibitors?
Darunavir-r
Atazanavir-r
Lopinavir-r
What are the main issues with PI and why they are no longer commonly used as first line?
- High pill burden
- Side effects - including lipodystrophy
- Multiple interactions - CYP450
According to WHO how long after commencement of treatment should someone be undetectable?
6 months
What is the viral copies/ml to be undetectable?
50 copies per ml
What is the reasoning behind cotrimoxazole preventative therapy? (5)
Prophylaxis from
1. PJP
2. Cerebral toxoplasmosis
3. Intestinal Protozoa
4. Gram -ve sepsis (invasive non typhoidal salmonella)
5. Malaria (partial protection)
Define IRS and types
immune reconstitution inflammatory syndrome
Unmasking IRIS - west undetected OI starts manifesting after starting ART
Paradoxical IRIS - known OI (on treatment) deteriorates after ART start
What is PREP?
Pre exposure prophylaxis of HIV (taken by negative patients)
What is oral PrEP composed of?
Usually 2 ARVs usually TDF/FTC - usually Truvada
What is Cabotegravir and its relationship with PREP?
long acting injectable intergrade inhibitor - injection every 8 week
Prevention of mother to child transmission of HIV?
- Mum on ART
- C section*
- Infant prophylaxis
- avoid breastfeeding*
Not used in most African countries - debated elsewhere especially if undetectable
Treatment for high risk infant prophylaxis in HIV
AZT and NVP for 6 weeks, if breastfed for another 6 weeks
Treament for prophylaxis low risk kids (mum on ART)
6 weeks of NVP