HIV antiretroviral tx

Question 1

ARV
i) how many drugs are used? what viral load is aimed for?
ii) name four drug types
iii) what backbone should be used? what other class of drug can also be added?
iv) which drug class ned to be given with a booster to make them active?

Answer 1

i) usually three drugs from two classes
ai for VL < 40 (undetectable)
ii) reverse transcription inhibtiors (NNRTI/NRTI), entry inhibitiors, proteas inhibitors, integrase inhibitors
iii) 2 NRTI backbone - emtrictitabine/lamivudine witth tenofovir
then add another drug class eg NNRTI, integrase inhibitor, protease inhibitor
iv) all proteaase inhiitor and integrase inhibtior - low dose retonivir

Question 2

ADHERENCE and SIDE EFFECTS
i) how should once daily regimens be taken?
ii) name four barriers to adherence
iii) name four general side effects of ARVs

Answer 2

i) take at the same time every 24 hrs
ii) depression, holidays, side effects, education
iii) GI, rash, headache, CNS disturbance

Question 3

DRUG INTERACTIONS
i) name a drug class that interacts with boosted ARVs eg retonivir? which two drugs in this class can be dose adjusted? which single drug is safe?
ii) which statin cant be prescribed with boosted regimens? which statin can be dose adjusted
iii) which anti coagulant class cant be given with boosted ARVs as effects are increased? name two that should be avoided? name one that can be dose adjusted?
iv) which anti coag will have decreased efficacy with ARVs?
v) how do PPIs affect ARVs?

Answer 3

i) boosted ARVs - avoid steroids (toxicity)
pred/methyl pred dose adjust
beclo is ok
ii) dont prescribe simvastatin
dose adjust atorvastatin
iii) inc levels of bleeding with DOACs - avoud apix and rivaroxabaan
dose djust edoxaban
iv) decreased efficacy of clopidogrel
v) dont prescribe PPIs - decrease ARV levels