HIV Antivirals

Question 1

Is HIV an RNA or DNA virus

Answer 1

RNA retrovirus

Question 2

Which cells do HIV infect

Answer 2

CD4

Question 3

Stages of HIV

Answer 3

acute infection – clinical latency – symptomatic – AIDS

Question 4

AIDS criteria

Answer 4

CD4 <200 or AIDS defining illness

Question 5

Normal CD4 levels

Answer 5

800-1200

Question 6

Types of HIV antiviral drugs that block viral entry into cells

Answer 6

CCR5 antagonists
fusion inhibitors
(New: CD4 lymphocyte post-attachment inhibitor, GT120 inhibitor)

Question 7

CCR5 antagonist prototype

Answer 7

Maraviroc (Selzentry)

Question 8

block ability for co-receptor (CCR5) to bind with GP 120 on HIV virion blocking entry of HIV into CD4 cell

Answer 8

CCR5 antagonist

Question 9

Which category of HIV drug would you test to see if patient’s HIV strain is CCR5-tropic

Answer 9

CCR5 antagonist

Question 10

Two coreceptors that HIV drug binds to

Answer 10

CXCR4 and CCR5 coreceptors

Question 11

When is Selzentry used?

Answer 11

Usually for treatment-resistant because it modifies the host cells

Question 12

Maraviroc (Selzentry) toxicity

Answer 12

hepatotoxicity

Question 13

Which drug category blocks entry of HIV into CD4 cells by binding GP41 on the HIV envelope preventing the HIV molecule from binding to the CD4 cell and fusing the two lipid bilayer membranes

Answer 13

Fusion inhibitor

Question 14

AE of Enfuvirtide (Fuzeon, T-20)

Answer 14

Injection site reactions

Question 15

Which drug category inhibits the creation of viral DNA by substituting a useless nucleotide in the strand of base pairs, which prevents further base pairs to be added.

Answer 15

Nucleotide/nucleoside reverse transcriptase inhibitor (NRTI)

Question 16

Zidovudine (AZT) drug class and SE

Answer 16

NRTI

anemia and neutropenia

Question 17

Abacavir (Ziagen, ABC) drug class

Answer 17

NRTI

Test for genetic variant HLA-B*5701. Don’t use if positive

Question 18

When is AZT typically used?

Answer 18

pregnancy and intrapartum

Question 19

When is Abacavir used

Answer 19

early treatment, when negative for genetic variant

Question 20

Which drug class binds to the active center of reverse transcriptase and causes direct inhibition

Answer 20

Non-nukes (NNRTI)

Question 21

AE of non-nukes

Answer 21

rash and hypersensitivity, BBB, teratogenic

Question 22

Prototype of non-nukes

Answer 22

Efavirenz (sustiva) but RARELY used because of neuro-psych effects

Question 23

Which drug category prevents HIV genetic material from being integrated into the DNA of the CD4 cel?

Answer 23

Integrase inhibitors

Question 24

Name formation of integrase inhibitors

Answer 24

*tegravir (Raltegravir, Dolutegravir, Elvitegravir)

Question 25

Prototype of integrase inhibitors

Answer 25

raltegravir

Question 26

AE of Raltegravir

Answer 26

well tolerated, can raise liver enzyme, weight gain, and rarely cause hypersensitivity reactions

Question 27

Current treatment recommendation drug classes

Answer 27

integrase inhibitor and 1-2 nukes

Question 28

Which drug class prevents protease enzyme from cutting HIV polyprotein. This keeps the HIV cell inactive and useless.

Answer 28

Protease inhibitor

Question 29

Which is the most effective class of HIV drug

Answer 29

protease inhibitors

Question 30

Why aren’t protease inhibitors always used as first line?

Answer 30

Lots and lots of drug interactions (manipulates CYP450), resistance to one predicts resistance to others, metabolic syndrome, increase liver enzymes, decreased cardiac conduction

Question 31

Big benefit of protease inhibitors

Answer 31

Can reduce viral load to undetectable levels (important for both transmission and prognosis)

Question 32

HAART

Answer 32

Highly Active Antiretroviral Therapy

Question 33

Ritonavir (Norvir) and Cobicistat (Tybost) category

Answer 33

Pharmacokinetic enhancers: boosters

Question 34

How can ritonavir (Norvir) be given in a protocol?

Answer 34

Low doses to boost effects of other drugs and improve tolerance

Question 35

Which drug blocks CYP450 3A4 enzyme increasing the concentration of certain antiviral drugs

Answer 35

Cobicistat (Tybost)

Question 36

In HIV, we typically use [one/multiple] drug(s) at a time

Answer 36

Multiple, 3-4

Question 37

When resistance occurs, do we change all drugs or just one?

Answer 37

All drugs

Question 38

Do we wait to treat patients until CD4 count gets low?

Answer 38

No, we treat regardless of CD4 count

Question 39

What does drug therapy for HIV include

Answer 39

• drugs to treat HIV
• drugs to treat side effects
• drugs to prevent/treat OIs
• drugs for non-HIV conditions

Question 40

c-section during pregnancy when viral load is greater than…

Answer 40

1000/mL

Question 41

When does antiviral therapy occur in the context of pregnancy?

Answer 41

During pregnancy, during L&D, post-partum (treat baby with PEP)

Question 42

Differentiate PEP and PrEP

Answer 42

Pre-Exposure Prophylaxis (PrEP)

Post-Exposure Prophylaxis (PEP)

Question 43

How soon does PEP need to be administered?

Answer 43

most effective within 1-2 hours, needs to be administered within 72 hours

Question 44

In a patient doing well on their drug therapy, CD4 count should be [low/high] and viral load should be [low/high]

Answer 44

cd4 high, viral load low