HIV Drugs Regal

Question 1

What is the general strategy for the treatment of HIV infections in treatment Naive adults?

Answer 1

COMBINATIONS:
-One of these (NNRTI, Protease inhib., Integrase inhib.) + Dual NRTI
NRTI = Nucleoside or Nucleotide reverse transcriptase inhibitor
NNRTI = Non-nucleoside reverse transcriptase inhibitor
PI = Protease inhibitor

Question 2

What are general concepts to remember with HIV treatment?

Answer 2

• Maximally inhibit viral replication
• Goal is fully undetectable level of virus
• The lower the viral RNA can be driven, the lower the rate of accumulation of drug resistant mutants will be, and the longer the therapeutic effect will last
• To achieve maximal and durable suppression of viral RNA, drug combinations and patient compliance are required.
• Resistance testing recommended before starting therapy
• Montior HIV RNA levels (viral load) and CD4 cell count
• -Increased viral load may indicate development of drug resistance
• Used drug combinations
• -But avoid contraindicated drug combinations (lists available)
• Think about drug complications
• Encourage compliance

Question 3

What might increased viral load indicate?

Answer 3

Development of drug resistance!

Question 4

Why are certain NRTI combinations avoided?

Answer 4

Due to either drug-drug interactions (they change drug concentrations if co-administered), similar resistance patterns, or overlapping toxicities.

Question 5

Why is Ritonavir used to “boost” the actions of Protease inhibitors, Atazanavir and Darunavir?

Answer 5

• High doses of Ritonavir (protease inhib.) is poorly tolerated
• It is used at lower doses to inc. serum conc. of other protease inhibitors & dec dosage frequency of other PIs.
• Ritonavir is a potent inhibitor of CYP3A4 which is the cytochroma that metabolizes a number of other PIs and dec. their effectiveness

Question 6

What does HAART stand for?

Answer 6

Highly active antiretroviral therapy

Question 7

What is HAART?

Answer 7

• A term generally used in reference to therapy with RTIs in combination with PI.
• Long term use of combination anti-retroviral therapy is associated with secondary effects, the most prevalent being HAART associated lipodystrophy.

Question 8

What is HAART associated lipodystrophy?

Answer 8

• Estimated to affect 25-50% of patients
• Wasting of subcutaneous fat
• Central adiposity
• Hyperlipidemia, insulin resistance and diabetes mellitus
• Most often seen with use of NRTIs + PI, but also seen with single NRTI treatment

Question 9

Compliance with Therapy: HIV?

Answer 9

• Difficult bc of the number of pills and the side effects of therapy
• Fixed dose combinations are becoming available but are less flexible in terms of dosage adjustment

Question 10

Drug Resistance: HIV?

Answer 10

• The risk of drug resistance is significantly decreased with complete suppression of HIV replication
• Resistance testing of HIV isolates is becoming part of standard HIV care