HIV Management

Question 1

what are the targets for anti-retroviral drugs

Answer 1

Reverse transcriptase 
Integrase 
Protease 
Entry 
-fusion 
-CCR5 receptor

Question 2

what drugs target reverse transcriptase

Answer 2

nucleoside analogues

building blocks for RNA, when virus goes to pick up amino acids to make itself it picks up a ‘dummy’ and cant replicate further

Non-nucleotide reverse transcriptase inhibitors

Question 3

what happens if you block integrase

Answer 3

virus cannot be integrated into the cells own DNA

Question 4

what is HAART

Answer 4

Highly active-antiretroviral therapy

Minimum of 3 drugs from 2 different drug classes to which the virus is susceptible

reduces viral load, keeps it down, allows immune system to recover and reduces morbidity and mortality

Question 5

what are the classes of HIV drugs

Answer 5

NRTI
-nucleoside reverse transcriptase inhibitor
NNTRI
-non nucleoside reverse transcriptase inhibitor 
PI
-protease inhibitor 
INSTI 
-intergrase strand transfer inhibitor

Question 6

how do you prevent drug resistance

Answer 6

Adherence !!

Question 7

common ways to cause resistance

Answer 7

stopping and starting drug therapy

only taking 2/3 of the drugs

Question 8

what is the ideal circumstance for antiretroviral therapy

Answer 8

Tolerability 
Low toxicity 
Low pill burden 
Low dosing frequency 
Minimal drug interactions 
High barrier to resistance

Question 9

what are signs of HAART toxicity

Answer 9

Gi side effects (protease inhibitors)

Skin- rash, hypersensitivity, Stevens-johnsons

CNS side effects- mood, psychosis

Renal toxicity - proximal renal tubulopathies (tenofovir, tazanavir)

Bone - osteomalacia (tenodovir)

CVS- increased MI risk

Haematology - anaemia

GI - transaminitis, fulminant hepatitis

Question 10

in what way to protease inhibitors and NNRTIs interact

Answer 10

protease inhibitors are potent liver enzyme inhibitors

NNRTIs are generally potent liver enzyme inducers

Question 11

what prevention medicine is done for those with HIV

Answer 11

STI screening 
Hep A/B vaccine 
Flu vaccine 
HPV vaccine 
Harm reduction (IVDUs) 
CVS risk 
Smoking cessation

Question 12

what psychological factors of HIV impact patients

Answer 12

Adjustment to diagnosis 
Confusion, guilt, blame 
Impact of HIV on health 
Concerns about future 
Feelings of isolation 
Relationship problems
Spiritual problems

Question 13

true/false - legally you have to disclose your HIV status to previous partners

Answer 13

false

voluntary process

may take weeks, months, years

duty of care to a known third party as the doctor

duty of confidentiality to patient

Question 14

what are some barriers to partner notification

Answer 14

fear
rejection
isolation
stigma

Question 15

what is stigma

Answer 15

shame or disgrace attach to something regarded as socially unacceptable

Question 16

how is onward transmission of HIV prevented

Answer 16

Condom use
HIV treatment
STI screening and treatment
Sero-Adaptive sexual behaviours

Question 17

how is onward transmission of HIV prevented

Answer 17

Condom use 
HIV treatment 
STI screening and treatment 
Sero-Adaptive sexual behaviours eg. HIV +ve not being the insertive partner 
Disclosure 
Post-exposure prophylaxis 
Pre-exposure prophylaxis

Question 18

what are conception options for sero-discordant couples (eg. one +ve and one -ve)

Answer 18

HIV+ male, HIV- female
-HIV PrEP for female partner

HIV+ female, HIV- male
-HIV prRP for male partners

Question 19

how do you prevent mother to child transmission

Answer 19

HAART during pregnancy
Vaginal delivery if undetected viral load
C-section if detected viral load
give anti-retroviral therapy for baby up to 4 weeks
exclusive formula feeding