HIV therapy

Question 1

if CD4 <350 then

Answer 1

MUST treat ART

Question 2

Rationale for earlier initiation of therapy is because it

Answer 2

reduces transmission 96%

reduce HIV-associated inflammation

Question 3

Absolute indications for therapy include

Answer 3

pregnancy, malignancy, co-infected with HBV, HIV-associated infection, nephropathy or thrombocytopenia

Question 4

within 3 months to 6 months after starting therapy what should the viral load be?

Answer 4

<40 copies/ml

Question 5

Rationale for combination therapy for HIV

Answer 5

100 million particles produced each day
Error rate of RT is 1 per 2,000 bp
~ 1 sense mutation per genome!

Question 6

What is the mechanism of action of NRTIs -nucleoside reverse transcriptase inhibitors

Answer 6

inhibit chain prolongation like acyclovir

Question 7

Tenofovir diproxil fumarate is a

Answer 7

nucleotide analogue

Question 8

Tenofovir (TDF)/Emtricitabine (FTC) and

Abacavir (ABC)/Lamivudine (3TC) are all

Answer 8

NRTIs

Question 9

Give examples of NNRT’s

Answer 9

Efavirenz (EFV)

Question 10

side effects of NNRTi efavirenz

Answer 10

• Rash
• low genetic barrier to resistance
• new one is active against resistant HIV
• DRUG INTERACTIONS!

Question 11

MOA of protease inhibitors =

Answer 11

prevent the cleavage of gag/pol/env

Question 12

Ritonavir (RTV), Atazanivir (ATV)

Darunavir (DRV) - are all

Answer 12

Protease inhibitors

Question 13

some side effects of protease inhibitors

Answer 13

-GI intolerance, hyperlipidemia
- drug interactions
“need boosting!”
HIGH genetic barrier to resistance

Question 14

RITONAVIR IS …

Answer 14

NOT a full drug

inhibits P450 enzymes 3A4 - used to boost other drugs

Question 15

Often Ritonavir used as

Answer 15

ATV/r
RTV/r
a half drug

Question 16

Example of a drug that inhibits fusion of the viral particle

Answer 16

Enfuvirtide

Question 17

• gravirs

- Elvitegravir (ELV), Dolutegravir

Answer 17

ARE all integrase inhibitors

require boosting with cobicistat

Question 18

unlike the protease inhibitors the Integrate inhibitors have

Answer 18

low genetic barriers to resistance

Question 19

Recommended drug use is

Answer 19

2 NRTIs - and 3rd drug

Question 20

Which is the only drug that has a class D label for pregnancy

Answer 20

EFV efavirenz NNRTI

Question 21

Special thing about integrase inhbitors

Answer 21

Rapid! reduction in viral load

Question 22

What’s a high viral load

Answer 22

> 100,000