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I & I Part II > HIV Therapy > Flashcards

HIV Therapy Flashcards

1
Q

Currently Available Antirteroviral Classes

A

• Reverse Transcriptase Inhibitors

  • Nucleoside/nucleotide analogues
  • Non-nucleoside analogues
  • Protease Inhibitors
  • Attachment Inhibitors
  • Integrase Strand Transfer Inhibitors
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2
Q

NRTIs

A
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3
Q

NNRTIs

A
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4
Q

Nucleoside Monophosphate - TDF

A
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5
Q

Nucleoside Monophosphate - TAF

A
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6
Q

Protease Inhibitors

A
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7
Q

INSTIs

A
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8
Q

HIV 1 Attachment Inhibitors

A
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9
Q

Fusion Inhibition

A
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10
Q

Ibalizumab

A
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11
Q

Fostemsavir

A
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12
Q

When to Start

A
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13
Q

What to Start

A

•INSTI + 2 nucleotide (nucleoside) analogues

OR

•Protease Inhibitor + 2 nucleotide (nucleoside) analogues

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14
Q

Goals of Antiretroviral Therapy

A
  • Within 6 weeks, plasma HIV RNA should have declined by >1 log
  • By six months, HIV RNA should be undetectable (<50 copies/ml)
  • CD4 cell count will rise with suppression of HIV RNA
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15
Q

The Problem of Viral Latency

A
  • ART suppresses all actively replicating virus BUT
  • There are reservoirs of non-replicating HIV-1 that are not susceptible to ART
  • When ART is stopped, these reservoirs cause new active replication
  • Recent data suggest that this reservoir is 60-fold larger than previously thought
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16
Q

If plasma HIV RNA [] copies/mL, transmission of HIV-1 does not appear to occur.

A

If plasma HIV RNA <20 copies/mL, transmission of HIV-1 does not appear to occur.

17
Q

Preexposure prophylaxis (PrEP)

A

•Providing therapy prior to an event to block the occurrence of that event

  • Malaria prophylaxis
  • Birth control

•Efficacy depends on

  • Risk of that event occurring
  • Effectiveness of the prevention

•In HIV infection, it is providing antiretroviral therapy (ART) to uninfected, at risk individuals

18
Q

What to provide & time to efficacy

A

•Only TDF/FTC once daily

  • TAF/FTC recently was approved
  • Do not use any other antiretroviral
  • Do not use other than daily dosing - iPrEP not currently recommended
  • Maximum concentrations in rectum takes up to 7 days; 20 days for blood and cervical-vaginal tissue
19
Q

Metabolic & skeletal complications of HIV therapy

A

• Body composition

  • Lipoatrophy
  • Visceral fat accumulation

• Dyslipidemia

  • Hypertriglyceridemia
  • Hypercholesterolemia
  • ↓HDL

• Abnormal glucose metabolism

  • Insulin resistance
  • Impaired glucose tolerance
  • Diabetes mellitus

• Cardiovascular disease

-Accelerated atherosclerosis

  • Lactic Acidosis
  • Bone disorders
  • Osteopenia
  • Osteoporosis
  • Osteonecrosis
20
Q

Pneumocystis pneumonia

A
  • Most common opportunistic infection in HIV
  • Risk ↑ when peripheral blood CD4 <200/µl
  • Presents as progressive dyspnea, fever
  • Chest radiograph: diffuse interstitial process
  • Arterial blood gas: ↓pO2, ↓pCO2
  • Bronchoalveolar fluid demonstrates cysts and trophozoites; fluorescent antibody staining useful
21
Q

Oral candidiasis

A
  • Overgrowth of Candida on mucosal surfaces
  • Presents initially in the oral cavity
  • Erythematous candidiasis
  • Pseudomembranous canididiasis

• With marked immunodeficiency, may involve the esophagus

  • Interferes with swallowing and nutrition
22
Q

Immune Response Inflammatory Syndrome

A
  • Over-reaction to smoldering infection when CD4 count rises due to antiretroviral treatment
  • May be particularly severe in CNS infections
  • Mycobacterium tuberculosis, M. avium, CMV, cryptococcosis are most common
  • Approach
  • in some cases, delay initiation of antiretroviral therapy

• cryptococcal and tuberculous meningitis

  • treat specific infection
  • ± corticosteroids
23
Q
A
24
Q

Labs to obtain prior to starting antiretroviral therapy

A
25
Q

HLA-B*5701 screening

A
  • Recommended before starting abacavir, to reduce risk of hypersensitivity reaction (HSR)
  • HLA-B*5701-positive patients should not receive abacavir (ABC)
  • Positive status should be recorded as an ABC allergy
  • If HLA-B*5701 testing is not available, ABC may be initiated after counseling and with appropriate monitoring for HSR
26
Q

Testing for Drug Resistance

A

Before initiation of ART:

  • Transmitted resistance in 6-16% of HIV-infected patients
  • In absence of therapy, resistance mutations may decline over time and become undetectable by current assays, but may persist and cause treatment failure when ART is started
  • Identification of resistance mutations may optimize treatment outcomes
  • Resistance testing (genotype) recommended for all at entry to care
  • Dolutegravir and darunavir may be started without results for resistance
27
Q

Lipoatrophy

A
28
Q

Visceral fat accumulation

A
29
Q

Malignancies

A

I & I Part II (25 decks)

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