HIV treatment

Question 1

what is the main overall goal of treatment?

Answer 1

drive HIV viral load (HIV RNA) to undetectable levels to maintain lifelong viral suppression

and prevent HIV from developing to AIDS

Question 2

what must occur after the HIV viral load is suppressed?

Answer 2

allow CD4 counts to recover to rebuild the immune system

Question 3

what are treatments of antiretroviral therapy?

Answer 3

1. 2 NRTS + integrase inhibitor
2. 2 NRTS + NNRTI
3. 2 NRTS + boosted protease inhibitor

Question 4

important factors of HIV viral load suppression

Answer 4

maintain drug adherence to prevent resistance

Question 5

how is HIV treatment resistance measured?

Answer 5

IC50 - observe the viral replication per drug conc.

Question 6

what are the pathways that result in resistance?

Answer 6

drug-resistant gene variants in patients
sub-effective drug levels - caused by low dose/poor adherence
host immune failure

Question 7

how many antiretroviral drugs are used?

Answer 7

combo - TWO NRTIS

Question 8

how is HIV treatment maximised?

Answer 8

testing among population to diagnose infection as early as possible

Question 9

when should people start taking HIV treatment?

Answer 9

ASAP to reduce viral load

especially:
- pregnancy - reduce transmission
- early HIV infection
- when certain HIV-related illnesses/co-infections start

Question 10

what happens when CD4 counts are low?

Answer 10

patient is at risk of infection

Question 11

what adherence factors are needed for HIV treatment?

Answer 11

same time every day
do not miss any doses = cause resistance

Question 12

what are the main barriers to HIV treatment adherence?

Answer 12

acceptance
understanding/knowledge of regimen schedule
side effects
drug interactions
language
medication factors
disclosure
stigma

Question 13

name NRTI back bone drugs

Answer 13

abacavir + lamivudine
tenofovir + emtricitabine

Question 14

name NNRTI drugs

Answer 14

efavirenz
rilpivirine
doravirine
nevirapine

Question 15

name integrase inhibitors drugs

Answer 15

raltegravir
dilutegravir
bictegravir

Question 16

name protease inhibitor drugs

Answer 16

darunavir
atazanavir

Question 17

what factors affect ART choice
(Antiretroviral Therapy)

Answer 17

CD4 count
viral load
baseline resistance
cost
pregnancy
pt/clinician preference
lifestyle
age
co-morbidities
drug interactions
HIV co-morbidities
potential for side effects
ability to swallow tablets

Question 18

drug interactions with antiretroviral

Answer 18

CYP450 inducers = decrease pharmacological effects
CYP450 inhibitors = increase pharmacological effects

Question 19

name antiretroviral drugs that are enzyme inducers

Answer 19

efavirenz
ritonavir
nevirapine

Question 20

name antiretroviral drugs that are enzyme inhibitors

Answer 20

ritonavir
cobicstat

Question 21

what are common efavirenz side effects

Answer 21

dizziness
drowsiness
depression
odd dreams

Question 22

what are common rilpivirine side effects

Answer 22

bloating
flatuence - farting

Question 23

what are common darunavir side effects

Answer 23

nausea
diarrhoea

after 7-10days of treatment

Question 24

what are common atazanavir side effects

Answer 24

jaundice due to raised bilirubin

Question 25

what are the long term effects of HIV treatment

Answer 25

renal dysfunction
neurocognitive dysfunction
neurological impairments
CVD
cancer
Osteoporosis /osteopenia
abnormal kidney function
reduced bone mineral density

Question 26

what does it mean if you HIV viral load is undetectable?

Answer 26

undetectable = untransmittable

Question 27

what are the pre-exposure prophylaxis treatment of HIV

Answer 27

Tenofovir DF 245mg/ Emtricitabine 200mg tablets

(1) Daily Regimen –
2 tablets 2-24 hours prior to anticipated sex. Continue OD and stop 48 hours after last condomless sex has occurred.
(2) On-demand Regimen/ Event-based
Regimen
2 tablets 2-24 hours before sex and 1 tablet at 24-48 hours after initial dose. Continue OD and stop 48 hours after last condomless sex has occurred.

Question 28

what are the post-exposure prophylaxis treatment of HIV

Answer 28

Must be started ASAP, within 72 hours.
- 28-day course – given a 30-day pack
- Tenofovir DF 245mg/Emtricitabine 200mg 1 tab OD PO
plus
- Raltegravir 1200mg (2 x 600mg) OD PO

Question 29

what are the post-exposure prophylaxis treatment of HIV in neonates

Answer 29

2-4week duration at first weeks of life