HIV treatment Flashcards

1
Q

what is the main overall goal of treatment?

A

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

and prevent HIV from developing to AIDS

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2
Q

what must occur after the HIV viral load is suppressed?

A

allow CD4 counts to recover to rebuild the immune system

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3
Q

what are treatments of antiretroviral therapy?

A
  1. 2 NRTS + integrase inhibitor
  2. 2 NRTS + NNRTI
  3. 2 NRTS + boosted protease inhibitor
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4
Q

important factors of HIV viral load suppression

A

maintain drug adherence to prevent resistance

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5
Q

how is HIV treatment resistance measured?

A

IC50 - observe the viral replication per drug conc.

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6
Q

what are the pathways that result in resistance?

A

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

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7
Q

how many antiretroviral drugs are used?

A

combo - TWO NRTIS

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8
Q

how is HIV treatment maximised?

A

testing among population to diagnose infection as early as possible

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9
Q

when should people start taking HIV treatment?

A

ASAP to reduce viral load

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

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10
Q

what happens when CD4 counts are low?

A

patient is at risk of infection

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11
Q

what adherence factors are needed for HIV treatment?

A

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

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12
Q

what are the main barriers to HIV treatment adherence?

A

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

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13
Q

name NRTI back bone drugs

A

abacavir + lamivudine
tenofovir + emtricitabine

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14
Q

name NNRTI drugs

A

efavirenz
rilpivirine
doravirine
nevirapine

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15
Q

name integrase inhibitors drugs

A

raltegravir
dilutegravir
bictegravir

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16
Q

name protease inhibitor drugs

A

darunavir
atazanavir

17
Q

what factors affect ART choice
(Antiretroviral Therapy)

A

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

18
Q

drug interactions with antiretroviral

A

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

19
Q

name antiretroviral drugs that are enzyme inducers

A

ritonavir
efavirenz
nevirapine

20
Q

name antiretroviral drugs that are enzyme inhibitors

A

ritonavir
cobicstat

21
Q

what are common efavirenz side effects

A

dizziness
drowsiness
depression
odd dreams

22
Q

what are common rilpivirine side effects

A

bloating
flatuence - farting

23
Q

what are common darunavir side effects

A

nausea
diarrhoea

after 7-10days of treatment

24
Q

what are common atazanavir side effects

A

jaundice due to raised bilirubin

25
Q

what are the long term effects of HIV treatment

A

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

26
Q

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

A

undetectable = untransmittable

27
Q

what are the pre-exposure prophylaxis treatment of HIV

A

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.

28
Q

what are the post-exposure prophylaxis treatment of HIV

A

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

29
Q

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

A

2-4week duration at first weeks of life