HIV treatment Flashcards
what is the main overall goal of treatment?
drive HIV viral load (HIV RNA) to undetectable levels to maintain lifelong viral suppression
and prevent HIV from developing to AIDS
what must occur after the HIV viral load is suppressed?
allow CD4 counts to recover to rebuild the immune system
what are treatments of antiretroviral therapy?
- 2 NRTS + integrase inhibitor
- 2 NRTS + NNRTI
- 2 NRTS + boosted protease inhibitor
important factors of HIV viral load suppression
maintain drug adherence to prevent resistance
how is HIV treatment resistance measured?
IC50 - observe the viral replication per drug conc.
what are the pathways that result in resistance?
drug-resistant gene variants in patients
sub-effective drug levels - caused by low dose/poor adherence
host immune failure
how many antiretroviral drugs are used?
combo - TWO NRTIS
how is HIV treatment maximised?
testing among population to diagnose infection as early as possible
when should people start taking HIV treatment?
ASAP to reduce viral load
especially:
- pregnancy - reduce transmission
- early HIV infection
- when certain HIV-related illnesses/co-infections start
what happens when CD4 counts are low?
patient is at risk of infection
what adherence factors are needed for HIV treatment?
same time every day
do not miss any doses = cause resistance
what are the main barriers to HIV treatment adherence?
acceptance
understanding/knowledge of regimen schedule
side effects
drug interactions
language
medication factors
disclosure
stigma
name NRTI back bone drugs
abacavir + lamivudine
tenofovir + emtricitabine
name NNRTI drugs
efavirenz
rilpivirine
doravirine
nevirapine
name integrase inhibitors drugs
raltegravir
dilutegravir
bictegravir
name protease inhibitor drugs
darunavir
atazanavir
what factors affect ART choice
(Antiretroviral Therapy)
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
drug interactions with antiretroviral
CYP450 inducers = decrease pharmacological effects
CYP450 inhibitors = increase pharmacological effects
name antiretroviral drugs that are enzyme inducers
ritonavir
efavirenz
nevirapine
name antiretroviral drugs that are enzyme inhibitors
ritonavir
cobicstat
what are common efavirenz side effects
dizziness
drowsiness
depression
odd dreams
what are common rilpivirine side effects
bloating
flatuence - farting
what are common darunavir side effects
nausea
diarrhoea
after 7-10days of treatment
what are common atazanavir side effects
jaundice due to raised bilirubin
what are the long term effects of HIV treatment
renal dysfunction
neurocognitive dysfunction
neurological impairments
CVD
cancer
Osteoporosis /osteopenia
abnormal kidney function
reduced bone mineral density
what does it mean if you HIV viral load is undetectable?
undetectable = untransmittable
what are the pre-exposure prophylaxis treatment of HIV
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.
what are the post-exposure prophylaxis treatment of HIV
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
what are the post-exposure prophylaxis treatment of HIV in neonates
2-4week duration at first weeks of life
