HIV Treatment Flashcards
As a general rule, HIV regimens consist of [+]
What is the BHIVA recommendation drug regimens to start for HIV tx? [4]
As a general rule, regimens consist of:
Two nucleoside reverse transcriptase inhibitors (NRTIs)
A third agent, typically one of:
- Ritonavir-boosted protease inhibitor (PI/r)
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Integrase inhibitor (INI) - RECOMENDED
OR
- Dolutegravir + Lamivudine
This is the list of BHIVA preffered drug regimens to start
In theory; any of above can be used; but BHIVA slide is the.
Why would you not use abacavir/lamivudine/dolutegravir for first line treatment of HIV? [1]
If 10 year risk of CVD more than 10%
Which
Entry inhibitors aim to prevent HIV from entering host cells.
Name two classes and drug examples of entry inhibitors used for HIV Tx
CCR5 inhibitors (CCR5 is a co-receptor for CD4 allowing the entry of HIV into target cells)
- E.g. Maraviroc
Fusion inhibitors:
- block glycoprotein-41
- Enfuvirtide
NB: not really used
Describe the MoA of NRTIs and NNRTIs [2]
NRTIs:
- inhibiting the action of reverse transcriptase
NNRTIs
- preventing the action of reverse transcriptase.
Name examples for NRTIs [4] and NNRTIs [2]
NRTIs:
* Tenofovir disoproxil fumarate
* Abacavir
* Emtricitabine
* Lamivudine
NNRTIs:
- Efavirenz
- Nevirapine
As NRTIs are the backbone - don’t want to be LATE with starting treatment Lamivudine, Abacavir TDF Emtricitabine
Describe the MoA of PIs [1]
Protease inhibitors (PIs) inhibit the action of protease preventing the cleavage of Gag-Pol polyproteins.
PIs are given alongside which drug [1] as they boost the action of the drug
Name two examples of PIs
They are given alongside ritonavir - referred to as a boosted PI - which increase the action of the drug.
PIs:
* Atazanavir
* Darunavir
* Lopinavir
Post-attachment inhibitors prevent envelope protein [] engaging with co-receptors.
Name an example [1]
Post-attachment inhibitors prevent envelope protein glycoprotein-120 engaging with co-receptors.
There is currently one medication in this class, the monoclonal antibody Ibalizumab. It is given as an IV infusion once every two weeks.
Tenofovir disoproxil fumarate is associated with renal failure and osteoporosis. Lamivudine has been shown to cause pancreatitis, whilst abacavir is avoided in patients with cardiovascular disease. Emtricitabine may cause hyperpigmentation of the palms of hands and soles of feet.
[] tend to have a high barrier to resistance and therefore may be preferred in patients where there are concerns regarding adherence
NRTIs
NNRTIS
PIs
II
EI
[] tend to have a high barrier to resistance and therefore may be preferred in patients where there are concerns regarding adherence
NRTIs
NNRTIS
PIs
II
EI
Which drugs are contained in PEP? [2]
For how long is the course? [1]
Once a day of:
* Tenofovir disoproxil fumerate
* Two Raltegravir
for 28 days
State 3 side effects of protease inhibitors [3]
There are many adverse effects including lipodystrophy, hyperlipidaemia, insulin resistance and hepatotoxicity.
Which drugs are used in PrEP? [1]
Tenofovir-df/emtricitabine
How do you measure safety and toxicity of ARTs? [3]
- Renal and liver test
- Lipids and metabolic tests
- FBCs
What is the most common cause of HIV VL rebounding? [1]
Intermittent adherence (but alsocould be low drug levels / bad luck)
Which ART causes a risk of hypersensitivty? [1]
Which drug class does it belong to? [1]
Abacavir: hypersensitivity
- NRTI
Which ART causes a risk of hepatotoxicity? [1]
Which drug class does it belong to? [1]
Nevirapine NNRTI
Which ART can cause this reaction? [1]
Which drug class? [1]
Darunavir
- PI
NB: Reaction = SJS
Which ART might cause this reaction
Abacavir
Efavirenz
Tenofovir
Darunavir
Nevirapine
Which ART might cause this reaction
Abacavir - get HLAB5701 screen
Efavirenz
Tenofovir
Darunavir
Nevirapine
Which two drugs make up long-acting drugs for HIV treatment? [2]
II and NNRTI
Name two side effects of Tenofovir DF long term use [2]
Tenofovir DF:
- Tubular toxicity (prevents re-ab of certain solutes at PCT - risk of kidney failure
- Reduction in bone mineral density
Which drug is most likely to cause a severe reaction at the injection site
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
Nevirapine
Which drug is most likely to cause a severe reaction at the injection site
Efavirenz
Emtricitabine
Lopinavir
Abacavir
Enfuvirtide (T-20)
Tenofovir
Atazanavir
Raltegravir
Ritonavir
Dolutegravir
