HIV treatment

Question 1

Who and when gets antiretroviral therapy?

Answer 1

everyone diagnosed with HIV, including pregnant women

CD4

Question 2

What about newborns born to HIV positive moms?

Answer 2

6 weeks of zidovudine after birth

test again, and continue treatment if the child is infected

Question 3

HAART

Answer 3

A combination of retroviral agents that work together

2 NRTIs (backbone)
1 of the following:
NNRTI
Protease inhibitor ("boosted")
Integrase inhibitor

must be taken daily, so combination pills have become popular

Question 4

NRTIs

Abacavir
Emtricitabine
Lamivudine
Zidovudine
Tenofovir

Answer 4

MOA: inhibits production of DNA from viral RNA, preventing incorporation of viral DNA into host genome

Class effects:
lactic acidosis
lipodystrophy

Specific drug effects:
Abacavir: hypersensitivity reaction
Zidovudine: bone marrow suppression and anemia

Question 5

NNRTIs

Efavirenz
Etravirine
Rilpivirine

Answer 5

MOA: inhibit reverse transcriptase by blocking the transcription of DNA from viral RNA

class effects: rash

Specific drug effects:

Efavirenz is
teratogenic and can cause neuropsychiatric symptoms (nightmares, depression)

Question 6

Protease inhibitors

Atazanavir
Darunavir
Fosamprenavir
Lopinavir
Rotinavir

Answer 6

MOA: interferes with viral replication and cause production of nonfunctional viruses

Class effects: 
metabolic derangements
GI toxicity (n/v/d)

Specific drug effects:
Atazanavir:Hyperbilirubinemia

Question 7

Integrase inhibitors:

Elvitegravir
Raltegravir

Answer 7

MOA: block integration of viral genome into host genome

Well- tolerated

Question 8

CCR5 antagonists

Miraviroc

Answer 8

block CCR5 coreceptor binding, preventing the entry of the virus into the cell

well- tolerated

Question 9

Fusion inhibitor:

enfuvertide

Answer 9

binds to glycoprotein 41

preventing the fusion of HIV viruses to the CD4 cells

Question 10

Surveillance measures for HIV patients on HAART- how well is the therapy working for the patient?

Answer 10

viral load
CD4 count

Goal: get viral load down to “undetectable”

Renal function, bone marrow function, liver function

Changes to therapy regimen usually based on genotype of patient’s virus, which tells which particular mutations exist, and which drug to start the patient on next

Question 11

Viral load

Answer 11

Direct drug therapy
infant screening (ELISA would be positive anyway)
adults with suspected acute HIV infection (mononucleosis-like syndrome)

Question 12

Antibiotic prophylaxis in HIV

Answer 12

started when CD4

Question 13

SE lactic acidosis

Answer 13

NRTI

Question 14

SE:GI intolerance

Answer 14

protease inhibitors

Question 15

SE: rash

Answer 15

NNRTIs

Question 16

SE: hyperglycemia, DM, lipid abnormalities

Answer 16

protease inhibitors

Question 17

SE: bone marrow suppression with megaloblastic anemia

Answer 17

zidovudine

Question 18

SE:potentially fatal hypersensitivity reaction

Answer 18

Abacavir

Question 19

SE: neuropsychiatric symptoms like depression and vivid nightmares

Answer 19

Efavirenz

Question 20

SE: hyperbilirubinemia, jaundice

Answer 20

atazanavir (protease inhibitor)

Question 21

SE: teratogenic

Answer 21

Efavirenz

Question 22

inhibits CYP450 and used to boost other PIs

Answer 22

ritonavir

Question 23

Which vaccines should not be given to HIV patients?

Answer 23

Do not give live vaccines including

varicella
zoster
intranasal influenza
oral polio
yellow fever
BCG
anthrax
oral typhoid
smallpox

MMR if not immune, if CD4>200, and no AIDS- defining conditions