W06_05 HIV Therapeutics

Question 1

when to start HIV ART?

Answer 1

for sure if CD4 < 350;

sometimes is CD4 < 500

Question 2

why initiate ART earlier for HIV?

Answer 2

morbidity/mortality benefit;
decrease risk of transmission;
decrease HIV-associated inflammation

Question 3

what are some absolute indications to start HIV ART?

Answer 3

opportunistic infection (e.g. thrush);
malignancy;
pregnancy;
HIV-associated nephropathy;
HIV-associated thrombocytopenia; 
HepB patients

Question 4

what’s an “undetectable” viral load in HIV?

Answer 4

<40 copies/mL

Question 5

what’s the mutation rate of the HIV?

Answer 5

~1 per day (1/2000 bp error, in a 9749 nucleoside genome)

Question 6

what are nucleoside reverse transcriptase inhibitors?

Answer 6

nucleoside analogues that lack a 3’ terminal hydroxy group

Question 7

what is abacavir?

Answer 7

nucleoside analogue for HIV

Question 8

what is tenofovir disoproxil fumarate (TDF)?

Answer 8

nucleoside analogue for HIV and HepB

Question 9

what’s TDF/FTC?

Answer 9

a combination NRTI

Question 10

what’s ABC/3TC

Answer 10

a combination NRTI

Question 11

MoA for non-nucleoside reverse transcriptase inhibitors?

Answer 11

bind at non-active side and induce conformational changes to prevent the enzyme function (noncompetitive)

Question 12

what’s efavirenz (EFV)?

Answer 12

NNRTI for HIV

Question 13

MoA for HIV protease inhibitors?

Answer 13

inhibit the HIV protease from splitting up the gag and pol proteins

Question 14

what’s ritonavir (RTV)?

Answer 14

protease inhibitor. note this is a “half drug” whose effects are better suited towards blocked CYP3A4

Question 15

what’s atazanavir (ATV)?

Answer 15

protease inhibitor

Question 16

what’s darunavir (DRV)?

Answer 16

protease inhibitor

Question 17

what’s maraviroc?

Answer 17

CCR5 antagonist that prevents HIV viral entry

Question 18

why aren’t fusion inhibitors used any longer?

Answer 18

they have injection site reactions

Question 19

what’s elvitegravir?

Answer 19

integrase inhibitor. often given as combination (TDF/FTC/ELV/c)

Question 20

what’s dolutegravir?

Answer 20

integrase inhibitor

Question 21

what’s colbicistat?

Answer 21

pharmacologic booster that inhibits 3A4 and is given with integrase inhibitor elvitegravir

Question 22

what do we have to test for before giving abacavir?

Answer 22

hypersensitivity; HLA*B5701 must be negative