HIV

Question 1

Helper-T CD4 Cells

Answer 1

Required for an effective immune response

Antibody production by B cells

Promote DTH

Activation of cytolytic T cells

Question 2

Role of Helper-T CD4 cells in HIV

Answer 2

• The main action of the HIV virus is to target and destroy CD4 t cells in order to replicate
• due to this action, a decrease in CD4 t cells can be seen in those who are infected with the HIV virus

Question 3

Testing for HIV

Answer 3

• low CD4 counts

- Viral load (plasma HIV RNA)

Question 4

Goals of HIV treatment

Answer 4

• suppress the virus for better quality of life
• restore immunologic function and preserve it
• Suppress HIV viral load
• prevent transmission of HIV

Question 5

Reasons to initiate HIV treatment

Answer 5

• increase quality of life
• restore immune functions
• prevent transmission

Question 6

Classifications of Antiretrovirals

Answer 6

• Drugs that inhibit enzymes for HIV (reverse transcriptase inhibitors, Integrase strand trasfer inhibitors, & protease inhbitors)
• drugs that block viral entry into cells (fusion inhibitors, CCR5 antagonists)

Question 7

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Answer 7

• inhibits HIV replication by suppressing synthesis of Viral DNA
• adverse effects include anemia/neutropenia, Lactic acidosis/hepatic steatosis, GI effects, and CNS reactions
• commonly used in combination with INSTIs, PIs, FIs, and NNRTIs
• Prototype drug: Zidovudine

Question 8

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Answer 8

• bind to the active center of reverse transcriptase and cause direct inhibiton
• Efavirenz is the prototype and only NNRTI recommended for first-line therapy for HIV infection
• commonly used with NRTIs
• adverse effects include transient adverse CNS effects, RASHES, and teratogenicity (dont use during first trimester)

Question 9

Protease Inhibitors

Answer 9

• among most effective antiretroviral drugs available
• commonly used in combinations with NRTIs
• can interact with drugs that effect P450, and herbs
• adverse effects include diabetes, hyperlipidemia, reduced bone density, increased bleeding, and elevation of serum transaminase

Question 10

Integrase Strand Transfer Inhibitors (INSTIs)

Answer 10

• Only member of this class is Raltegravir
• used in combination with NRTIs
• adverse side effects include insomnia, headach, and hypersensativity reactions
• DO NOT USE IN PREGNANCY

Question 11

Fusion Inhibitors (FIs)

Answer 11

• only one (Enfuvirtide)
• blocks entry of HIV into CD4 cells
• adverse effects include injection site reactions, pneumonia, and hypersensitivity

Question 12

Administration of Antiretrovirals

Answer 12

• NEVER use just one
• generally not recommended to administer just one drug
• Typically a treatment consists of 3 drugs
• common combinations include 1 NNRTI and 2 NRTIs, 1 PI and 2 NRTIs, and 1 INSTI and 2 NRTIs
• only use NRTIs and certain NNRTIs in pregnant women