Antiretroviral Agents (HIV drugs)

Question 1

What are the 4 classes of antiretroviral agents/drugs?

Answer 1

• NRTI inhibitors
• NNRTI inhibitors
• Integrase inhibitors
• Protease inhibitors (protease enzyme plays a role in maturing HIV viral particles n aid in making them infectious)

*Nucleotide Reverse Transcriptase Inhibitor (NRTI)

Question 2

What are the 2 prominent side effects seen with NRTI use?

Answer 2

• Lactic Acidosis
• Hepatic Steatosis(accumulation of fats on liver hepatocytes)

Question 3

What are the signs and symptoms of using NRTIs?

Answer 3

• Abdominal distention,
• abdominal pain,
• nausea, vomiting,
• diarrhea,
• weight loss,
• difficulty
  breathing,
• generalized weakness
• myalgias (muscle aches n pain)
  *lactic acidosis general function

Question 4

What are the 2 NRTI drugs that are never to be used with pregnancy?

Answer 4

• Stavudine
• Didanosine

Question 5

What are the possible adverse effects from using NNRTIs?

*Nivaperine & viramune ( sever rash appears within the 1st 4 weeks of therapy)

Answer 5

• Rash (7%)
• increased transaminase levels,
• hepatitis

Question 6

A NNRTI drug with Rash (1.7%), increased transaminase levels, and CNS conditions (e.g. vivid dreams, dizziness, and drowsiness) as potential side effects?

*Side effects resolve in 2 to 4 weeks

Answer 6

Efavirenz (EFVZ)

*Must be used with caution on in patients who have a history of psychiatric illness

*Can trigger cravings in patients with a history of
substance abuse

Question 7

Which antiretroviral agents or drugs cause metabolic complications?

Answer 7

Protease inhibitors

Question 8

What metabolic complications are seen with the use of Protease inhibitors?

Answer 8

• Glucose intolerance
  -Rare diabetes
  -diabetic ketoacidosis
• Lipodystrophy
  -Central obesity, “buffalo hump”,
  -peripheral fat wasting
• Hyperlipidemia
  -Hypertriglyceridemia and/or hypercholesterolemia
• Osteonecrosis, osteopenia, osteoporosis

Question 9

What is the eligibility criteria for ART initiation?

Answer 9

U must have been infected with HIV, and must start treatment immediatetly, right after testing positive.

Question 10

Which groups can see deferral of ATRS?

Answer 10

• Those with drug sensitive TB (if CD4<50, must start ART within 2 weeks of starting TB treatment. If CD4>/=50; start ART 8 weeks after starting TB treatment)
• Those with cryptococcal meningitis (start ART in 4-6 weeks after antifungal treatment is complete.
• Those with TB meningitis ( Start ART 4-8 weeks after start of TB treatment)
• Pneumocystis jirovecii pneumonia ( Start ART 1-2 weeks after commencing treatment for infection)

Question 11

Which groups must see rapid or immediate initiation of ART?

Answer 11

• Pregnant women
• breastfeeding women
• infants and children <5