ART therapy for HIV patients (anti-retroviral therapy)

Question 1

average number of years to be lived at age 25 after starting ART is about

Answer 1

40-50 years

Question 2

what indicates extent of HIV induced damage already suffered

Answer 2

CD4 count

Question 3

major indicator of immune function and predictor of disease progression is…?

Answer 3

CD4 count

Question 4

adequate response to ART is….

Answer 4

CD4 increase 50-150 cells/microliter per year

and

HIV RNA below detection (

Question 5

CD4 monitoring procedure

Answer 5

check baseline twice

then atleast every 3-6 months

Question 6

ART …usually monotherapy or combo?

Answer 6

mono is NOT standard of care

combo is used.

Question 7

goals of ART

Answer 7

maximum suppression of viral replication
preserve or restore effective immune response against HIV
delay progressive immune dysfunction
prevent HIV transmission
improve quality of life and overall survival

Question 8

regardless of viral load, there is a low risk of progression if CD4 count is …

Answer 8

greater or equal to 350

Question 9

regardless of CD4 count, ART initiation is recommended for 6 conditions:

Answer 9

1 history of AIDs defining illness
2 pregnant women
3 HIV associated nephropathy
4 HepB coinfection, when HBV treatment is indicated
5 acute opportunistic infections
6 age >50 yo

Question 10

when to start ART based on CD4 count?

Answer 10

exact is unknown BUT evidence supports starting ART at higher counts

currently –> ART for all

Question 11

ART is strongly recommended for all ________ individuals

Answer 11

HIV infected

Question 12

A1 recommendation for ART

Answer 12

means strong recommendation with high quality evidence (1+ randomized control trials)

Question 13

3 reasons for deferral of ART?

Answer 13

• huge barriers to adherence
• if co-morbidities complicate or prohibit ART
• elite controllers and long-term non-progressors

Question 14

early ART may prevent ____

Answer 14

HIV related end organ damage

Question 15

ART in relation to HIV sexual transmission

Answer 15

has been shows to prevent transmission to a sexual partner

should be considered in patients who are at risk of transmitting HIV to sexual partner

Question 16

combo therapy blocks HIV replication ______

Answer 16

at multiple different steps

if virus cant replicate, it cant mutate –> less resistance

Question 17

HIV lifecycle

Answer 17

binding and fusion - HIV enters CD4 cells with binding to CD4R and co-receptor (either CCR5 or CXCR4) and releases RNA into cell

reverse transcription - HIV RNA is changed to DNA by HIV RT

integration - new HIV DNA enters CD4 nucleus and HIV integrase combines the HIV DNA and the CD4 DNA

transcription - virus integrated into CD4 cell and commands it to make new HIV proteins

assembly - HIV protease cuts proteins and those piece merge with HIV RNA = new viruses

budding - buds out of CD4 cell to infect other cells

Question 18

what kind of inhibitor is maraviroc ?

Answer 18

entry inhibitor (CCR5 antagonist)

Question 19

what kind of inhibitor is fuzeon

Answer 19

fusion inhibitor

Question 20

what kind of inhibitor is AZT?

Answer 20

RT inhibitor

Question 21

what kind of inhibitor is raltegravir?

Answer 21

integrase inhibitor

Question 22

what kind of inhibitor is indinavir?

Answer 22

protease inhibitor

Question 23

what does it mean that HIV is a retrovirus?

Answer 23

that means that its genetic info is stored on single stranded RNA instead of dsDNA and to replicate HIV uses reverse transcriptase to convert RNA to DNA

Question 24

NRTIs and NNRTIs both exert effect over

Answer 24

reverse transcriptase

Question 25

NRTIs and NNRTIs

Answer 25

``` NRTIs = Z-LASTED NNRTIs = N-DEER ``` ``` zidovudine lamivudine abacavir stavudine tenofovir emtricitabine didanosine ``` ``` nevirapine delavirdine efavirenz etravirine rilpivirine ```

Question 26

integrase inhibitors

Answer 26

end in -gravir raltegravir elvitegravir dolutegravir

Question 27

what kind of inhibitor is enfuvirtide

Answer 27

a fusion inhibitor

Question 28

ART combinations

Answer 28

2 NRTIs and 1 PI 2NRTIs and 1 II 1 NNRTI and 2 NRTIs

Question 29

what 3 NRTIs also have activity against hepB

Answer 29

lamivudine emtricitabine tenofovir

Question 30

what NRTI causes lactic acidosis

Answer 30

stavudine

Question 31

which NRTI causes neuropathy and pancreatitis

Answer 31

zalcitabine

Question 32

which NRTI is the safest?

Answer 32

lamivudine

Question 33

what drug should NOT be used with HLAB5701

Answer 33

abacavir | since it causes anaphylaxis hyppersensitivity

Question 34

what drug is the 1 nucleotide RT inhibitior?

Answer 34

tenofovir ---the others are nucleoside RT inhibitors

Question 35

which ART drug can cause fanconi's syndrome?

Answer 35

tenofovir this syndrome is renal tubular dysfunction = phosphaturia and glucosuria

Question 36

what combo is used in PrEP

Answer 36

pre exposure prophylaxis is made of emtricitibine + tenofovir

Question 37

k103N mutation

Answer 37

confers resistance to efavirez and other NNRTIs

Question 38

efavirenz

Answer 38

NNRTI that is backbone to ART (combine with tenofovir and emtricitabine) crosses BBB - nightmares and teratogen

Question 39

common triple ART combo

Answer 39

tenofovir + emtricitibine + efavirenz = ATRIPLA

Question 40

etravirine

Answer 40

NNRTI that doesnt have same mutation resistance KN103 as efavirenz and no vivid dreams not as potent cannot be used with 2 NRTIs

Question 41

why are protease inhibitors so toxic?

Answer 41

because our cellular proteases are also blocked and interacts with cytp450

Question 42

all protease inhibitors can cause....

Answer 42

insulin resistance, hyperglycemia, and diabetes dyslipidemia and fat redistribution increased risk for MI

Question 43

protease inhibitors

Answer 43

``` ritonavir indinavir atazanavir lopinavir darunavir ```

Question 44

RTV boost

Answer 44

ritonavir (protease inhibitor) used at low doses with other protease inhibitors

Question 45

indinavir

Answer 45

protease inhibitor that has effects on kidney (nephrolithiasis, sterile pyuria) so drink lots of water on this drug

Question 46

fusion inhibitors

Answer 46

T20 or enfuvirtide subcutaneous injection blocks HR1 region of Gp41 so that HIV cannot bind and enter the Cd4 cell prevents HR1 and HR2 interaction

Question 47

maraviroc

Answer 47

ccr5 chemokine receptor antagonist inhibits HIV binding to ccr5 receptor and inhibits entry some patients lack ccr5 so not always effective

Question 48

co receptor tropism

Answer 48

HIV may use either ccr5 or cxcr4 to enter the host cell can be dual or mixed R5 virus X4 virus d/M virus

Question 49

raltegravir

Answer 49

targets the HIV1 integrase so cannot integrate into host dna

Question 50

WHICH combo is better? | atripla (tenofovir, emtricitabine + efavirenz) or dolutegravir/abacavir/3TC?

Answer 50

dolutegravir + 3TC/abacavir better tolerated and suppresses HIV faster FIRST LINE recommended as of 2015

Question 51

elvitegravir

Answer 51

new HIV integrase stand transfer inhibitor

Question 52

cobicistat

Answer 52

no activity against HIV but it does act as a pharmacokinetic enhancer of elvitegravir

Question 53

OI prophylaxis can stop for the following at what CD4 level? 1) MAC 2) CMV 3) PCP

Answer 53

1 ) >100 2) >150 3) >200

Question 54

HIV ART therapy is recommended for all ____

Answer 54

preganant women regardless of cd4 and viral loads

Question 55

if viral load is >1000 at delivery ...

Answer 55

do a C section

Question 56

what agent should you NOT use with pregnanct women

Answer 56

efavirenz (teratogen) | any "d" drugs = lactic acidosis and hepatosteatosis