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Flashcards in CPTP 3.9 HIV Treatment Deck (39)
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How does HIV bind to and access T-Cells?

gp120 protein on the virus binds to CD4 proteins expressed on the surface of T cells

They enter by endocytosis, leaving the envelope in the plasma membrane


What is the nuclear information of HIV kept in? What is found within this?

A nuclear capsid made of protein p24

• Reverse transcriptase
• Protease


What type of virus is HIV?

A retrovirus:
• Starts off as RNA
• Becomes a DNA/RNA hybrid
• This finds other DNA and makes a template which gets expressed by the cell
• The cell expresses the new protein, forming mRNA


Wh y does it take over 100 years of current treatment to eradicate HIV?

CD4-containing cells have a very slow turnover rate, virus DNA survives in the cell


Why are vaccines and antivirals not effective in many RNA viruses?

Drug resistance:

Millions of copies are made, many with mutations, so they can evolve very quickly compared to bacteria. (Also, HIV attacks the cells that are supposed to defend against them)


What methods can be used against viruses?

• Vaccines
• Virucides (not ingestible, for cleaning)
• Antivirals (virus-specific effect, e.g. prevents cell attachment)
• Immunomodulators (augments host response to pathogen)


What is CI?

Chemotherapeutic Index:

Maximum tolerable dose per kg of body weight divided by the minimum dose per kg of body weight which cures the disease


What are the ideal properties of antivirals?

• High CI
• High bioavailability
• Good distribution
• Low ability to induce resistance


How do most antivirals work? What is this poor at combatting?

By targetting viral nucleic acid synthesis

This cannot eliminate latent viruses or non-replicative viruses


How can drug resistance to antivirals be minimised?

• Adherence to medication
• Ensure that mutations gained are likely to make the virus less fit for replication
• Increase the number of changes the virus must make to become resistant (i.e. less specificity within the virus)


Why do RNA viruses become resistant to medication far easier than DNA viruses?

They replicate much faster


Name the co-receptors used by HIV as well as CD4

• CCR5


What are the stages of the HIV cycle that can be targeted by drugs?

• Binding and fusion
• Reverse transcription
• Integration (into DNA)
• Transcription
• Assembly
• Budding
• Maturation


What happens once the virus RNA is transcribed by the host cell?

It is cleaved into the three proteins needed by the virus by protease


What are the three proteins HIV viruses need and what do they do?

• Reverse transcriptase (makes DNA from RNA)
• Integrase (enables its genetic material to be integrated into the DNA of the infected cell)
• Protease (cleaves the long protein product into the three separate proteins)

(also needs structural proteins)


What drugs are available

• Nucleoside reverse transcriptase inhibitors
• Non-nucleoside reverse transcriptase inhibitors
• Protease inhibitors
• Integrase inhibitors
• Fusion inhibitors


How are antiviral drugs found?

Rational drug design
• Determine the target's structure and theoretically design an inhibitor

Combinatorial chemistry
• Machine is given several chemical subunits and uses them to make random compounds and test them
• Active compounds are identified and used as a lead compound


How do NRTIs work? Name the formulary example. What does it treat?

They inhibit reverse transcriptase, stopping the conversion of viral RNA into DNA. They are shaped like nucleotides used to form DNA, and once it is mistaken for one, further growth of the DNA chain stops


Treats HIV


Outline the pharmacokinetics of NRTIs.

• Orally absorbed
• Become biologically active once inside cells as they become phosphorylated into nucleoside triphosphates
• Plasma half-life is therefore irrelevant, the intracellular half-life is important


What are the adverse cellular effects of NRTIs?

They also inhibit the action of DNA polymerase and so prevent mitochondrial replication, causing disturbance of the respiratory cycle of the cell, leading to:
• Lactic acidosis
• Steatosis
• Lipoatrophy
• Metabolic syndrome


How can NRTI resistance occur?

• Mutant reverse transcriptase may remove nucleoside analogues
• Mutant reverse transcriptase may not bind to the nucleoside analogues (i.e. the NRTIs)


Outline the steps in reverse transcription

• The next nucleoside (or nucleoside analogue) triphosphate binds
• It is incorporated onto the end of the growing viral DNA chain and pyrophosphate is released
• The incorporated nucleoside is translocated to a different confirmation to allow addition of next nucleoside


Name an NNRTI (non-nucleoside reverse transcriptase inhibitor). How do these work?


NNRTIs bind directly to reverse transcriptase, preventing it from adding new nucleotides to the growing DNA chain


How can NNRTI resistance occur?

Binding site mutation (this is a very easy mutation)


Outline the pharmacokinetics of NNRTIs.

• Absorbed orally
• Long plasma half life (plasma half life is important in this case unlike NRTIs)
• Metabolised by liver CYP p450 enzyme (therefore interacts with many drugs)


What is the most common resistance mutation against NNRTI?



Name the formulary protease inhibitor.



What is the mechanism of action of protease inhibitors?

Inhibits the cleavage of the protein product of the DNA (which was integrated into the host cell) by the protease into the building blocks of the new viruses.


Outline the pharmacokinetics of protease inhibitors.

• Absorbed orally
• Metabolised in Liver (CYP p450) therefore many interactions
• Also metabolised in the small intestine


What can the absorption of protease inhibitors be affected by?

PPI use (e.g. omeprazole and lansoprazole)