Flashcards in HIV Deck (13):
What is the initial therapy regime for treatment naïve?
2 NRTI + either 1
- integrase inhibitor
NRTI block RNA dependent DNA synthesis. Examples
Abacavir - screen for HLAB*5701 -> hypersensitivity reaction
Zidovudine - LIPODYSTROPHY, takes 10 years to recover fat
Efavirenz - difficult to use. Replaced.
Nevirapine - lots of patients on this. Older drug, well tolerated, been around since 1996 with undetectable viral load 20 years later.
Class effects: N, rash (SJS and LFTs more frequent with nevirapine)
Protease inhibitors - inhibit HIV protease which lyses viral proteins into their active form following translation.
Atazanavir - most common
Darunavir - most common
HYPERLIPIDAEMIA, LIPODYSTROPHY, HYPERGLYCAEMIA
possible risk of bleeding in pts with haemophilia A or B
HIV entry inhibitor. MOA, examples. Indications?
CCR5 inhibitors preventing binding of the R5 tropic virus
Add to optimised Tx in patient with R5 virus on a BG of sustained HIV levels despite Tx with 3 classes
If patients have undetectable viral load and getting side effects from drugs. Next step?
Can do single drug swap to help with side effects.
Can switch therapy if virological failure.
Switching therapy does not work if you have immunological therapy
Fixed dose combinations e.g. atripla consist of?
Tenofavir (NRTI) + emtricitabine (NRTI)and efavirenz (NNRTI)
Which protease inhibitor is a potent cyp inhibitor?
Ritonavir most potent
All PIs inhibit cyp
Which NNRT induces cyp?
AE: severe hepatotoxicity
Which medications are absolute CI in ART therapy?
Cisaparide -> Long QT
Lovastatin -> rhabdomyolysis. Use pravastatin instead.
Midazolam -> prolonged sedation. Use propafol
Which NNRTI affects methadone metabolism?
Nevirapine induces cyp -> withdrawal
Stopping results in overdose!
What are the specific reactions of PI with
- Hormone replacement
- PPI, reduces PI dose
- Warfarin - increases, decreases dose
- Rivaroxiban - PI increases dose
- TCA increases
- Clarithromycin increases
- Rifampin decreases PI concentration