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Flashcards in HIV Deck (13):
1

What is the initial therapy regime for treatment naïve?

2 NRTI + either 1
- NNRTI
- integrase inhibitor
- PI

2

NRTI block RNA dependent DNA synthesis. Examples

Abacavir - screen for HLAB*5701 -> hypersensitivity reaction
Emtricitabine
Lamivudine
Tenofovir
Zidovudine - LIPODYSTROPHY, takes 10 years to recover fat

3

NNRTI
Examples
Class effects

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)

4

Protease inhibitors - inhibit HIV protease which lyses viral proteins into their active form following translation.
Examples
Class effects

Atazanavir - most common
Lopinavir
Darunavir - most common
Fosamprenavir
Indinavir
Saquinavir
Tipranavir

Class effects:
N/D
HYPERLIPIDAEMIA, LIPODYSTROPHY, HYPERGLYCAEMIA
possible risk of bleeding in pts with haemophilia A or B

5

HIV entry inhibitor. MOA, examples. Indications?

CCR5 inhibitors preventing binding of the R5 tropic virus

Examples:
Maraviroc
Enfuvirtide

Indications:
Add to optimised Tx in patient with R5 virus on a BG of sustained HIV levels despite Tx with 3 classes

6

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

7

Fixed dose combinations e.g. atripla consist of?

Tenofavir (NRTI) + emtricitabine (NRTI)and efavirenz (NNRTI)

8

Which protease inhibitor is a potent cyp inhibitor?

Ritonavir most potent
All PIs inhibit cyp

9

Which NNRT induces cyp?

Nevirapine
AE: severe hepatotoxicity

10

Which medications are absolute CI in ART therapy?

Cisaparide -> Long QT
Lovastatin -> rhabdomyolysis. Use pravastatin instead.
Midazolam -> prolonged sedation. Use propafol

11

Which NNRTI affects methadone metabolism?

Nevirapine induces cyp -> withdrawal
Stopping results in overdose!

12

What are the specific reactions of PI with
- PPI
- warfarin
- Rivatoxaban
- TCA
- Clarithromycin
- Hormone replacement

- PPI, reduces PI dose
- Warfarin - increases, decreases dose
- Rivaroxiban - PI increases dose
- TCA increases
- Clarithromycin increases
- Rifampin decreases PI concentration

13

Malignancy is increasing in HIV patients. T/F

True