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Flashcards in HIV treatment Deck (23):
1

Who and when gets antiretroviral therapy?

everyone diagnosed with HIV, including pregnant women

CD4

2

What about newborns born to HIV positive moms?

6 weeks of zidovudine after birth

test again, and continue treatment if the child is infected

3

HAART

A combination of retroviral agents that work together

2 NRTIs (backbone)
1 of the following:
NNRTI
Protease inhibitor ("boosted")
Integrase inhibitor

must be taken daily, so combination pills have become popular

4

NRTIs

Abacavir
Emtricitabine
Lamivudine
Zidovudine
Tenofovir

MOA: inhibits production of DNA from viral RNA, preventing incorporation of viral DNA into host genome

Class effects:
lactic acidosis
lipodystrophy

Specific drug effects:
Abacavir: hypersensitivity reaction
Zidovudine: bone marrow suppression and anemia

5

NNRTIs

Efavirenz
Etravirine
Rilpivirine

MOA: inhibit reverse transcriptase by blocking the transcription of DNA from viral RNA

class effects: rash

Specific drug effects:

Efavirenz is
teratogenic and can cause neuropsychiatric symptoms (nightmares, depression)

6

Protease inhibitors

Atazanavir
Darunavir
Fosamprenavir
Lopinavir
Rotinavir

MOA: interferes with viral replication and cause production of nonfunctional viruses

Class effects:
metabolic derangements
GI toxicity (n/v/d)

Specific drug effects:
Atazanavir:Hyperbilirubinemia

7

Integrase inhibitors:

Elvitegravir
Raltegravir

MOA: block integration of viral genome into host genome

Well- tolerated

8

CCR5 antagonists

Miraviroc

block CCR5 coreceptor binding, preventing the entry of the virus into the cell

well- tolerated

9

Fusion inhibitor:

enfuvertide

binds to glycoprotein 41
preventing the fusion of HIV viruses to the CD4 cells

10

Surveillance measures for HIV patients on HAART- how well is the therapy working for the patient?

viral load
CD4 count

Goal: get viral load down to "undetectable"

Renal function, bone marrow function, liver function

Changes to therapy regimen usually based on genotype of patient's virus, which tells which particular mutations exist, and which drug to start the patient on next

11

Viral load

Direct drug therapy
infant screening (ELISA would be positive anyway)
adults with suspected acute HIV infection (mononucleosis-like syndrome)

12

Antibiotic prophylaxis in HIV

started when CD4

13

SE lactic acidosis

NRTI

14

SE:GI intolerance

protease inhibitors

15

SE: rash

NNRTIs

16

SE: hyperglycemia, DM, lipid abnormalities

protease inhibitors

17

SE: bone marrow suppression with megaloblastic anemia

zidovudine

18

SE:potentially fatal hypersensitivity reaction

Abacavir

19

SE: neuropsychiatric symptoms like depression and vivid nightmares

Efavirenz

20

SE: hyperbilirubinemia, jaundice

atazanavir (protease inhibitor)

21

SE: teratogenic

Efavirenz

22

inhibits CYP450 and used to boost other PIs

ritonavir

23

Which vaccines should not be given to HIV patients?

Do not give live vaccines including

varicella
zoster
intranasal influenza
oral polio
yellow fever
BCG
anthrax
oral typhoid
smallpox

MMR if not immune, if CD4>200, and no AIDS- defining conditions