HIV: Treatment and Care Flashcards
(17 cards)
Principles of HIV treatment?
- Highly Active Anti-Retroviral Therapy (HAART)
2. PCP prophylaxis
What is used for PCP prophylaxis?
Co-trimoxazole 480 mg (low dose) daily
Targets for anti-retroviral drugs?
- Reverse transcriptase
- Integrase
- Protease
- Entry:
• Fusion
• CCR5 receptor - Maturation
Define HAART?
Combo of 3 drugs from at least 2 drugs classes to which the virus is susceptible
NOTE - co-formulations are now available, i.e: a single tablet for the 3 drugs
Aims and purpose of HAART?
- Reduce viral load to undetectable
- Restore immunocompetence
- Reduce morbidity and mortality
- Minimise toxicity and maximise tolerability
How to prevent drug resistance to HAART?
ADHERENCE
Classes of anti-retroviral agents?
Nucleoside reverse transcriptase inhibitors (NRTIs), e.g: • Abacavir • Lamivudine • Tenofovir • Zidovudine
Non-nucleoside reverse transcriptase inhibitors (NNRTIs):
• Efavirenz
• Nevirapine
Protease inhibitors (PIs): • Atazanavir
Integrase inhibitors (INSTIs): • Dolutegravir
Fusion inhibitors (FIs)
Chemokine receptor
antagonists (CCR5 antagonists)
Potential toxicity features of HAART?
GI side effects - may occur with protease inhibitors
Skin - rash, hypersensitivity, SJS with abacavir and nevirapine
CNS side effects - mood, psychosis with efavirenz
Renal toxicity - proximal renal tubulopathies with tenofovir and atazanavir
Bones - ostemalacia with tenofovir
CVS - increased risk of MI with abacavir, lopinavir, maraviroc
Haematology - anaemia with zidovudine
GI - transaminitis, fulminant hepatitis with nevirapine and most others
Which HAART drugs are mostly implicated with drug-drug interactions?
Protease inhibitors are potent liver enzyme INHIBITORS
NNRTIs are potent liver enzyme INDUCERS
Some drugs require pharmacological boosting with potent liver enzyme inhibitors, like protease inhibitors
Co-infections to consider with HIV treatment?
Hepatitis B - has the same treatment
Hepatitis C - drug interactions are present
TB - drug interactions are present
Other considerations with HIV treatment?
Comorbidities conditions
Ageing
Psychsocial wellbeing - adjusting to the diagnosis; often there are concerns about their future and relationships, spiritual issues, feelings of isolation, confusion, guilt and blame
Why is partner notification and disclosure important?
Duty of care to a known 3rd party; this is a voluntary process and there are different strategies (partner referral, provider referral, conditional referral)
Patient barriers to partner notification and disclosure?
Fear of rejection, isolation and violence
Confidentiality
Stigma assoc. with HIV diagnosis - manifests as discrimination and ostracism
Prevention of onward HIV transmission?
- Condom use
- HIV treatment
- STI screening and treatment - risk of transmission is higher with concurrent STIs
- Seroadaptive sexual behaviours, e.g: having sex with other HIV +ve people, only having anoreceptive sex, etc
- Disclosure
- Post-exposure prophylaxis (within 3 days)
- Pre-exposure prophylaxis (PreP)
Methods of reproducing when a person in the couple is HIV +ve?
If male is HIV +ve and female is HIV -ve:
• Treat the HIV in the male
• PreP in female
If female is HIV +ve and male is HIV -ve:
• Treatment as prevention
• PreP in male partner
• Some patient use self-insemination
Prevention of HIV transmission from mother to child?
- HAART during pregnancy:
• If undetected viral load - vaginal delivery
• If detected viral load - caesarian section - PEP for neonatate, for 4 weeks
- Exclusive formula feeding (as transmission can occur via breastmilk)
NOTE - if in a deprived region of the world, advise exclusive breastfeeding; HIV transmission is higher with mixed breast and formula feeding
Risk of HIV transmission from mother to child?
If treated and undetected viral load, <0.1%
