Optimising Care for HIV Patients

Question 1

What 2 things are taken into account when a patient is on anti-retroviral therapy (ART)?

Answer 1

Viral load of the virus, and CD4 count in the body.

Question 2

What are the aims of anti-retroviral therapy (ART)?

Answer 2

1. Prolong life
2. Improve quality of life
3. Reduce transmission of virus

Question 3

By which week should the HIV viral load in the body be <50%?

Answer 3

By week 48.

Question 4

What is the current recommendation of drugs for anti-retroviral therapy (ART)?

Answer 4

TRIPLE THERAPY

- 2 NRTIs + 3rd agent from a different drug class

Question 5

What is the mode of action of NRTIs in HIV treatment?

Answer 5

• Nucleotide reverse transcriptase inhibitors (NRTIs)

They inhibit the enzyme RT, which is responsible for viral DNA to integrate into the nuclear DNA of the host

Question 6

What are some examples of NRTIs in HIV treatment?

Answer 6

1. Zidovudine
2. Tenofovir
3. Emtricitabine

• They mostly all end in -ine

Question 7

What is the mode of action of protease inhibitors in HIV treatment?

Answer 7

They inhibit the formation of viral proteins by preventing the budding of viral proteins into a HIV virion

Question 8

Which 2 drugs are always used in ART?

Answer 8

Tenofovir + Emtricitabine (Truvada)

- This is the NRTI backbone

Question 9

What are some examples of agents used during ART as a 3rd drug?

Answer 9

1. Atazanavir/r - protease inhibitor
2. Darunavir/r - protease inhibitor
3. Elvitegravir/c - integrase inhibitor
4. Rilpivirine - NNRTI

Question 10

What is the role of the pharmacist in HIV patients?

Answer 10

1. Adherence support
2. Side effects
3. Drug interactions
4. Optimising therapy

Question 11

Why is adherence support essential in HIV patients?

Answer 11

Because missing doses can lead to increased risk of viral resistance, and another drug might need to be used.

Question 12

What are some side effects of the initial stage of therapy in HIV patients?

Answer 12

1. Nausea + vomiting
2. Diarrhoea
3. Bloating/flatulence
4. Vivid dreams
5. Liver enzyme abnormalities

• These side effects go away after 2 weeks

Question 13

What are some long-term side effects of HIV treatment?

Answer 13

1. Changes in renal function
2. Changes in bone mineral density - osteoporosis
3. Dyslipidemia
4. Diabetes
5. Peripheral neuropathy
6. Risk of CV

Question 14

Why can ritonavir causes drug interactions in HIV patients, and what is it combined with?

Answer 14

Because it is an enzyme inhibitor, so it is combined with other protease inhibitors to boost their levels in the blood (known as boosters).

Question 15

Which enzyme is mostly associated with the drug interactions of HIV treatment?

Answer 15

CYP3A4

Question 16

What 2 drugs interact with HIV treatment and reduce its levels?

Answer 16

1. Rifampicin
2. St Johns Wort

They are both enzyme inducers, so reduce the levels of the drugs in the body.

Question 17

Which type of people cannot take abacavir for HIV treatment?

Answer 17

People with mutations for the gene HLA-B*5701, as it can cause hypersensitivity reactions.

Question 18

What does choosing a regimen for HIV treatment revolve around?

Answer 18

1. Adherence
2. Lifestyle
3. Renal/hepatic impairment
4. Hepatitis co-infection

Question 19

When is Truvada (tenofovir + emtricitabine) taken?

Answer 19

Once daily with food.

Question 20

What parameters should be monitored during HIV treatment?

Answer 20

1. CD4 count & viral load
2. Lipids
3. HbA1c
4. Renal function
5. Bone profile

Question 21

What 2 things are associated with treatment failure in HIV treatment?

Answer 21

1. Adherence

2. Changing therapy