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Treatment goal of antiretroviral therapy maximally and durably suppress viral replication. avoid development of drug resistance. restore and preserve immune function. prevent opportunistic infections. minimize adverse effects.
CD4 cell counts 200 or lower begin drug prophylaxis for opportunistic infections
3 primary modes of HIV transmission sexual contact. contact with blood or blood products. mother to child during gestation
Indications to start ART therapy AIDS defining illness CD4 count < 350 Strongly encouraged in 350-500 Encouraged in >500 Pregnancy Treating Hep B infection
Minimum number of antiretroviral drugs pt should be on 3 or more combinations (increase durability of viral suppression and decreases potential for development of resistance)
preferred combination of ART (3 or more two nucleotide reverse transcriptase inhibitors and either a NNRTI or a ritonavir-boosted PI
name the six different classes of drug 1. Nucleoside (NRTI)/ nucleotide (NtRTI) reverse transcriptase inhibitor, 2. Protease inhibitor. 3. Nonnucleoside reverse transcriptase inhibitor (NNRTI). 4. Fusion inhibitors 5. CCR5 inhibitors and 6. Integrase inhibitors
3 combinations of class recommended 1. NNRTI (efavirenz) + 2 NRTIs (tenofovir + emtricitabine) 2. Ritonavir-boosted PI (atazanavir + ritonavir or darunavir + ritonavir) + 2 NRTIs (tenofovir + emtricitabine) 3. Integrase inhibitor (raltegravir) + 2 NRTIs (tenofovir + emtricitabine)
Patient failed ART, next step before selecting new regimen (need to assess reason for treatment failure) Assess a comprehensive review of patient's severity of disease, Antiretroviral treatment history Adherence to therapy (intolerance or toxicity) concomitant drug therapies, comorbidities, current and past HIV resistance testing should be performed
NRTIs MOA Stop RNA conversion to DNA by inhibiting reverse transcriptase
NRTI (Abacavir or ABC, Ziagen) BBW and AR hypersensitivity reaction (rash, fever, malaise, N/V, SOB, sore throat, loss of appetite) - Alcohol DI, renal excretion of metabolites BBW: serious hypersensitivity rxn lactic acidosis, severe hepatomegaly
Abacavir hypersensitivity increased in certain patients? HLA-B*5701 allele. need to do screening
Emtricitabine (FTC), Emtriva Renal excretion BBW: lactic acidosis
List ways to limit the risk of HIV transmission. Use condoms with water based lubricant for vaginal or anal intercourse. Treat other STIs since they help increase genital tract HIV viral load, and increase risk of HIV transmission to sexual partners.
What is a good predictor of improved clinical outcomes? After the initiation of antiretroviral therapy, a rapid decline to undetectable HIV RNA in 16-24 weeks is a predictor of improved clinical outcomes
What is the BEST predictor of progression to AIDS and help decide when to initiate treatment? CD4 Lymphocyte count
List indications to start antiretroviral therapy: -Any aids defining illness -CD4 count < 350cells/mm3 -CD4 count 350-500 cells/mm3 - strongly encouraged -CD4>500 - encouraged -Pregnancy -Treating hepatitis B coinfection
What is the minimum number of antiretroviral drugs a patient should be on? 3 or more active drugs is the standard of care which increases the durability of viral suppression and decreases the potential for the development of resistance. Two nucleoside reverse transcriptase inhibitors and either a NNRTI or a ritonavir boosted PI
What three combos of classes are recommended for initial therapy in a treatment naive patient? 1. NNRTI (efavirenz) + 2NRTIs (tenofovir+emtricitabine) 2. Ritonavir boosted PI(atazanavir+ritonavir or darunavir + ritonavir) +2 NRTIs (tenofovir +emtrictabine) 3.Integrase inhibitor (raltegravir) +2NRTIs (tenofovir+emtrictiabine)
If a patient has failed antiretroviral therapy as determined by patient's provider, list what should be done prior to selecting a new regimen? Prior to changing therapy, the reasons for treatment failure should be identified. A comprehensive review of the patient's severity of disease, antiretroviral treatment history, adherence to therapy, intolerance or toxicity, concomitant drug therapies.
Created by: Illusion