Term
| What is important in regards to HIV resistance? |
|
Definition
- It is inevitable
- It is permanent
- Cross resistance may occur within classes, not across classes
- Can quickly limite therapy options |
|
|
Term
| How does HIV resistance occur? |
|
Definition
- High level of virus production and turnover
- RT prone to error
- Drug susceptible virus depressed
- mutated species flourishes
- Treatment becomes ineffective
- Viral load increases unchecked
- resistance to one agent confers resistance to another, lose treatment options
- Adherence and proper HAART recommendations are vital to avoid resistance and preserve treatment options |
|
|
Term
| What are the goals of HAART therapy? |
|
Definition
- Suppresion of viral load
- Restoration of immune function
- Improve quality of life
- Reduce HIV-related morbidity and mortality |
|
|
Term
| What are potential advantages of HAART? |
|
Definition
- decrease rate of HIV transmission
- Taiwan introduced free HAART treatment to all HIV+ citizens
- HAART decreases mother to child transmission of HIV
- Post-exposure prophylaxis |
|
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Term
| Who should begin HAART depends on several factors. What are they? |
|
Definition
- Symptomatic disease (AIDS defining illness), start therapy
- Poor immune function, such as low CD4 count
- High viral load
- Patient adherence
- Co-morbidities |
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Term
| What are the DHHS guidelines concerning when to start a patient on HAART? |
|
Definition
Start on HAART if.....
- history of AIDS defining illness
- CD4 < 350
- Regardless of CD4, if the patient is: pregnant, has HIV nephropathy, coinfected with HBV when HBV is treatment is indicated |
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Term
| What should happen if a patient's CD4 count is > 350 and does not meet any other condition for therapy? |
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Definition
| - Benefits and risks, co-morbidities, patient readiness, and adherence should be considered |
|
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Term
| How do you build an initial HAART regimen? |
|
Definition
- Normally at LEAST 3 active agents together
- Typically a PI or NNRTI + 2 NRTI's (backbone)
1. PI (boosted or alone) + 2 NRTI's
2. NNRTI + 2 NRTI's |
|
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Term
| What are some factors to consider when starting a drug regimen? |
|
Definition
- Patient willingness
- Adherence potential
- Pill burden and food restrictions
- Severity of disease
- Potential adverse effects
- Co-morbidities
- Potential drug interactions |
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|
Term
| For initial treatment, give the preferred NNRTI-based for DHHS guidelines |
|
Definition
Effavirenz..
+
(emtricitabine or lamivudine) + tenofovir |
|
|
Term
|
Definition
nAtazanavir/ritonavir or lopinavir/ritonavir (Kaletra®) or fosamprenavir/ritonavir or darunavir/ritonavir
+ (emtricitabine or lamivudine) + tenofovir
|
|
|
Term
| What are some alternative treatments for NNRTI based treatments? |
|
Definition
Alternative regimens:
n- Efavirenz + (lamivudine or emtricitabine) + (abacavir or zidovudine) [Combivir] or [Epzicom]
n- Nevirapine + (all the same NRTI combinations listed with efavirenz)
|
|
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Term
| What are some alternative PI-based regimens? |
|
Definition
Atazanavir (with no RTV) or
Fosamprenavir (with no RTV) or
Indinavir/ritonavir or
Nelfinavir or
Saquinavir/ritonavir or
+
same NRTI options as for the NNRTI-based regimen
|
|
|
Term
| What are the advantages and disadvantages of an NNRT-based regimen |
|
Definition
Advantages: Less fat malabsorption, less dyslipidemia, less metabolic disorders, conserve PI's for future use
Disadvantages: Low barrier to resistance, drug interactions, rash, hepatotoxicity with nevirapine |
|
|
Term
| What are the advantages and disadvantages of a PI-based regimen? |
|
Definition
Advantages:
- Conserve NNRTI's for future use, longest data on survival, greater barrier for resistance
- Data show higher virologic success
Disadvantages:
- Metabolic complications, drug interactions, Pill burden
- Remember individual advantages/disadvantages of PI's
- Data show less emergence of resistance
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Term
| Why would you not use Stavudine and Zidovudine together? |
|
Definition
| They compete for the same phosporylation site |
|
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Term
| Why would you not use Didanosine and Stavudine together? |
|
Definition
- Additive toxiicty for periphal neuropathy and lactic acidosis
- still MIGHT be used when other options are unavailable |
|
|
Term
| Why would you not do a full dose of Ritonavir? |
|
Definition
- Poor tolerance
- Long term adverse effects |
|
|
Term
| Would you give Efavirenz to a pregnant person? |
|
Definition
|
|
Term
| When would you use Emtricitabine and Lamivudine together? |
|
Definition
| Never, they're basically the same thing |
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