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MOLECULAR MEDICINE
AntiviralTherapies
Girish Kumar K
V MSc Biomedical Science
Bharathidasan University
Antiviral/Antiretroviral Therapy
• Treatment with antiretroviral medicines, against the retrovirus (HIV), which
resides and multiplies within the human body
• HIV, a retrovirus – etiological agent ofAIDS
• Hallmark of HIV – RNA virus that transcripts DNA from RNA via the Reverse
Transcriptase enzyme
Classification of Antiretroviral medicines
• NRTI (Nucleoside ReverseTranscriptase Inhibitors)
• NtRTI (Nucleotide ReverseTranscriptase Inhibitors)
• NNRTI ( Non-Nucleoside ReverseTranscriptase Inhibitors)
• PI (Protease Inhibitors)
• Entry Inhibitors
• Integrase Inhibitors
NRTI (Nucleoside ReverseTranscriptase Inhibitors)
• Abacavir (ABC)
• Didanosine (DDI)
• Emtricitabine (FTC)
• Lamivudine (3TC)
• Stavudine (D4T)
• Zidovudine (AZT)
• Tenofovir (TDF) - NtRTI
NNRTI ( Non-Nucleoside ReverseTranscriptase Inhibitors)
• Efavirenz (EFV)
• Nevirapine (NVP)
• Etravirine
• Rilpivirine
PI (Protease Inhibitors)
• Atazanavir (ATV)
• Durunavir (DRV)
• Fosamprenavir (f-APV)
• Indinavir (IDV)
• Lopinavir (LPV)
• Nelfinavir (NFV)
• Ritonavir (RTV)
• Saquinavir (SQV)
• Tripranvir (TPV)
Other ARVs
• Entry inhibitors: Enfuvirtide, Maraviroc
• Integrase inhibitors: Raltegravir, Elvitegravir
• Maturation inhibitors: Beviramat
Uses Of ARVs
• ART (AntiretroviralTherapy)
• PMTCT (Prevention of MotherTo ChildTransmission)
• PEP (Post Exposure Prophylaxis)
• PrEP (Pre Exposure Prophylaxis)
ART
•Combines at least 3 ARVs from at least 2 different classes.
•The combination gives
Synergism
Reduced toxicity
Prevent resistance
Goals of ART
• Maximal and durable suppression of viral replication to prevent development
of HIV, drug resistance and treatment failure
• Restoration/ preservation of immunologic function
• Reduction of HIV-related morbidity and mortality
• Improvement of the patient’s quality of life
• Prevention of onward transmission of HIV infection
Indications of ART
Indicated in all HIV-positive adults and adolescents with the following:
 WHO clinical stage 1 or 2 and a CD4 count ≤ 350 cells/mm3,
 WHO clinical stage 3 or 4 regardless of CD4 count,
 HIV andTB co-infection regardless of the CD4 count,
 HIV/HBV co-infection with evidence of active liver disease.
First line ART regimens
Recommended first-line antiretroviral regimens in treatment of naive adults
and adolescents are:
• TDF + 3TC + EFV or NVP or AZT + 3TC + NVP or EFV
Changing to Second line may be due to:
• Treatment failure
1. Clinical
2. Immunological
3.Virological
• Inability to tolerate a drug because of adverse effect.
Second line ART regimens
Recommended second-line for patients failing first line therapy
First-line Second-line
TDF + 3TC + EFV or NVP AZT + 3TC + LPV/r or ATV/r
AZT + 3TC + EFV or NVP TDF + 3TC + LPV/r or ATV/r
d4T + 3TC + EFV or NVP TDF + 3TC + LPV/r or ATV/r
ThankYou

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Antiviral therapy - Molecular Medicine

  • 1. MOLECULAR MEDICINE AntiviralTherapies Girish Kumar K V MSc Biomedical Science Bharathidasan University
  • 2. Antiviral/Antiretroviral Therapy • Treatment with antiretroviral medicines, against the retrovirus (HIV), which resides and multiplies within the human body • HIV, a retrovirus – etiological agent ofAIDS • Hallmark of HIV – RNA virus that transcripts DNA from RNA via the Reverse Transcriptase enzyme
  • 3. Classification of Antiretroviral medicines • NRTI (Nucleoside ReverseTranscriptase Inhibitors) • NtRTI (Nucleotide ReverseTranscriptase Inhibitors) • NNRTI ( Non-Nucleoside ReverseTranscriptase Inhibitors) • PI (Protease Inhibitors) • Entry Inhibitors • Integrase Inhibitors
  • 4. NRTI (Nucleoside ReverseTranscriptase Inhibitors) • Abacavir (ABC) • Didanosine (DDI) • Emtricitabine (FTC) • Lamivudine (3TC) • Stavudine (D4T) • Zidovudine (AZT) • Tenofovir (TDF) - NtRTI
  • 5. NNRTI ( Non-Nucleoside ReverseTranscriptase Inhibitors) • Efavirenz (EFV) • Nevirapine (NVP) • Etravirine • Rilpivirine
  • 6. PI (Protease Inhibitors) • Atazanavir (ATV) • Durunavir (DRV) • Fosamprenavir (f-APV) • Indinavir (IDV) • Lopinavir (LPV) • Nelfinavir (NFV) • Ritonavir (RTV) • Saquinavir (SQV) • Tripranvir (TPV)
  • 7. Other ARVs • Entry inhibitors: Enfuvirtide, Maraviroc • Integrase inhibitors: Raltegravir, Elvitegravir • Maturation inhibitors: Beviramat
  • 8. Uses Of ARVs • ART (AntiretroviralTherapy) • PMTCT (Prevention of MotherTo ChildTransmission) • PEP (Post Exposure Prophylaxis) • PrEP (Pre Exposure Prophylaxis)
  • 9. ART •Combines at least 3 ARVs from at least 2 different classes. •The combination gives Synergism Reduced toxicity Prevent resistance
  • 10. Goals of ART • Maximal and durable suppression of viral replication to prevent development of HIV, drug resistance and treatment failure • Restoration/ preservation of immunologic function • Reduction of HIV-related morbidity and mortality • Improvement of the patient’s quality of life • Prevention of onward transmission of HIV infection
  • 11. Indications of ART Indicated in all HIV-positive adults and adolescents with the following:  WHO clinical stage 1 or 2 and a CD4 count ≤ 350 cells/mm3,  WHO clinical stage 3 or 4 regardless of CD4 count,  HIV andTB co-infection regardless of the CD4 count,  HIV/HBV co-infection with evidence of active liver disease.
  • 12. First line ART regimens Recommended first-line antiretroviral regimens in treatment of naive adults and adolescents are: • TDF + 3TC + EFV or NVP or AZT + 3TC + NVP or EFV Changing to Second line may be due to: • Treatment failure 1. Clinical 2. Immunological 3.Virological • Inability to tolerate a drug because of adverse effect.
  • 13. Second line ART regimens Recommended second-line for patients failing first line therapy First-line Second-line TDF + 3TC + EFV or NVP AZT + 3TC + LPV/r or ATV/r AZT + 3TC + EFV or NVP TDF + 3TC + LPV/r or ATV/r d4T + 3TC + EFV or NVP TDF + 3TC + LPV/r or ATV/r