2. ART is the treatment of people infected with human
immunodeficiency virus (HIV) using anti-HIV drugs. The
standard treatment consists of a combination of drugs
(often called "highly active antiretroviral therapy" or
HAART) that suppress HIV replication.
4. Nucleoside reverse transcriptase
inhibitors [NRTIs]
MOA;
Inhibit reverse transcription by causing chain termination after they have been
incorporated into viral DNA.[competes with natural nucleotides to incorporate in
viral DNA]
Blocks HIV replication , preventing infection of new cells .
Used in combination of other drugs , to avoid resistance for hiv
HAART[ Highly active anti retroviral therapy ] consist of highly synergistic
combinations of NRTIs and Protease inhibitors .
Ex; NRTIs[2] + PI[1]
NRTIs[2]+abacavir
NRTIs+NNRTIs+PI
S/E; lactic acidosis , severe hepatomegaly
5. Non Nucleoside Reverse Transcriptase
Inhibitors
MOA;
Stop HIV production by directly bonding on to reverse transcriptase non
competitively and prevents conversion from RNA to DNA.
When used with NRTIs and protease inhibitors show high synergistic effct as it
block viral replication at 2 different steps .
S/E; skin rashes and elevated liver enzymes
EFAVIRENZ is the only NNRTI approved for once daily dosing , can be
administered to both children and adults and prescribed for post
exposure prophylaxis.
6. Nucleotide reverse transcriptase
inhibitors ;[NTRTIs]
Ex ; tenofovir
MOA;
Hydrolysed by the liver first , later gets phosphorylated to to active tenofovir
diphosphate , inhibits hiv reverse transcriptase enzyme and causes
termination of chain elongation .
ae ; Osteomalacia and nausea , vomiting and diarrhoea .
7. WHO recommendations of ART
All adults including pregnant female with HIV infection with cd4 counts < or =
to 350 cells/mm3, should start ART.
Those with clinically advanced disease should start ART irrespective of cd4
count .
First line Therapy ;
NNRTI[1]+NRTIs[2]
One of which it should consist of either tenofovir or zidovudine
Second line therapy ;
A Ritonavir boosted PI + NRTIs , one of which should be zidovudine or
tenofovir .
Ritonavir and lopinavir are preferred Protease Inhibitors.
8. HIV + pregnant women
NRTIs[2] +NNRTI[1]
Zidovudine preferred but tenofovir acceptable
Nevirapine and efavirenz included as NNRTI options
Nevirapine preferred more as it benefits outweighs risk when cd 4 count
between 250 to 350
Ex ; following regimen can be administered ;
zidovudine + lamivudine + nevirapine
9. HIV/TB co-infection
ART should be initiated as soon as possible in hiv patients with active
Tuberculosis infection .
In cases where patient with hiv and tuberculosis need treatment concurrently
first line treatment includes zidovudine/lamivudine or stavudine/lamivudine
plus an NNRTIs.
EX;
1.zidovudine + lamivudine + efavirenz
2. tenofovir + lamivudine + efavirenz
3.zidovudine +emtricitabine+ efavirenz
10. HIV/HBV Co-infection
First line or second line treatments for these patients should contain
tenofovir and either emtricitabine or lamivudine
Ex ; tenofovir + lamivudine + efavirenz
