The document discusses the current status of antiretroviral therapy for HIV/AIDS. It outlines the course of HIV infection and aims of treatment. It describes potential drug targets and currently available antiretroviral medications, including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. It also discusses guidelines for initiating therapy, monitoring response to treatment, managing treatment failure and drug resistance.
Current Indian Guidelines for Antiretriviral Therapy 2012Lakshya K Solanki
The document outlines current Indian guidelines for antiretroviral therapy (ART). ART involves the use of combination drug regimens to suppress the HIV virus and improve health outcomes. The guidelines recommend initiating ART early, with preferred first-line regimens including tenofovir/emtricitabine plus efavirenz or nevirapine. Patients on ART require monitoring of viral load and CD4 counts, and clinicians must watch out for potential complications and drug interactions. ART should be changed if the initial regimen fails or becomes suboptimal due to toxicity, interactions or other issues.
This document summarizes antiretroviral drugs used to treat HIV/AIDS, including their mechanisms of action, approval timelines, and adverse effects. It discusses the classes of antiretrovirals - nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, and CCR5 inhibitors. For each drug class and individual drugs, it provides details on their approval dates, dosages, drug interactions, and common adverse effects that patients should be counseled on. The document aims to inform healthcare providers about the appropriate use and counseling for antiretroviral regimens.
This document summarizes potential uses of integrase inhibitors in clinical practice based on current guidelines and data. Some key points:
1. Integrase inhibitors are recommended as preferred treatment options for treatment-naive patients, especially those unable to tolerate NNRTIs or PIs. They have shown non-inferior efficacy to EFV in treatment-naive patients.
2. Integrase inhibitors can be used to simplify or reduce toxicity of regimens in virologically suppressed patients, though some studies like SWITCHMRK did not meet predefined criteria for non-inferiority.
3. For treatment-experienced patients, integrase inhibitors are generally used as part of
HIV AIDS is one of the most dreadful of all diseases. Newer drugs and drug combination are coming quite frequently. Attempts to design an HIV vaccine is also underway.
This seminar is my attempt this interesting topic with all the latest data I could collect on the internet.
1. HIV is a retrovirus that contains RNA and incorporates its genome into host cells, hijacking their functions to replicate and eventually destroy the cells.
2. HIV targets CD4+ T-cells, weakening the immune system. It was first recognized in 1981.
3. HIV infection progresses through stages from asymptomatic to development of opportunistic infections that define AIDS. Common symptoms include fatigue, weight loss, and recurrent infections.
This document discusses HAART (Highly Active Antiretroviral Therapy) for treating HIV. It describes the goals of ART in reducing morbidity and prolonging survival. It classifies antiretroviral drugs into five types that inhibit HIV enzymes or block viral entry. Common first line regimens are described along with guidelines for monitoring patients and changing therapy. It also outlines recommendations for preventing opportunistic infections in HIV-infected individuals.
This presentation deals with important pathophysiological steps involved with HIV infection, the various classes of drugs used in treatment of this condition, along with WHO-guidelines for treatment regimen(depending on various ages & conditions).
Newer drugs have also been mentioned and emphasized upon.
An overview of the acquired immune deficiency syndrome (AIDS) caused by the human deficiency virus (HIV) and the drugs used for its treatment, including a classification of the established drugs, the HAART regimen, and investigational approaches
Current Indian Guidelines for Antiretriviral Therapy 2012Lakshya K Solanki
The document outlines current Indian guidelines for antiretroviral therapy (ART). ART involves the use of combination drug regimens to suppress the HIV virus and improve health outcomes. The guidelines recommend initiating ART early, with preferred first-line regimens including tenofovir/emtricitabine plus efavirenz or nevirapine. Patients on ART require monitoring of viral load and CD4 counts, and clinicians must watch out for potential complications and drug interactions. ART should be changed if the initial regimen fails or becomes suboptimal due to toxicity, interactions or other issues.
This document summarizes antiretroviral drugs used to treat HIV/AIDS, including their mechanisms of action, approval timelines, and adverse effects. It discusses the classes of antiretrovirals - nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, and CCR5 inhibitors. For each drug class and individual drugs, it provides details on their approval dates, dosages, drug interactions, and common adverse effects that patients should be counseled on. The document aims to inform healthcare providers about the appropriate use and counseling for antiretroviral regimens.
This document summarizes potential uses of integrase inhibitors in clinical practice based on current guidelines and data. Some key points:
1. Integrase inhibitors are recommended as preferred treatment options for treatment-naive patients, especially those unable to tolerate NNRTIs or PIs. They have shown non-inferior efficacy to EFV in treatment-naive patients.
2. Integrase inhibitors can be used to simplify or reduce toxicity of regimens in virologically suppressed patients, though some studies like SWITCHMRK did not meet predefined criteria for non-inferiority.
3. For treatment-experienced patients, integrase inhibitors are generally used as part of
HIV AIDS is one of the most dreadful of all diseases. Newer drugs and drug combination are coming quite frequently. Attempts to design an HIV vaccine is also underway.
This seminar is my attempt this interesting topic with all the latest data I could collect on the internet.
1. HIV is a retrovirus that contains RNA and incorporates its genome into host cells, hijacking their functions to replicate and eventually destroy the cells.
2. HIV targets CD4+ T-cells, weakening the immune system. It was first recognized in 1981.
3. HIV infection progresses through stages from asymptomatic to development of opportunistic infections that define AIDS. Common symptoms include fatigue, weight loss, and recurrent infections.
This document discusses HAART (Highly Active Antiretroviral Therapy) for treating HIV. It describes the goals of ART in reducing morbidity and prolonging survival. It classifies antiretroviral drugs into five types that inhibit HIV enzymes or block viral entry. Common first line regimens are described along with guidelines for monitoring patients and changing therapy. It also outlines recommendations for preventing opportunistic infections in HIV-infected individuals.
This presentation deals with important pathophysiological steps involved with HIV infection, the various classes of drugs used in treatment of this condition, along with WHO-guidelines for treatment regimen(depending on various ages & conditions).
Newer drugs have also been mentioned and emphasized upon.
An overview of the acquired immune deficiency syndrome (AIDS) caused by the human deficiency virus (HIV) and the drugs used for its treatment, including a classification of the established drugs, the HAART regimen, and investigational approaches
03.03 management of patients on antiretroviral drugs changiDavid Ngogoyo
This document provides guidance on changing or stopping antiretroviral therapy (ART) in a rational manner. It describes the main reasons for altering a patient's ART regimen as drug toxicity, interactions, or treatment failure. It discusses how to diagnose and manage common adverse drug reactions and interactions. It emphasizes the importance of assessing adherence before changing a patient's failing regimen and consulting national treatment guidelines and experts when making decisions about second-line therapy.
This document discusses pharmacokinetics and important drug interactions for treating HIV. It describes the four components of pharmacokinetics - absorption, distribution, metabolism and excretion - and explains how the liver's cytochrome P450 system plays a key role in drug metabolism. It provides examples of cytochrome P450 inducers and inhibitors and how they can affect substrate drugs. Specifically, it notes that the antibiotic rifampin is a strong inducer that significantly decreases levels of protease inhibitors, NNRTIs, methadone and antifungals by inducing cytochrome P450. Managing interactions is important for successful HIV treatment.
Highly Active Antiretroviral Therapy (HAART) involves using a combination of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease. HAART decreases the viral load, improves immune function, and prevents opportunistic infections. The goals of HAART are to prolong life, improve quality of life, achieve maximal viral suppression, restore immune function, reduce HIV transmission, and rationally sequence drugs to limit toxicity while maintaining treatment options. Current guidelines recommend starting ART for all individuals regardless of CD4 count. Second line regimens are recommended when clinical or immunological failure occurs on first line therapy. Managing adverse events and comorbidities like hepatitis co-infection is also
Early initiation of haart why, when and how 21 juneanil kumar g
This document discusses guidelines for early initiation of HIV treatment. It recommends starting antiretroviral therapy (ART) for all people living with HIV, including pregnant and breastfeeding women, regardless of CD4 count or clinical stage. The benefits of early treatment include reduced progression to AIDS, lower rates of illness and death, and decreased HIV transmission. First-line ART regimens preferably include tenofovir, lamivudine and efavirenz. Viral load testing is the best way to monitor treatment response and detect treatment failure.
Highly active antiretroviral therapy incidence of adverse drug reactionspharmaindexing
This document summarizes research on adverse drug reactions (ADRs) experienced by patients taking highly active antiretroviral therapy (HAART) to treat HIV/AIDS. Several studies cited found that the most common ADRs were anemia, hepatotoxicity, gastrointestinal issues, hematological issues, neurological issues, and skin problems. Risk factors for ADRs included CD4 count below 200 cells/μl, female gender, tuberculosis co-infection, and hepatitis C co-infection. While ADR rates were high, some studies found they did not often lead to HAART interruptions. Overall the document examines the incidence and types of ADRs experienced on HAART as well as risk factors. Close patient monitoring
This is a presentation of Anti-Retroviral Therapy (ART) guidelines for HIV infection by the World Health Organization (WHO) updated as of December 2018.
Arv active-toxcity-monitoring-gaberone-training-workshop-on-managmentprempanigrahi
This document outlines key aspects of monitoring and managing adverse drug reactions related to antiretroviral therapies. It discusses WHO recommendations for antiretroviral drugs, defines important terms like adverse drug reactions and treatment limiting toxicities, and describes the major toxicities associated with different antiretroviral regimens as well as approaches for clinical management. It also covers recommendations for routine and active toxicity monitoring.
HIV treatment and PrEP options have advanced significantly since 2015. Key points:
1) Treatment as prevention is now recommended, with antiretroviral therapy shown to reduce HIV transmission by 96% and dramatically lower prevalence over time if treatment is scaled up.
2) PrEP using daily oral Truvada was found to reduce HIV risk by up to 92% in multiple studies when taken consistently, though adherence is important. Intermittent or on-demand PrEP was also found highly effective in some populations.
3) Several real-world demonstration projects confirmed PrEP's effectiveness in different settings and populations, with up to 86% reduced risk of HIV acquisition when PrEP was provided.
This document provides information on HIV/AIDS in India, mother-to-child transmission of HIV (MTCT), and the management of HIV-infected pregnant women. Some key points:
- An estimated 2.39 million people are living with HIV in India, with 0.9 million women infected.
- Without intervention, the rate of MTCT is 20-45%, but can be reduced to 10-1% with proper intervention.
- Triple antiretroviral therapy is recommended for all HIV-infected pregnant women in India, regardless of CD4 count, to be continued lifelong.
- Elective c-section is recommended at 38 weeks for women with high viral loads (>1000 copies/mL
Anti-retroviral therapy (ART) effectively suppresses HIV replication if medication is taken correctly. Successful viral suppression restores the immune system and prevents disease progression and opportunistic infections. Adherence to the ART regimen is vital to treatment success, as any irregularity can lead to drug resistance. NACO recommends standardized first-line and second-line ART regimens based on factors like CD4 count, clinical stage, pregnancy status, and co-infections. The goal of the second-line regimen is to achieve long-term viral suppression through a combination of tenofovir, lamivudine, and atazanavir/ritonavir.
Arrhythmias are abnormalities in the formation and conduction of electrical impulses in the heart that can cause the heart rate to be too fast (tachyarrhythmias) or too slow (bradyarrhythmias). They are commonly caused by conditions that damage the heart like ischemia, infarction, or heart failure. Non-cardiac conditions like electrolyte imbalances, hyperthyroidism, or drugs can also trigger arrhythmias. Arrhythmias are diagnosed using an electrocardiogram and treated with drugs that block sodium, potassium, or calcium channels in the heart or slow the heart rate. Antiarrhythmic drugs have different side effects and dosing based on their mechanism of action and a patient's kidney
Telaprevir is a protease inhibitor approved to treat genotype 1 chronic hepatitis C in
combination with peginterferon and ribavirin. It works by inhibiting the HCV NS3/4A protease
to prevent viral replication. Several clinical trials found telaprevir combination therapy resulted
in higher rates of undetectable HCV RNA levels and sustained virologic response compared to
peginterferon-ribavirin alone. The most common side effects were rash, pruritis, fatigue, and
gastrointestinal issues. Though telaprevir is associated with more side effects, its ability to
shorten treatment duration and improve outcomes outweighs the increased costs. As such, the
Drug Monograph and Literature Review: "Arcapta Neohaler"Joy Awoniyi
This document provides a drug monograph and literature review for Arcapta Neohaler, which contains indacaterol maleate. It is approved for the treatment of chronic obstructive pulmonary disease (COPD) as a once-daily long-acting beta agonist. The monograph details the drug's indications, dosage forms, mechanism of action, pharmacokinetics, contraindications, warnings, adverse effects, drug interactions, and dosing. It concludes with a review of the literature on indacaterol maleate and COPD treatment.
Initiation Of Warfarin Pharmacotherapy Final VersionMmorshed217
This document provides guidance on initiating and monitoring warfarin therapy. It discusses the pharmacokinetics and pharmacodynamics of warfarin, outlines a dosing protocol for the first 5 days of therapy based on INR levels, identifies factors that influence dosing such as genetic polymorphisms and drug interactions, and reviews management of bleeding risks and toxicities. The goal is to educate on safely initiating warfarin and maintaining patients within their therapeutic INR range.
This document summarizes hepatitis C treatments and outreach efforts. It discusses current and upcoming antiviral treatments including simeprevir, sofosbuvir, and direct-acting antivirals. It also describes side effects of pegylated interferon and ribavirin treatments. The document estimates hepatitis C prevalence in Lambeth and the potential impact of untreated infection based on natural disease progression models. It overviews the antiviral therapy outreach service collaboration between Kings College Hospital and South London and Maudsley to engage patients in drug and alcohol centers through peer advocacy.
The document presents a case study of a 69-year-old male patient with hypercholesterolemia, diabetes, hypertension, and ischemic heart disease, outlining his medical history, current medications, lab results, and a pharmaceutical care plan to monitor and control his conditions through lifestyle changes, medication management, and treatment goals. Risk factors for his conditions included obesity, family history, smoking, physical inactivity, and age. His diseases were assessed as uncontrolled despite medications due to additional risk factors.
This document summarizes guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) for the treatment of hepatitis C virus (HCV) infection. It provides recommendations for testing, treatment goals, treatment regimens, duration based on genotype and cirrhosis status, and monitoring for a variety of patient populations. Key recommendations include treating all patients with chronic HCV infection with direct-acting antiviral regimens of 8 to 12 weeks depending on genotype and cirrhosis status, and using longer durations of 24 weeks for decompensated cirrhosis patients who are ineligible for ribavirin.
02.01 adult art classification,action a nd side effects gsnDavid Ngogoyo
This document discusses the classification, sites of action, and common side effects of antiretroviral drugs (ARVs) used to treat HIV/AIDS. It describes the main classes of ARVs which target different stages of the HIV lifecycle, including reverse transcriptase inhibitors, protease inhibitors, and entry inhibitors. Common side effects are outlined for different drug classes and specific drugs, such as peripheral neuropathy, lipodystrophy, hepatotoxicity, and rashes. Rare but serious side effects like lactic acidosis are also mentioned.
This document discusses anti-retroviral therapy (ART) for HIV/AIDS. It describes several classes of antiretroviral drugs including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), entry inhibitors, and integrase inhibitors. For each class and drug, it provides information on composition, dose, elimination pathways, and common adverse effects. It also discusses goals of ART, indications for starting treatment, evaluations before initiating therapy, first and second line regimens according to national guidelines, monitoring of therapy, drug combinations to avoid, and criteria for changing a failing regimen.
03.03 management of patients on antiretroviral drugs changiDavid Ngogoyo
This document provides guidance on changing or stopping antiretroviral therapy (ART) in a rational manner. It describes the main reasons for altering a patient's ART regimen as drug toxicity, interactions, or treatment failure. It discusses how to diagnose and manage common adverse drug reactions and interactions. It emphasizes the importance of assessing adherence before changing a patient's failing regimen and consulting national treatment guidelines and experts when making decisions about second-line therapy.
This document discusses pharmacokinetics and important drug interactions for treating HIV. It describes the four components of pharmacokinetics - absorption, distribution, metabolism and excretion - and explains how the liver's cytochrome P450 system plays a key role in drug metabolism. It provides examples of cytochrome P450 inducers and inhibitors and how they can affect substrate drugs. Specifically, it notes that the antibiotic rifampin is a strong inducer that significantly decreases levels of protease inhibitors, NNRTIs, methadone and antifungals by inducing cytochrome P450. Managing interactions is important for successful HIV treatment.
Highly Active Antiretroviral Therapy (HAART) involves using a combination of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease. HAART decreases the viral load, improves immune function, and prevents opportunistic infections. The goals of HAART are to prolong life, improve quality of life, achieve maximal viral suppression, restore immune function, reduce HIV transmission, and rationally sequence drugs to limit toxicity while maintaining treatment options. Current guidelines recommend starting ART for all individuals regardless of CD4 count. Second line regimens are recommended when clinical or immunological failure occurs on first line therapy. Managing adverse events and comorbidities like hepatitis co-infection is also
Early initiation of haart why, when and how 21 juneanil kumar g
This document discusses guidelines for early initiation of HIV treatment. It recommends starting antiretroviral therapy (ART) for all people living with HIV, including pregnant and breastfeeding women, regardless of CD4 count or clinical stage. The benefits of early treatment include reduced progression to AIDS, lower rates of illness and death, and decreased HIV transmission. First-line ART regimens preferably include tenofovir, lamivudine and efavirenz. Viral load testing is the best way to monitor treatment response and detect treatment failure.
Highly active antiretroviral therapy incidence of adverse drug reactionspharmaindexing
This document summarizes research on adverse drug reactions (ADRs) experienced by patients taking highly active antiretroviral therapy (HAART) to treat HIV/AIDS. Several studies cited found that the most common ADRs were anemia, hepatotoxicity, gastrointestinal issues, hematological issues, neurological issues, and skin problems. Risk factors for ADRs included CD4 count below 200 cells/μl, female gender, tuberculosis co-infection, and hepatitis C co-infection. While ADR rates were high, some studies found they did not often lead to HAART interruptions. Overall the document examines the incidence and types of ADRs experienced on HAART as well as risk factors. Close patient monitoring
This is a presentation of Anti-Retroviral Therapy (ART) guidelines for HIV infection by the World Health Organization (WHO) updated as of December 2018.
Arv active-toxcity-monitoring-gaberone-training-workshop-on-managmentprempanigrahi
This document outlines key aspects of monitoring and managing adverse drug reactions related to antiretroviral therapies. It discusses WHO recommendations for antiretroviral drugs, defines important terms like adverse drug reactions and treatment limiting toxicities, and describes the major toxicities associated with different antiretroviral regimens as well as approaches for clinical management. It also covers recommendations for routine and active toxicity monitoring.
HIV treatment and PrEP options have advanced significantly since 2015. Key points:
1) Treatment as prevention is now recommended, with antiretroviral therapy shown to reduce HIV transmission by 96% and dramatically lower prevalence over time if treatment is scaled up.
2) PrEP using daily oral Truvada was found to reduce HIV risk by up to 92% in multiple studies when taken consistently, though adherence is important. Intermittent or on-demand PrEP was also found highly effective in some populations.
3) Several real-world demonstration projects confirmed PrEP's effectiveness in different settings and populations, with up to 86% reduced risk of HIV acquisition when PrEP was provided.
This document provides information on HIV/AIDS in India, mother-to-child transmission of HIV (MTCT), and the management of HIV-infected pregnant women. Some key points:
- An estimated 2.39 million people are living with HIV in India, with 0.9 million women infected.
- Without intervention, the rate of MTCT is 20-45%, but can be reduced to 10-1% with proper intervention.
- Triple antiretroviral therapy is recommended for all HIV-infected pregnant women in India, regardless of CD4 count, to be continued lifelong.
- Elective c-section is recommended at 38 weeks for women with high viral loads (>1000 copies/mL
Anti-retroviral therapy (ART) effectively suppresses HIV replication if medication is taken correctly. Successful viral suppression restores the immune system and prevents disease progression and opportunistic infections. Adherence to the ART regimen is vital to treatment success, as any irregularity can lead to drug resistance. NACO recommends standardized first-line and second-line ART regimens based on factors like CD4 count, clinical stage, pregnancy status, and co-infections. The goal of the second-line regimen is to achieve long-term viral suppression through a combination of tenofovir, lamivudine, and atazanavir/ritonavir.
Arrhythmias are abnormalities in the formation and conduction of electrical impulses in the heart that can cause the heart rate to be too fast (tachyarrhythmias) or too slow (bradyarrhythmias). They are commonly caused by conditions that damage the heart like ischemia, infarction, or heart failure. Non-cardiac conditions like electrolyte imbalances, hyperthyroidism, or drugs can also trigger arrhythmias. Arrhythmias are diagnosed using an electrocardiogram and treated with drugs that block sodium, potassium, or calcium channels in the heart or slow the heart rate. Antiarrhythmic drugs have different side effects and dosing based on their mechanism of action and a patient's kidney
Telaprevir is a protease inhibitor approved to treat genotype 1 chronic hepatitis C in
combination with peginterferon and ribavirin. It works by inhibiting the HCV NS3/4A protease
to prevent viral replication. Several clinical trials found telaprevir combination therapy resulted
in higher rates of undetectable HCV RNA levels and sustained virologic response compared to
peginterferon-ribavirin alone. The most common side effects were rash, pruritis, fatigue, and
gastrointestinal issues. Though telaprevir is associated with more side effects, its ability to
shorten treatment duration and improve outcomes outweighs the increased costs. As such, the
Drug Monograph and Literature Review: "Arcapta Neohaler"Joy Awoniyi
This document provides a drug monograph and literature review for Arcapta Neohaler, which contains indacaterol maleate. It is approved for the treatment of chronic obstructive pulmonary disease (COPD) as a once-daily long-acting beta agonist. The monograph details the drug's indications, dosage forms, mechanism of action, pharmacokinetics, contraindications, warnings, adverse effects, drug interactions, and dosing. It concludes with a review of the literature on indacaterol maleate and COPD treatment.
Initiation Of Warfarin Pharmacotherapy Final VersionMmorshed217
This document provides guidance on initiating and monitoring warfarin therapy. It discusses the pharmacokinetics and pharmacodynamics of warfarin, outlines a dosing protocol for the first 5 days of therapy based on INR levels, identifies factors that influence dosing such as genetic polymorphisms and drug interactions, and reviews management of bleeding risks and toxicities. The goal is to educate on safely initiating warfarin and maintaining patients within their therapeutic INR range.
This document summarizes hepatitis C treatments and outreach efforts. It discusses current and upcoming antiviral treatments including simeprevir, sofosbuvir, and direct-acting antivirals. It also describes side effects of pegylated interferon and ribavirin treatments. The document estimates hepatitis C prevalence in Lambeth and the potential impact of untreated infection based on natural disease progression models. It overviews the antiviral therapy outreach service collaboration between Kings College Hospital and South London and Maudsley to engage patients in drug and alcohol centers through peer advocacy.
The document presents a case study of a 69-year-old male patient with hypercholesterolemia, diabetes, hypertension, and ischemic heart disease, outlining his medical history, current medications, lab results, and a pharmaceutical care plan to monitor and control his conditions through lifestyle changes, medication management, and treatment goals. Risk factors for his conditions included obesity, family history, smoking, physical inactivity, and age. His diseases were assessed as uncontrolled despite medications due to additional risk factors.
This document summarizes guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) for the treatment of hepatitis C virus (HCV) infection. It provides recommendations for testing, treatment goals, treatment regimens, duration based on genotype and cirrhosis status, and monitoring for a variety of patient populations. Key recommendations include treating all patients with chronic HCV infection with direct-acting antiviral regimens of 8 to 12 weeks depending on genotype and cirrhosis status, and using longer durations of 24 weeks for decompensated cirrhosis patients who are ineligible for ribavirin.
02.01 adult art classification,action a nd side effects gsnDavid Ngogoyo
This document discusses the classification, sites of action, and common side effects of antiretroviral drugs (ARVs) used to treat HIV/AIDS. It describes the main classes of ARVs which target different stages of the HIV lifecycle, including reverse transcriptase inhibitors, protease inhibitors, and entry inhibitors. Common side effects are outlined for different drug classes and specific drugs, such as peripheral neuropathy, lipodystrophy, hepatotoxicity, and rashes. Rare but serious side effects like lactic acidosis are also mentioned.
This document discusses anti-retroviral therapy (ART) for HIV/AIDS. It describes several classes of antiretroviral drugs including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), entry inhibitors, and integrase inhibitors. For each class and drug, it provides information on composition, dose, elimination pathways, and common adverse effects. It also discusses goals of ART, indications for starting treatment, evaluations before initiating therapy, first and second line regimens according to national guidelines, monitoring of therapy, drug combinations to avoid, and criteria for changing a failing regimen.
This document discusses HIV management and life expectancy after antiretroviral therapy (ART) initiation. A study of over 200,000 HIV patients in Thailand found that:
- Median life expectancy after starting ART at age 20 was 25.4 years, but was 51.9 years for those who started with CD4 counts over 350 cells/mm3.
- 83% of patients achieved undetectable viral loads. Starting ART earlier with higher baseline CD4 counts was associated with increased life expectancy.
- These results support guidelines recommending starting ART irrespective of CD4 count.
1) The document discusses antiretroviral therapy for HIV infection, describing several classes of antiretroviral drugs including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase strand transfer inhibitors (INSTIs), fusion inhibitors, and chemokine receptor antagonists.
2) It provides details on specific drugs within each class, including dosage forms, adult dosages, administration recommendations, and common adverse effects.
3) The document emphasizes that antiretroviral therapy has significantly improved survival for those with HIV/AIDS but that mortality remains higher than the general population, and that resistance
1) The document discusses pharmacological principles for treating HIV in pregnant women to reduce mother-to-child transmission.
2) Updated perinatal guidelines from 2007 recommend initiating HAART after 14 weeks of gestation and continuing treatment throughout pregnancy, labor, and delivery.
3) Clinical scenarios provide examples of applying the guidelines, such as recommending HAART, scheduled C-sections if viral load is high, and 6 weeks of infant ZDV treatment starting within hours of birth.
The document discusses different classes of antiretroviral drugs used to treat HIV, including their mechanisms of action, common side effects, drug interactions, and importance of adherence. It covers nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, chemokine receptor antagonists, and integrase inhibitors. It also discusses metabolic pathways, drug combinations, dose adjustments, and key drug interactions to consider.
HIV Infection and AIDS 2007 Family Practice Board Review
The document summarizes key aspects of HIV infection including epidemiology, natural history, diagnosis, treatment, and complications. It covers acute HIV infection, defining AIDS, CD4 cell counts, opportunistic infections, antiretroviral treatment guidelines, adverse effects, and disease prevention strategies.
The document provides guidance on treating hepatitis C, defining sustained virologic response, identifying appropriate treatment candidates, and differentiating treatment by genotype. It discusses factors that affect treatment response, common side effects of treatment medications like peginterferon and ribavirin, and screening and monitoring processes during treatment. The future of hepatitis C treatment involves adding protease inhibitors telaprevir or boceprevir to peginterferon and ribavirin regimens.
A power point presentation on Hepatitis C virus on epidemiology, presentation, diagnosis and current treatment strategies we are practicing in BSMMU at a international standerd.
Medical Undergraduate Lecture slides on Pharmacotherapy of HIV-AIDS. These slides include life cycle of HIV. Classification of available drugs based on target site. Individual Drugs with Mechanism of action, PK, AE and drug interactions. Treatment principles and guidelines for HIV-AIDS based on NACO(National Aids Control Organisation, India) Guidelines.
This document summarizes a seminar on the management of hepatitis C. It discusses the virology of hepatitis C virus and outlines guidelines for patient evaluation, counseling, and antiviral therapy. The summary focuses on the evolution of hepatitis C treatment from interferon-based regimens to highly effective all-oral direct-acting antiviral combination therapies that achieve over 95% cure rates.
Hepatitis (C) Story …. Past & Present & future
Most Recant Updating Guidelines by ASSLD & FDA
RAVS &How to deal with It ----12/7/2016.....
((Residents Lectures))
The document describes a case study of a woman named Tewabech who is experiencing side effects after starting antiretroviral therapy (ART) including fatigue, nausea, trouble sleeping, and nightmares. It examines which of her side effects are likely caused by the specific drugs in her regimen, efavirenz, lamivudine, and zidovudine. It then provides an overview of the classes of antiretroviral drugs, their mechanisms of action, common side effects, and considerations for starting ART.
This document discusses antiretroviral (ARV) drugs for AIDS care and treatment in Nigeria. It describes the recommended first-line ARV regimen in Nigeria as a combination of three drugs - two nucleoside reverse transcriptase inhibitors (NRTI) like d4T or ZDV plus 3TC, plus a non-nucleoside reverse transcriptase inhibitor (NNRTI) like NVP or EFV. The document provides details on the mechanisms of different drug classes, dosages, administration and storage of specific first-line ARV drugs available in Nigeria according to national guidelines.
This document discusses various antiretroviral agents used to treat HIV infection. It describes the classes of antiretrovirals including nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase inhibitors, CCR5 receptor inhibitors, and fusion inhibitors. It provides details on specific drugs in each class, their mechanisms of action, dosages, side effects, and usage recommendations. The document also discusses treatment guidelines and regimens for both adults and children, as well as prophylaxis for preventing mother-to-child HIV transmission.
Hepatitis C affects over 184 million people worldwide and is a major cause of chronic liver disease. It is caused by the hepatitis C virus and transmitted via contact with infected blood. New highly effective direct acting antiviral regimens can cure over 95% of infections and guidelines recommend treatment for all patients except those who will receive a liver transplant within 6 months. Treatment involves combinations of antiviral drugs tailored to hepatitis C genotype and cirrhosis status, with sustained virologic response assessed 12-24 weeks post treatment indicating cure.
This document summarizes guidelines for anticoagulation therapy, including direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. It discusses their indications, dosing, efficacy, safety profiles compared to warfarin, drug interactions, and perioperative management. The key points are that DOACs are generally noninferior or superior to warfarin for stroke prevention with equal or lower risks of bleeding, though drug interactions and the lack of reversal agents for some need to be considered. Perioperative bridging therapy should only be used selectively for high-risk patients, and interruption of anticoagulation should be
This document provides information on hepatitis C, including its types, sources of infection, epidemiology, treatment options, and key details about specific medications used to treat hepatitis C. It discusses the types of hepatitis C as acute or chronic. It notes that the WHO estimates that around 3% of the world's population has been infected with hepatitis C virus (HCV) and over 170 million people have chronic hepatitis C infection. The document discusses classes of antiviral medications used to treat hepatitis C including protease inhibitors, polymerase inhibitors, NS5A inhibitors, and interferons. It provides details on particular protease inhibitors like simeprevir and daclatasvir, the polymerase inhibitor sofosbuvir, and combination treatments containing sofosbuvir
8. First Line ART regimen ICAPRev.presentationptxyakemichael
The document discusses the first-line antiretroviral therapy (ART) regimens for HIV in South Sudan. It recommends tenofovir, lamivudine, and efavirenz as the preferred first-line regimen for adults. For children under 3 years, it recommends abacavir, lamivudine, and lopinavir/ritonavir or nevirapine. It provides dosing, administration, side effects, and contraindications for the drugs in the first-line regimens. It also describes the classes and mechanisms of action of antiretrovirals and the goal of ART to suppress viral replication without providing a cure.
This document discusses the classification and management of genitourinary fistulas. It begins with an introduction defining a fistula and classifying them based on organ of origin and termination point in the urinary tract. It then describes various types of genitourinary fistulas involving the bladder, ureter, and urethra. The remainder of the document covers etiology, clinical features, investigations, prevention, and surgical and non-surgical management of genitourinary fistulas.
This document discusses Sweety's story and how eplusclinic matters for healthcare. eplusclinic is a division of Superknowledge that aims to provide quality healthcare through various initiatives and programs.
telemedicine
healthcare
doctors
videoconferencing with doctors
talk to doctors
send files to doctors
access doctors from mobile phones
e medicine
e healthcare
web based videoconferencing
internet based medicine
e prescription
rural healthcare
medical diagnostic devices
remote healthcare
affordable healthcare
Hopes everybody will be able to understand the signs and symptoms of snake bite and can know which are the most common poisonous snakes in India. This is for everybody not only medicos.
This document discusses rotavirus, a major cause of diarrhea and gastroenteritis in children under 5. It causes over 6 lakh deaths globally each year. The virus has a wheel-shaped appearance and belongs to the Reoviridae family. It replicates in the cytoplasm of intestinal cells. Two vaccines, Rotarix and RotaTeq, launched in 2006 help prevent rotavirus infection and have 95-100% efficacy. Challenges to vaccine introduction include uncertain demand, insufficient supply, high prices, and emergence of new viral strains.
Insomnia is a condition where an individual has trouble falling asleep or staying asleep. There are two main types - primary insomnia which is not caused by another condition, and secondary insomnia which is caused by an underlying medical, physical, or psychological condition. Common causes of secondary insomnia include illnesses, pain, anxiety, depression, certain medications, caffeine, alcohol, and sleep disorders. Insomnia can be diagnosed through a medical history, physical exam, and potentially a sleep study. Treatment options include lifestyle changes, cognitive behavioral therapy, and medication to establish a regular sleep schedule. Insomnia is a common problem that can negatively impact daytime functioning if left untreated.
24 Hour Anonymous Medical Information ServiceSmruti Patanaik
This document describes a pilot study conducted in Sweden during the summer of 2008 that tested an anonymous 24-hour mobile telephone medical information service provided by dermatologists. 18 medical consultations were answered within 24 hours using MMS photos of skin conditions. A survey of 10 dermatologists found they could consistently diagnose common conditions like insect bites but had more varied agreement on diagnoses like acne. Users were generally satisfied with the advice but most also sought additional information online or from doctors. The study concluded such a service could complement internet self-diagnosis for common issues but cannot replace in-person doctor visits. More research is needed to create cost-effective models that encourage well-being.
A C C I D E N T R E S C U E T R A I N I N G M O D U L E F O R A M B U L ...Smruti Patanaik
This document outlines guidelines for extrication and rescue methods for emergency teams. It discusses the 7 basic steps to any operation which include size-up, hazard control, gaining access, providing life-saving care, disentanglement, preparing for removal, and removal of the patient. Key points emphasized are stabilizing hazards first, avoiding rushing extractions, and properly packaging patients while maintaining spinal precautions before removing them from the vehicle or scene of the incident. Planning, training, and following established protocols are stressed as essential to successful rescue operations.
The document discusses a proposed European Patient Summary (EPS) infrastructure that would allow sharing of patient summary data across Europe at an EU-wide level. The infrastructure would need to be scalable to support 500 million citizen summaries across 5,000 health authorities and 1 million users. It would use a "Triple Space" approach with a decentralized, distributed shared space where healthcare parties can publish and access patient data while respecting different national privacy regulations and data ownership policies. The architecture is described as using ontologies to model clinical data and define subspaces within each patient summary space for administrative, clinical and private data with corresponding access control policies. Examples are given of how the EPS infrastructure could integrate with the NHS Spine system in the UK and the
The document provides information about acute abdomen including potential causes, relevant history questions, physical exam findings, and management strategies. It discusses signs and symptoms of several specific conditions that can cause acute abdomen such as appendicitis, duodenal ulcer, kidney stones, abdominal aortic aneurysm, pancreatitis, cholecystitis, and bowel obstruction. The physical exam involves assessing vital signs, palpating the abdomen, and listening to bowel sounds while the management focuses on airway, nothing by mouth, and considering other potential causes like cardiac or gynecological issues.
OncoNet is a telemedicine network in Kerala, India that connects the Regional Cancer Centre in Trivandrum to peripheral cancer treatment centers. The network allows for remote expert consultations, sharing of pathology and radiology images, continuing medical education, and follow-up care for cancer patients in rural areas. By improving access to cancer specialists and reducing unnecessary travel, OncoNet aims to enhance early detection and treatment of cancer in developing regions of India.
The boy is worried about his grandfather who has not returned from his evening walk. His grandfather spends a lot of time with him, helping with homework and telling him stories. Now his exams are starting and he is missing his grandfather. The boy is afraid something may have happened to his grandfather or that he has lost his way home.
The knee joint is the largest and most complicated joint in the body, formed by the fusion of the femur, tibia, and patella bones. It contains several ligaments like the anterior and posterior cruciate ligaments that provide stability, as well as menisci that act as shock absorbers. Injuries to the ligaments and menisci are common and can be diagnosed using clinical tests, with treatments including physical therapy, surgery such as arthroscopy, or in severe cases, knee replacement surgery.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
The document discusses anti-retroviral drug resistance in HIV. It notes that drug resistance is a major reason why HIV drugs stop being effective over time. It outlines steps India is taking to monitor and prevent drug resistance, including establishing a national committee on HIV drug resistance to develop surveillance strategies. Pilot sites for initial threshold surveys and drug resistance monitoring are proposed to provide initial data on transmission levels and resistance in patients on antiretroviral therapy.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
RPMS TEMPLATE FOR SCHOOL YEAR 2023-2024 FOR TEACHER 1 TO TEACHER 3
AIDS PPT. www.medicotesting.com
1. A Wanchu, MD, DM, MAMS Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh Antiretroviral Therapy: Current Status
4. Potential targets RT Provirus Proteins RNA DNA RNA DNA DNA RT Viral regulatory proteins Viral protease Reverse transcriptase Viral integrase RNA RNA Binding, fusion and entry DNA DNA DNA
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8. How to evaluate and start CD4< 200 CD4> 200 Follow up only Absolute lymphocyte count (or CD4) > 1200 (or CD4>200) < 1200 (or CD4<200) Start ARV Start ARV Follow up only All HIV positive patients Symptomatic Asymptomatic CD4 available CD4 not available WHO stage IV WHO stage II, III
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10. WHO’s recommended second line regimens in adults and adolescents for treatment failure on first line ARV regimen (WHO 2003) TDF or ABC + ddI + LVP/r or SQV/r D4T or ZDV + 3TC + NVP or EV Second-line regimen First-line regimen
11. Indications for Initiation of Therapy: Chronic Infection Treatment should be offered, with consideration of pros and cons Any value >200 cells/µL but <350 cells/µL Asymptomatic Treat Any value <200 cells/µL Asymptomatic, AIDS Treat Any value Any value Symptomatic (AIDS, severe symptoms) Recommendation Plasma HIV RNA CD4 + T Cell Count Clinical Category
12. Indications for Initiation of Therapy: Chronic Infection Defer therapy <100,000 copies/mL CD4 + T cells >350 cells/µL Asymptomatic Most clinicians recommend deferring therapy; some will treat >100,000 copies/mL >350 cells/µL Asymptomatic Recommendation Plasma HIV RNA CD4 + T Cell Count Clinical Category
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16. Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTI’s)- I Zidovudine (AZT) Didanosine (ddI) Zalcitabine (ddC) Dose 200 mg tid or 300 mg bid or with 3TC, 1 bid >60kg: 200 mg bid; 60kg: 125mg bid 0.75 mg tid Food No effect Levels No effect Adverse Events BM suppression: Anemia and/or neutropenia GI upset, headache, insomnia, asthenia Pancreatitis Peripheral neuropathy nausea diarrhea Peripheral neuropathy Stomatitis
17. Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTI’s)- I Zidovudine (AZT) Didanosine (ddI) Zalcitabine (ddC) Dose 200 mg tid or 300 mg bid or with 3TC, 1 bid >60kg: 200 mg bid; 60kg: 125mg bid 0.75 mg tid Food No effect Levels No effect Adverse Events BM suppression: Anemia and/or neutropenia GI upset, headache, insomnia, asthenia Pancreatitis Peripheral neuropathy nausea diarrhea Peripheral neuropathy Stomatitis
18. Characteristics of NRTI’s – II Stavudine (d4T) Lamivudine (3TC) Abacavir (ABC) Dose >60 kg: 40 mg bid; < 60 kg: 30 mg bid 150 mg bid or with ZDV bid 300mg bid or with ZDV + 3TC bid Food No effect No effect No effect Adverse Events Pancreatitis Peripheral neuropathy Minimal Hypersensitivity (can be fatal);fever, rash, nausea, vomit, malaise/fatigue, loss of appetite Resp. symp. (sore throat, cough, SOB)
19. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Nevirapine Delavirdine Efavirenz Dosing 200 mg po qd x 14 days, then 200 mg po bid 400 mg po tid or four 100 mg tab in > 3 oz water Separate dosing with ddI or antacids by 1 hr 600 mg po HS Food Effects No regards to meals No regards to meals Avoid after high fat meals Adverse Events Rash Rash Rash CNS symptoms
20. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Nevirapine Delavirdine Efavirenz Dosing 200 mg po qd x 14 days, then 200 mg po bid 400 mg po tid or four 100 mg tab in > 3 oz water Separate dosing with ddI or antacids by 1 hr 600 mg po HS Food Effects No regards to meals No regards to meals Avoid after high fat meals Adverse Events Rash Rash Rash CNS symptoms
21. Protease Inhibitors - I Fat redistribution, lipid abnormalities and hyperglycemia are common to all Name Indinavir Ritonavir Nelfinavir Dose 800 mg q8h. Separate dosing with ddI by 1 hr 600 mg q 12h. Separate dosing with ddI by 2 hrs 750 mg tid or 1250 mg bid Food Levels 77%. Take 1 hr before or 2 hrs after meals with skim milk/ low fat meal Levels 15%. Take with food if possible, may improve tolerability Levels 2-3 fold. With meal/ snack Side Effects Nephrolithiasis GI intolerance, nausea indirect bilirubinemia Headache, asthenia, blurred vision, dizziness, rash, metallic taste, thrombocytopenia. GI intolerance, nausea, vomiting, diarrhea Paresthesias - circumoral, extremities. Hepatitis. Pancreatitis. Asthenia. Taste perversion. CPK & uric acid. transaminases , Triglycerides >200%. Diarrhea
22. Protease Inhibitors - II GI intolerance, fat redistribution, lipid abnormalities & hyperglycemia are common Name Saquinavir Amprenavir Lopinavir + Ritonavir Dosing 1200 mg TID >50 kg: 1200 mg bid. <50 kg: 20mg/kg bid. Max. 2400 mg d 400 mg lopinavir + 100 mg ritnonavir bid Food Effect Levels 6-fold with large meal High fat meal AUC 21%; with or without food Mod. fat meal AUC by 48%. Take with food. Side Effects Nausea, diarrhea, abd. pain, dyspepsia Headache transaminases Nausea, vomiting, diarrhea. Rash Oral paresthesias. liver function tests Nausea, vomiting, diarrhea. Asthenia transaminases
23. Protease Inhibitors - II GI intolerance, fat redistribution, lipid abnormalities & hyperglycemia are common Name Saquinavir Amprenavir Lopinavir + Ritonavir Dosing 1200 mg TID >50 kg: 1200 mg bid. <50 kg: 20mg/kg bid. Max. 2400 mg d 400 mg lopinavir + 100 mg ritnonavir bid Food Effect Levels 6-fold with large meal High fat meal AUC 21%; with or without food Mod. fat meal AUC by 48%. Take with food. Side Effects Nausea, diarrhea, abd. pain, dyspepsia Headache transaminases Nausea, vomiting, diarrhea. Rash Oral paresthesias. liver function tests Nausea, vomiting, diarrhea. Asthenia transaminases
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32. Treatment Failure and Drug Resistance CD4 Count Viral Load Virologic failure Immunologic failure Clinical failure Drug Resistance
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38. Adherence in the Chandigarh Cohort Characteristics of patients totally adherent & those who missed > 1at least one dose in the preceding 4 wks AIDS and Behavior (in press) Men Women Number who missed >1 dose 147 53 Age, yrs 40.4 + 8.1 36.6 + 6.6 Regimen Nevirapine based 39 43 Efavirenz based 104 10 Source of funding Self 73 31 State 74 22
39. Adherence in the Chandigarh Cohort Reasons for non-adherence among 53 patients AIDS and Behavior (in press) 2 (12.5%) 3 (8.1%) Too toxic 3 (18.8%) 2 (5.4%) Too many pills 0 (0%) 6 (16.2%) Away from home 1 (6.3%) 7 (18.9%) Ran out of drugs 3 (18.8%) 9 (24.3%) Forgot 7 (43.7%) 10 (27.0%) Financial constraints Women (16) Men (37) Reason
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43. 3X5 31st Dec ‘05 60 centers & 21,318 patients on ART 0 50K 100K 150K 200K 250K 300K 350K 400K 450K 500K South Africa India Nigeria Zimbabwe Brazil Tanzania Ethiopia Kenya Mozambique Republic of Congo Zambia Malawi Thailand Uganda Côte d'Ivoire Cameroon Russian Federation Botswana China Sudan 20 countries with the highest ARV need As of June 2004 June to December 2004 January to June 2005 People still needing treatment to reach "3 by 5" target People receiving ARV therapy TARGET MET TARGET MET TARGET MET
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Editor's Notes
Currently Available Antiretroviral Medications There are three classes of antiretroviral drugs available; two of them—the NRTIs and the NNRTIs—target HIV’s reverse transcriptase enzyme; the third—the PIs—target the protease enzyme.
The decision to begin therapy for the asymptomatic patient is complex and must be made in the setting of careful patient counseling and education. Considerations of initiating antiretroviral therapy should be primarily based on the prognosis of disease-free survival as determined by baseline CD4 + T cell count [27-29] ( Figure A ; and Table 3a, 3b ) . Also important are baseline viral load [27-29] , readiness of the patient to begin therapy; and assessment of potential benefits and risks of initiating therapy for asymptomatic persons, including short-and long-term adverse drug effects; the likelihood, after counseling and education, of adherence to the prescribed treatment regimen. Recommendations vary according to the CD4 count and viral load of the patient, as follows. <200 CD4 + T cell count, with AIDS-defining illness, or symptomatic. Randomized clinical trials provide strong evidence of improved survival and reduced disease progression by treating symptomatic patients and patients with <200 CD4 + T cells/mm 3 [30-33]. Observational cohorts indicate a strong relationship between lower CD4 + T cell counts and higher plasma HIV RNA levels in terms of risk for progression to AIDS for untreated persons and antiretroviral naïve patients beginning treatment. These data provide strong support for the conclusion that therapy should be initiated in patients with CD4 + T cell count <200 cells/mm 3 ( Figures A and Table 3a ) (AI) [27, 28]. 200-350 CD4 + T cell count, patient asymptomatic. The optimal time to initiate antiretroviral therapy among asymptomatic patients with CD4 + T cell counts >200 cells/mm 3 is unknown. For these patients, the strength of the recommendation for therapy must balance other considerations, such as patient readiness for treatment and potential drug toxicities. After considering available data in terms of the relative risk for progression to AIDS at certain CD4 + T cell counts and viral loads, and the potential risks and benefits associated with initiating therapy, most specialists in this area believe that the evidence supports initiating therapy in asymptomatic HIV-infected persons with a CD4 + T cell count of 200-350 cells/mm 3 (BII) . There is a paucity of data from randomized, controlled trials concerning clinical endpoints (e.g., the development of AIDS-defining illnesses or death) for asymptomatic persons with >200 CD4 + T cells/mm 3 to guide decisions on when to initiate therapy. Observational data from cohorts of HIV-infected persons provide some guidance to assist in risk assessment for disease progression. … . While there are clear strengths to these observational data, there are also important limitations. Uncontrolled confounding factors could impact estimates in both studies. Furthermore, neither study provides direct evidence on the optimum CD4 + T cell count to begin therapy. Such data will have to come from studies that follow patients who start therapy at different CD4 + T-cell counts above 200 cells/mm 3 and compare them with a similar group of patients (e.g., with similar CD4 + T cell count and HIV RNA level) who defer treatment. To completely balance the benefits and risks of therapy, follow-up will have to examine progression to AIDS, major toxicities, and death. >350 CD4 + T cell count, patient asymptomatic. There is little evidence on the benefit of initiating therapy in asymptomatic patients with CD4 + T cell count > 350 cells/mm 3 . Most clinicians would defer therapy. • The deferred treatment approach is based on the recognition that robust immune reconstitution still occurs in the majority of patients who initiate treatment while CD4 + T cell counts are in the 200–350 cells/mm 3 range. Also, toxicity risks and adherence challenges generally outweigh the benefits of initiating therapy at CD4 + T cell counts >350 cells/mm 3 . In the deferred treatment approach, increased levels of plasma HIV RNA (i.e., >100,000 copies/mL) are an indication for monitoring of CD4 + T cell counts and plasma HIV RNA levels at least every three months, but not necessarily for initiation of therapy. For patients with HIV RNA <100,000 copies/mL, therapy should be deferred (DII) . • In the early treatment approach, asymptomatic patients with CD4 + T cell counts >350 cells/mm 3 and levels of plasma HIV RNA >100,000 copies/mL would be treated because of the risk for immunologic deterioration and disease progression (CII) . An estimate of the short term risk of AIDS progression may be useful in guiding clinicians and patients as they weigh the risks and benefits of initiating versus deferring therapy in this CD4 cell range. As cited above, Table 3b provides an analysis of data from the CASCADE Collaboration, demonstrating the risk of AIDS progression within 6 months for different strata of CD4 + T cell count, viral load, and age. As seen in Table 3b , a 55 year old with a CD4 + T cell count of 350 and a HIV viral load of 300,000 copies/ml has a 5% chance of progression in 6 months, compared with a 1.2% chance for a similar patient with a viral load of 3000 copies/mL.
Antiretroviral Regimens Not Recommended Monotherapy (EII). Single antiretroviral drug therapy does not demonstrate potent and sustained antiviral activity and should not be used. The rare exception, though controversial, is the use of zidovudine monotherapy to prevent perinatal HIV-1 transmission in a woman who does not meet clinical, immunologic, or virologic criteria for initiation of therapy and who has an HIV RNA <1,000 copies/mL [96, 97] (DIII) . Most clinicians, however, prefer to use a combination regimen in the pregnant woman for the management of both the mother’s HIV infection and in the prevention of perinatal transmission. Dual nucleoside regimens (DII). These regimens are not recommended because they have not demonstrated potent and sustained antiviral activity as compared to three-drug combination regimens [98]. For patients previously initiated on this treatment who have achieved sustained viral suppression, it is reasonable to continue on this therapy or to add a PI or NNRTI to this regimen (DIII) . If the patient is to stay on a 2-NRTI regimen, the plan should be to change to a three or more drug combination if viral rebound occurs. (See Managing the Treatment Experienced Patient: Assessment of Antiretroviral Treatment Failure and Changing Therapy .) 3-NRTI regimen of abacavir + tenofovir + lamivudine (EII). In a randomized trial for treatment naïve patients, those randomized to a regimen consisting of abacavir + tenofovir + lamivudine had a significantly higher rate of “early virologic nonresponse” when compared to patients treated with efavirenz + abacavir + lamivudine [55] . This combination should not be used as a 3-NRTI regimen in any patient. 3-NRTI regimen of didanosine + tenofovir + lamivudine (EII). In a small pilot study, a high rate (91%) of virologic failure (defined as <2 log reduction of HIV-RNA by week 12) was seen in treatment-naïve patients initiated on this 3-NRTI regimen [84]. This combination should not be used as a 3-NRTI regimen in any patient. The Panel DOES NOT RECOMMEND the use of the following 3-NRTI regimens as sole antiretroviral combination at any time: • abacavir + tenofovir + lamivudine (EII) • didanosine + tenofovir + lamivudine (EII)
Didanosine + stavudine (EII). The combined use of didanosine and stavudine as a 2-NRTI backbone can result in a high incidence of toxicities, particularly peripheral neuropathy, pancreatitis, and lactic acidosis [50, 87, 99] .This combination has been implicated in several deaths in HIV-1 infected pregnant women secondary to severe lactic acidosis with or without hepatic steatosis and pancreatitis [100] . In general, a combination containing didanosine and stavudine should be avoided unless other 2-NRTI combinations have failed or have caused unacceptable toxicities, and where potential benefits outweigh the risks of toxicities (DIII) . Stavudine + zidovudine (EII). Combination regimens containing these two NRTIs should be avoided due to the demonstration of antagonism in vitro [103] and in vivo [104] . Emtricitabine + lamivudine (EIII). Both of these drugs have similar resistance profiles and have minimal additive antiviral activity. Didanosine + zalcitabine or stavudine + zalcitabine (EII). These combinations are contraindicated due to increased rates and severity of peripheral neuropathy [101, 102] . Lamivudine + zalcitabine (EII). In vitro data showed that these two agents may inhibit intracellular phosphorylation of one another, resulting in decreased triphosphate concentration and antiretroviral activities.
Efavirenz in first trimester of pregnancy and women with significant childbearing potential (EIII). Efavirenz use was associated with significant teratogenic effects in primates at drug exposures similar to those representing human exposure. Several cases of congenital anomalies have been reported after early human gestational exposure to efavirenz [57, 58] . Efavirenz should be avoided in pregnancy, particularly during the first trimester, and in women who are trying to conceive or who are not using effective and consistent contraception. If no other antiretroviral options are available in the woman who is pregnant or at risk for becoming pregnant, consultation should be obtained with a clinician who has expertise in both HIV and pregnancy. Nevirapine . Higher incidence of hepatotoxicity than with other NNRTIs, including serious and even fatal cases of hepatic necrosis • Female patients and patients with high pre-NVP CD4+ T cell counts (>250 cells/mm3 in females & >400 cells/mm3 in males) are at a higher risk of symptomatic hepatic events. NVP is not recommended in these patients unless the benefit clearly outweighs the risk.
Abacavir hypersensitivity reaction can be fatal-fever, rash, nausea, vomiting, malaise or fatigue and loss of appetite. Abacavir should be stopped immediately if hypersensitivity reaction is suspected. Abacavir should ot be re-started, because more severe symptoms will recur within hours and may include life-threatening hypotension and death. Cases of abacavir hypersensitivity syyndrome should be reported to the Abacavir Hypersensity Registry at 1-800-270-0425. Cases of fatal and nonfatal pancreatitis have occurred in treatment-naïve and treatment-experienced patients during therapy with ddI or in combination with other drugs, particularly d4T or d4T + hydroxyurea.
In clinical trials, NNRTIs were discontinued because of rash in 7% of patients taking nevirapine, 4.3% of patients taking delavirdine, and 1.7% of patients taking efavirenz. Rare cases of Stevens-Johnson Syndrome have been reported with the use of all three NNRTIs. CNS symptoms may include dizziness, somnolence, insomnia, abnormal dreams, confusion, abnormal thinking, impaired concentration, amnesia, agitation, depersonalization, hallucinations, and euphoria, The overall frequency of any of these symptoms associated with the use of efavirenz was 52% compared with 26% in controls. 2.6% of those on efavirenz discontinued the drug due to these symptoms.
Cases of worsening glycemic control in patients with pre-existing diabetes, and cases for new-onset diabetes including diabetic ketoacidosis have been reported with the use of all protease inhibitors. Fat redistribution and lipid abnormalities have been increasingly recognized with the use of protease inhibitors. Discontinuation of PIs may be required to reverse fat redistribution. Patients with hypertriglyceridemia or hypercholesterolemia should be evaluated for risks for cardiovascular events and pancreatitis. Possible interventions include dietary modification, lipid lowering agents, or discontinuation of PIs.