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HIV and Antiretroviral Therapy Basics
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HIV and Antiretroviral Therapy Basics
HIV and Antiretroviral Therapy Basics
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1
Question
What are viruses and how do they replicate?
Answer
Viruses are obligate intracellular parasites that lack a cell wall and cell membrane and cannot replicate on their own.
2
Question
What do HIV and AIDS stand for?
Answer
HIV stands for human immunodeficiency virus, which causes HIV infection. AIDS stands for acquired immunodeficiency syndrome, the most advanced stage of HIV infection.
3
Question
What cells does HIV attack?
Answer
HIV attacks and destroys CD4 cells (CD4 T lymphocytes) of the immune system.
4
Question
What are opportunistic infections?
Answer
Opportunistic infections are infections that occur in immunocompromised patients that would not normally harm an immunocompetent person.
5
Question
Give some examples of opportunistic infections.
Answer
Examples include pneumonia, salmonella infection, candidiasis, toxoplasmosis, and TB.
6
Question
What are the goals of ART therapy?
Answer
Maximally and durably suppress HIV RNA replication, restore and preserve immunologic function, reduce HIV-related morbidity and mortality, improve quality of life, and prevent onward transmission of HIV infection.
7
Question
What are the different classes of antiretroviral drugs?
Answer
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs), Nonnucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs), Entry inhibitors, Integrase inhibitors.
8
Question
What is the preferred initial therapy for HIV?
Answer
The preferred initial therapy is a combination of two NRTIs with a PI, an NNRTI, or an integrase inhibitor.
9
Question
Give examples of NRTIs
Answer
Zidovudine (AZT), Lamivudine (3TC), Abacavir (ABC), Tenofovir (TDF), Emtricitabine (FTC)
10
Question
Give examples of PIs
Answer
Ritonavir (R), Atazanavir (ATV), Lopinavir (LPV), Darunavir (DRV)
11
Question
Give examples of Integrase inhibitors
Answer
Raltegravir (RTG), Dolutegravir (DTG)
12
Question
Give examples of NNRTIs
Answer
Efavirenz (EFV), Nevirapine (NVP), Etravirine (ETV)
13
Question
Give examples of Entry inhibitors
Answer
Maraviroc, Enfuvirtide
14
Question
What is combination ARV therapy and why is it used?
Answer
Combines at least 3 ARVs from at least 2 different classes. Reasons include synergism, reduced toxicity, and preventing resistance.
15
Question
What are the targets for ARV drugs?
Answer
CCR5 co-receptors, fusion and viral uncoating processes, and reverse transcriptase enzyme.
16
Question
What enzyme catalyzes the integration of viral DNA provirus into the host cell chromosome?
Answer
Integrase
17
Question
What enzyme enhances the release of newly assembled virus from the host cells?
Answer
Protease
18
Question
What is a common resistance pattern in NRTI resistance?
Answer
Mutation at viral RT codon 184
19
Question
What does mutation at viral RT codon 184 confer resistance to?
Answer
Lamivudine and emtricitabine
20
Question
What does mutation at viral RT codon 184 restore sensitivity to?
Answer
Zidovudine and tenofovir
21
Question
Why should zidovudine and stavudine not be used together?
Answer
They are both analogs of thymidine and cross-resistance and antagonism occur between agents of the same analog class.
22
Question
What type of analog is Zidovudine (AZT)?
Answer
Pyrimidine analog
23
Question
What is Zidovudine approved for?
Answer
Treatment of HIV in children and adults and to prevent perinatal transmission of HIV.
24
Question
What are some toxicities associated with Zidovudine?
Answer
Bone marrow toxicity causing anemia and neutropenia, headaches
25
Question
What type of analog is Tenofovir (TDF)?
Answer
Nucleotide analog
26
Question
What must be monitored when administering Tenofovir?
Answer
Serum creatinine
27
Question
What are some common GI complaints associated with Tenofovir?
Answer
Nausea and bloating
28
Question
What interaction does Tenofovir have with Atazanavir?
Answer
Tenofovir decreases the concentrations of the PI atazanavir such that atazanavir must be boosted with ritonavir if these agents are given concurrently.
29
Question
What does Lamivudine (3TC) inhibit?
Answer
The RT of both HIV and HBV
30
Question
What toxicities is Lamivudine less likely to cause compared to other NRTIs?
Answer
Mitochondrial DNA synthesis or bone marrow precursor cell toxicity