{"id":556,"date":"2020-02-16T21:56:53","date_gmt":"2020-02-16T16:26:53","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=556"},"modified":"2020-02-16T21:56:53","modified_gmt":"2020-02-16T16:26:53","slug":"anti-retroviral-therapy-drugs-for-hiv-infection","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/anti-retroviral-therapy-drugs-for-hiv-infection\/","title":{"rendered":"Anti-retroviral Therapy: Drugs for HIV Infection"},"content":{"rendered":"\n
HIV<\/strong><\/p>\n\n\n\n Nucleoside reverse transcriptase inhibitors (NRTls)<\/strong><\/p>\n\n\n\n Zidovudine<\/strong><\/p>\n\n\n\n Didanosine (ddl)<\/strong><\/p>\n\n\n\n Stavudine (d4T)<\/strong><\/p>\n\n\n\n Lamivudine (3TC)<\/strong><\/p>\n\n\n\n Abacavir (ABC)<\/strong><\/p>\n\n\n\n Tenofovir (TDF)<\/strong><\/p>\n\n\n\n Emtricitabine (FTC)<\/strong><\/p>\n\n\n\n Non-nucleoside reverse transcriptase inhibitors (NNRTls) <\/strong>\u00e0 Nevirapine (NVP), Efavirenz (EFV)<\/strong><\/p>\n\n\n\n Etravirine<\/strong><\/p>\n\n\n\n Retroviral protease inhibitors (Pis)<\/strong><\/p>\n\n\n\n lntegrase inhibitors<\/strong><\/p>\n\n\n\n Entry (fusion) inhibitor<\/strong> \u00e0 Enfuvirtide<\/p>\n\n\n\n CCRS receptor inhibitor <\/strong>\u00e0 <\/strong>Maraviroc<\/p>\n\n\n\n HIV <\/strong>TREATMENT PRINCIPLES AND GUIDELINES<\/strong><\/p>\n\n\n\n Therapeutic regimens<\/strong><\/p>\n\n\n\n First line regimens universally include 2 NRT!s + I NNRTl.<\/p>\n\n\n\n Placing emphasis over efficacy and tolerability, the preferred NRTI s are lamivudine, abacavir, tenofovir and emtricitabine.<\/p>\n\n\n\n Efavirenz is preferred over nevirapine as the NNRTI,<\/p>\n\n\n\n important general points are:<\/strong><\/p>\n\n\n\n Changing a failing regimen<\/strong><\/p>\n\n\n\n An ART regimen is considered to have failed when:<\/p>\n\n\n\n \u2022 Plasma HIV-RNA count is not rendered undetectable (<50 copies\/~1L) within 6 months therapy.<\/p>\n\n\n\n \u2022 Repeated detection of virus in the plasma after initial suppression to undetectable levels despite continuation of the drug regimen.<\/p>\n\n\n\n \u2022 Clinical deterioration, fall in CD4 cell count, serious opportunistic infection while continuing drug therapy.<\/p>\n\n\n\n Salient Points of NACO-October 2018 Guidelines<\/strong><\/strong><\/p>\n\n\n\n Abbreviations used:<\/strong><\/p>\n\n\n\n T: Tenofovir L: Lamivudine E: Efavirenz A: Abacavir L\/r: Lopinavir + Ritonavir N: Nevirapine<\/p>\n\n\n\n The first dose of Post exposure prophylaxis <\/strong>should be administered ideally within 2 hours (but certainly within the first 72 hours) of exposure and the risk evaluated as soon as possible<\/p>\n\n\n\n When to start ART:<\/strong><\/td> In all patients irrespective of CD4 count or symptoms<\/td><\/tr> 2. First Line ART: <\/strong><\/td><\/tr> a) Adults and adolescents<\/td> T+ L +E<\/td><\/tr> b) Children<\/td> A+ L+E<\/td><\/tr> c) Any person with weight less than 30Kg<\/td> A+ L+E<\/td><\/tr> d) If elevated serum creatinine<\/td> A+ L+E<\/td><\/tr> e) Infection with HIV-2 (or HIV-1 + HIV-2)<\/td> T+ L +L\/r<\/td><\/tr> 3. ART in pregnancy and breastfeeding<\/strong><\/td><\/tr> a) ART-native female<\/td> T+ L +E<\/td><\/tr> b) Already on ART<\/td> Continue same<\/td><\/tr> c) Exposure too nevirapine alone in prior pregnancy<\/td> T+ L +L\/r<\/td><\/tr> 4. Infant prophylaxis: <\/strong><\/td><\/tr> a) Mother taking ART for \u2265 4 weeks<\/td> N for 6 weeks<\/td><\/tr> b) Mother taken ART for < 4 weeks<\/td> N for 12 weeks<\/td><\/tr> c) Mother exposed to nevirapine previously<\/td> Z for 6\/12 weeks<\/td><\/tr> 5. Post-exposure Prophylaxis:<\/strong><\/td> T+ L +L\/r<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n