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TM: HIV Tx (i) (Baseline (co-morbidities (drug use (cocaine, heroin,…
TM: HIV Tx (i)
Baseline
co-morbidities
drug use (cocaine, heroin, alcohol)
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renal, liver + haematology status
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genotypic pharmacology
abacavir-induced hypersensitivity reaction has been associated with HLA-B5701 - avoid this drug if patient is this HLA type
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sexual health - smear tests, contraception
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When to start Tx
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start all drugs together, stop all suddenly + together (don't add 1 drug to a failing regime)
used to start tx after latency - now asap - stops spread, brain dysfunction + CVD
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ART classes
RT inhibitors
nucleoside analgues (NA)
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zidovudine (for pregnancy from 14 wks), lamivudine, didanosine, abacavir, stavudine, emtracitabine
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Integrase inhibitors
raltegravir, dolutegravir, elvitegravir
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HAART choices
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OR PI
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ritonavir
must be used in combo with other drugs - only a booster - inhibits CYP450 to improve T1/2s of other drugs
Atripla: 1 pill/day for tenofovir, emtracitabine + efavirenz
alternatives
tenofovir, lamivudine, nevirapine
stavudine, lamivudine, nevirapine
OI prophylaxis
PCP
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daily septrin 960mg, co-trimoxazole, if allergic then dapsone
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HIV life cycle
viral protease allows virus to bind, fuse + enter host cell
RT, viral integrase + viral regulatory proteins allow rep of viral DNA
Tx success
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decreased viral load (undetectable @ <50 copies/ml - untrassmissable - no longer infectious :smiley:)