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Anti-Retrovirals Types (NRTI (NucleoSide Reverse Transcriptase Inhibitors,…
Anti-Retrovirals Types
NRTI
NucleoSide Reverse Transcriptase Inhibitors
Emtricitabine
Stavudine
Abacavir
Didanosine
Lamivudine
Zidovudine
nucleoTide reverse transcriptase inhibitor
Tenofovir
SE
Hepatitis - stop if ↑ LFTs
Lactic Acidosis (type B)
Painful peripheral neuropathy
Rash
GI disturbance
PIs
Ritonavir
Indinavir
Saquinavir
Lopinavir / ritonavir = “Kaletra”
Interacts with P450 inhibitors
SE Metabolic syndrome
Lipodystrophy
Ritonavir is used to boost levels of other PIs
MOA Inhibit viral protease required for virus assembly
NNRTI
Efavirenz Nevirapine
MOA Non-competitive inhibition of reverse transcriptase
Nevirapine is used to prevent HIV transmission during pregnancy
SE Insomnia, vivid dreams,
dizziness, EM → SJS
Integrase
inhibitors
Raltegravir
Elvitegravir
MOA Inhibit integration of transcribed viral DNA into host genome
Fusion inhibitor
Enfuviritide
MOA Binds gp41 and inhibits fusion
SE Hypersensitivity at injection site
CCR5 inhibitor
Maraviroc
Binds CCR5 preventing interaction with gp120
Inhibits attachment of HIV
Anti-Retrovirals Extra
Immune Reconstitution Inflammatory Syndrome
Marked inflammatory reaction vs. residual opportunistic organisms
Improvement in immune function 2O to ARV Rx
Paradoxical worsening of symptoms on initiation of ARVs
Indications
CD4 ≤350
AIDS-defining illness
Pregnancy
HIVAN
Co-infected with HBV when Rx is indicated for HBV
Lipodystrophy
Fat redistribution
↓ SC fat
↑ abdo fat
Buffalo hump
Dyslipidaemia
Insulin resistance
Use 2 NRTIs + 1 NNRTI or PI