Extremely diverse symptoms and generalised viral malaise

Lymph nodes: Swelling/lymphadenopathy - a characteristic sign of HIV

Viral load drops and Ab raises, thus Ab and virus lives in equilibrium.

Diagnosis is difficult due to diverse symptoms and long onset of non-symptomatic features. Pre-exposure prophylaxis is given to sex workers to combat and suppress transmission

Appropriate counselling to reduce ths stigma and avoidance factor.

Social hisotry/contacts and partners - to identify potential infections

Referral to specialist - maybe initial treatment ARTs (antiretro virals)

Monitoring - CD4, VL and Resistance are important + general bloods (Hep B, Full Biochem, CrCl, LFTs, Lipids, BGL, pregnancy)

First gen ART - hard to tolerate and felt worse + resistance occured

Analogue incorporated into DNA but different structure causing DNA chain termination

Comes in TDF (older) and TAF (newer) where TAF has better absorption into cell nucleus reducing organ toxicities and lowers the dose required.

Hypersensitivty risk in HLA*5071 causing fever and rash, potential increase risk in MI in older patients. Liver metabolised (3A4) thus potential DDIs.

All works well, selection based on ADR profile and resistance. IN STR, Tenofovir and Emtricitabine are commonly used. Abacavir and Lamivudine are used in the Triumeq STR.

Delays progession to AIDS/Mortality, decrease HIV related morbidities (Nephropathy, CVD risk, Malignancy and Neurology (aids dementia)) and prevention of transmission.

ARTs recommended for everyone with HIV infection and to prevent transmission, but initiation of ART is made by individuals.

Very effective and powerful, good PK and once daily dosing. Renally cleared thus less DDIs with CYP enzymes, no food interaction and generally well tolerated

Hep B cross activity - can also inhibit Hep B in some effect, thus changing therapy may influence an imbalance of supression causing loss of control in either one of the viruses.

Can inhibit human mitochondrial DNA polymerase - cause lactic acidosis, peripheral neuropathy and fat loss and panacreatitis

Use for backbone therapy - minimal toxicities, hyperpigmentation may occur and careful in renal impairment

Used for backbone therapy - can cause nephrotoxicity, fracture risk and GI disturbance (reduced when taking with food), care in renal impairment. These kidney ADRs are less with TAF

Well tolerated, potential hair loss and insomnia, care in renal impairment

Greatest level of potential mutation and resistance. Hepatic metabolism, complex PK (auto-induction, long hlaf lives and PGP substrates.

Most virologically active, once daily dosing on empty stomach.

Potential neuropsychiatric effects - sleep distrubance, abnormal dreams, fatigue, depression and suicidal ideation. (Subsides winthin a month)

CYP3A4 inducer and inhibitor - mostly induction but dose changes are not required for this drug, but other substrates may require dose changes.

(Evipleria replacement for Atripla), fewer CNS, dyslipidaemia and skin rash. Was a good option until INSTIs were developed. Slightly better than Efavirenz due to less ADRs

Potential 3A4 DDIs (its a 3A4 substrate), less effective at high viral loads, must take with fatty meal to increase absorption and requires a low pH for effective absorption.

Used for resistance to nNRTIs and other classes unavailable due to its flexible conformation. 2nd line on PBS, twice daily after food and generally well tolerated. 80% excreted in faeces thus minimal hepatic and kidney interactions.

Prevents cleavage of gag-pol polyproteins, preventing formation of the final virus. It produces immautre and non-infectious viruses reducing viral load. Resistance unlikely due to genetic barrier and minimal cross resistance. Strong 3A4 inhibition

Usually taken with food to prevent GI ADRs and has a short half life - thus multiple dosings required. Potential metabolic effects (hepatotoxicity, insulin resistance, high cholesterol and burning lipo-stores.

Can be used in 2 dosing strengths. 1200mg to kill virus or 200mg as a PK booster. 200mg dose has low ADRs and well tolerated.

Pure PK booster with strong inhibition of 3A4, great aqueous ability and improved side effects profile with reduced adipose and insulin resistance effects. No HIV activity thus no resistance potential.

Same efficacy as COBI and RTV. better PK and ADR profile, but does have GI disturbance, hepatitis, neutropenia are common, skin rash and SJS are rare.

Newest class, no similar enzyme in human thus more specific and improved ADRs and minimal toxicity. Highly effective and well tolerated, all INSTIs cause significant weight gain. They are all chelating ions, interact with antacids

Resistance maybe an issue - too early to know, significant weight gain - good as patients are generally underweight but bad due to changes in CVD risk. May require boosting or abacavir.

Used in STR as Triumeq (Abacavir + Lamivudine + Dolutegravir), highly effective and well tolerated. DTG has the highest barrier to resistance

No food requirements and 3A4 DDIs which is good for polypharmacy, very tolerable and twice daily dosing. STR is a triple therapy, still preferred over Atripla (dual therapy) due to good ADR profile.

Resistance increasingly observed, more data in STR with tenofovir and emtricitabine.

In combo abacavir - risk of MI, and DTG has significant weight gain, potential increase in all CVD risk. Blocks OCT2 but stabilises in 4 weeks.

Quad pill therapy as Genova (TAF + Emtricitabine + Cobicistat + Elvitegravir). highly effective and well tolerated.

EVG is metabolised by 3A4 thus potential DDIs similarly to PIs.

Excellent INSTI, comes in STR as Biktarvy (TAF + Emitricitabine + Bictegravir). Best backbone + INSTI = highly effective and no boosting.

Does interact with cations, contraindicated if GFR < 30 and safety is not recommended in first trimester.

Last line defence, salvage therapy when resistance occurs. Works by blocking the virus entry into cell

Fusion inhibitor - synthetic AA analogue binds to gp41 preventing infection. Twice daily subcut dosing and expensive

CCR5 antagonist, twice daily dosing adn only effective on R5 tropic.

Hepatotoxicity, increased CV risk, 3A4 substrate and care with renal impairment <50mL/min