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Antiretroviral Therapy - Coggle Diagram
Antiretroviral Therapy
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Classes
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Protease inhibitors
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e.g. lopinavir, atazanavir, darunavir (these are boosted with ritonavir)
Fusion inhibitors
Disrupts the final stage of HIV fusion with the target cell, thus preventing infection
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Current SA guidelines
All adults & children with confirmed HIV - prioritise pregnant women, advanced disease, children <5yrs
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Starting regimen: ADULTS
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DTG
Pros: provides rapid viral suppression, higher genetic barrier to resistance, no interactions with hormonal contraceptives, side-effects are mild & uncommon
Risks: may increase risk of neural tube defects if used in first 4 weeks after conception, drug interactions with Rifampicin
EFV
Pros: safe in pregnancy, no significant interaction with TB treatment
Risks: low genetic barrier to resistance, drug interactions with contraceptive, neuropsychiatric side-effects
Side effects
NRTIs
Tenofovir - renal dysfunction, osteopaenia
Zidovudine - anaemia, neutropaenia
Class effect - lactic acidosis (stavudine & didanosine most mitochondrially toxic, TDF & ABC are least)
NNRTIs
Efavirenx & nevirapine - rash, hepatotoxicity
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Integrase inhibitors
Dolutegravir - insomnia, CNS side effects, possibly weight gain
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Protease inhibitors
Lopinavir & ritonovir - diarrhoea, hypertriglyceridaemia, hypercholesterolaemia
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