presented by: siti rohaizah bt othman. arv drugs available in ummc combivir (lamivudine +...
TRANSCRIPT
Presented by: Siti Rohaizah bt Othman
Arv DRUGS AVAILABLE IN UMMC
Combivir (Lamivudine + Zidovudine)Stocrin (Efavirenz 600mg)Kaletra (Lopinavir 200mg + Ritonavir 50mg)Retrovir (Zidovudine 100mg)3TC (Lamivudine 150 mg)Nevirapine(200 mg)D4T(Stavudine 30mg)Zeffix (Lamivudine 100 mg)Ten-EM (Tenofovir 300mg + Emtricitabine 200mg)Raltegravir ( 400 mg)-under study Indinavir (400 mg)Ritonavir (100mg)SLN(S-30.mg L-150mg, N-200mg)Darunavir (300 mg)-under studyAtazanavir (200mg)-under study
OVERVIEW
What is HIV?What is AIDS?How do you get infected?How does treatment work?Treatment OptionsWhen to Start Patient Counselling
WhaT IS HIV?Human Immunodeficiency Virus (HIV)
Is caused by a retrovirus known as lentiviruses.
It infects CD4-T cells and begins to replicate rapidly. Then, HIV disables the immune system which could lead to AIDS.
What is AIDS?Acquired Immuno Deficiency Syndrome
• Prolong weakening of immune system due to HIV infection
• AIDS as HIV-infected persons with fewer than 200 CD4+T cells and/or persons with HIV who develop certain opportunistic infections.
OPPORTUNISTIC INFECTIONS
Transmission
Transmission
YOU CANNOT GET HIV FROM;HUGGING, MOSQUITO BITES, SNEEZING, SHAKING
HANDS AND SHARING FOOD
Nucleoside analog reverse transcriptase inhibitors (NRTIs) for HIV/AIDS
Eg.Combivir,(Lamivudine/Zidovudine),d4T(Stavudine).3TC(lamivudine), TEN_EM(tenofovir/emtricitabine)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV/AIDS
E.G: Efavirenz, Nevirapine,
HOW THE TREATMENTS WORK?
Protease inhibitors (PIs) Eg. Indinavir Sulfate, Ritonavir
Integrase InhibitorRaltegravir
Fusion InhibitorMaraviroc, enfuvirtide
What to use in firstlinetherapy?
Either an NNRTI OR a Protease Inhibitor OR an Integrase Inhibitor] PLUS [a dual-NRTI component]
Combivir(Lamivudine + Zidovudine)+ Efavirenz
ten-em + Efavirenz
--who art guideline 2010
What to use insecond-line therapy
ritonavir-boosted protease inhibitor (PI) plus two NRTIs
Eg: one of which should be AZT or TDF, based on what was used in first-line therapy. Ritonavir-boosted atazanavir (ATV/r) or lopinavir/ritonavir (LPV/r) are the preferred PIs.
-who art guideline 2010
UMMC guidelinesExamples of some possible
combinations◦Stavudine +Lamivudine+Efavirenz
◦Kaletra+Indinavir+ Ritonavir
◦Combivir(Zidovudine+Lamivudine)+Efavirenz
◦Combivir(Zidovudine+Lamivudine)+Indinavir +Ritonavir
HIV Symptoms CD4 cells/μl Start Treatment
Yes Any Yes
Yes <350 Yes
No >=350 Yes
Laboratorymonitoring
CD4 cell–count testHIVRNA (viral-load)Drug toxicity
Goal of treatment
• Inhibit viral replication, re-establishment & persistence of an effective immune response that will prevent or delay HIV-related morbidity.
• Fully undetectable levels of virus (< 50 c/ml) is the target of therapy for ALL patients, regardless of stage of disease or number / type of prior regimens
• The lower the viral RNA can be driven, the lower the rate of accumulation of drug resistance mutations & the longer the therapeutic effect will last.
Common side effects of ARTAnaemiaRash Liver damage-can be seen as dark
colored stools or urine or yellow coloration of eye whites.
Hyperglycemia and insulin resistanceLactic acidosis-nausea, vomiting, belly
painDyslipidemiaOsteonecrosisFat redistribution
Patient counselling
Adherance and compliance to ART therapy and follow up report any side effects the doctor during follow up.
Patient must change lifestyle to reduce cardiovascular risk- consistent monitoring of lipid profile and glucose HbA1c, smoking cessation
Prevention of secondary transmission-Safe sex- reduce high risk behaviour, eg; the usage of condoms
Stop sharing needles- needle exchange programme
Bring potentially infection partners for HIV screening, if initial screening shows negative, bring partner for screening again in 6 months in case of window period of infection
Reduce or avoid contact people who are ill as there is the potential of opportunistic infection.
Follow up every 3-6 months with CD4 cell count or viral load testing to ensure treatment success and detect possible therapeutic failure.
referencesThe Sanford Guide To
Antimicrobial Therapy 2010Package insert http://www.aids.gov.nih.myUMMC guidelines