Antiretroviral TherapyPresentation - University Health ：抗逆轉(zhuǎn)錄病毒治療演示-大學(xué)健康

1、ANTIRETROVIRAL THERAPYDr. Samuel Mwaniki(BPharm., MSc TID, UoN)University of Nairobi ISO 9001:2021 1Treatment with antiretroviral medicines, against the retrovirus (HIV), which resides and multiplies within the human bodyHIV; etiological agent of AIDSHallmark of HIV; RNA virus that transcripts DNA f

2、rom RNA via the Reverse Transcriptase enzymeDefinition of ARTUniversity of Nairobi ISO 9001:2021 2NRTI (Nucleoside Reverse Transcriptase Inhibitors)NtRTI (Nucleotide Reverse Transcriptase Inhibitors)NNRTI ( Non-Nucleoside Reverse Transcriptase Inhibitors)PI (Protease Inhibitors)Entry InhibitorsInteg

3、rase InhibitorsClassification of Antiretroviral medicinesUniversity of Nairobi ISO 9001:2021 3Abacavir (ABC)Didanosine (DDI)Emtricitabine (FTC)Lamivudine (3TC)Stavudine (D4T)Zidovudine (AZT)Tenofovir (TDF) - NtRTINRTIsUniversity of Nairobi ISO 9001:2021 4Efavirenz (EFV)Nevirapine (NVP)Etravirine Ril

4、pivirineNNRTIsUniversity of Nairobi ISO 9001:2021 5Atazanavir (ATV) Durunavir (DRV)Fosamprenavir (f-APV)Indinavir (IDV)Lopinavir (LPV)Nelfinavir (NFV)Ritonavir (RTV)Saquinavir (SQV)Tripranvir (TPV)PIsUniversity of Nairobi ISO 9001:2021 6Entry inhibitors: Enfuvirtide, MaravirocIntegrase inhibitors: R

5、altegravir, ElvitegravirMaturation inhibitors: BeviramatOther ARVsUniversity of Nairobi ISO 9001:2021 7ART (Antiretroviral Therapy)PMTCT (Prevention of Mother To Child Transmission)PEP (Post Exposure Prophylaxis)PrEP (Pre Exposure Prophylaxis)Uses of ARTUniversity of Nairobi ISO 9001:2021 8Combines

6、at least 3 ARVs from at least 2 different classes.Why combination?SynergismReduced toxicityPrevent resistance ARTUniversity of Nairobi ISO 9001:2021 92 NRTI + 1 NNRTI1 NRTI + 1 NtRTI + 1 NNRTI2NRTI + boosted PI1 NRTI + 1 NtRTI + boosted PI3 NRTI (One must be Abacavir)ART CombinationsUniversity of Na

7、irobi ISO 9001:2021 10Maximal and durable suppression of viral replication to prevent development of HIV, drug resistance and treatment failureRestoration/ preservation of immunologic functionReduction of HIV-related morbidity and mortalityImprovement of the patients quality of lifePrevention of onw

8、ard transmission of HIV infectionGoals of ARTUniversity of Nairobi ISO 9001:2021 11Indicated in all HIV-positive adults and adolescents with the following:WHO clinical stage 1 or 2 and a CD4 count 350 cells/mm3,WHO clinical stage 3 or 4 regardless of CD4 count,HIV and TB co-infection regardless of t

9、he CD4 count, HIV/HBV co-infection with evidence of active liver disease.Indications of ARTUniversity of Nairobi ISO 9001:2021 12Recommended first-line antiretroviral regimens in treatment of naive adults and adolescents are:TDF + 3TC + EFV or NVP or AZT + 3TC + NVP or EFVFirst line ART regimensUniv

10、ersity of Nairobi ISO 9001:2021 13Treatment failure ClinicalImmunological Virological Inability to tolerate a drug because of adverse effectsChanging to second lineUniversity of Nairobi ISO 9001:2021 14Recommended second-line for patients failing first line therapySecond line ART regimensUniversity

11、of Nairobi ISO 9001:2021 15First-line Second-line TDF + 3TC + EFV or NVPAZT + 3TC + LPV/r or ATV/rAZT + 3TC + EFV or NVPTDF + 3TC + LPV/r or ATV/rd4T + 3TC + EFV or NVPTDF + 3TC + LPV/r or ATV/rMTCT accounts for more than 90% of pediatric HIV infection.Risk factors for MTCT:Maternal (high viral load

12、, advanced HIV disease, mixed feeding )Obstetric (Vaginal delivery, prolonged rupture of membranes 4 hours, placental infection)Infant (prematurity 37 weeks, low birth weight, oral candidiasis)MTCTUniversity of Nairobi ISO 9001:2021 16Prevention of HIV Infection among all women of reproductive age g

13、roup from getting HIVPrevention of unintended pregnancies among HIV-positive womenEffective interventions to reduce HIV transmission to infants during pregnancy, labor, delivery and post.Chronic care and support for the HIV-infected women, their infants, partners and familiesInterventions to reduce

14、MTCTUniversity of Nairobi ISO 9001:2021 17When to start:CD4 350 cells/mm3 irrespective of clinical symptoms ORWHO clinical stage 3 or 4 irrespective of CD4 cell countWhat to start:As adult/adolescent first-lineAZT preferred but TDF acceptableEFV included as a NNRTI option (not in first trimester)Inf

15、ants: NVP, 3TC or AZT. PMTCT ART regimensUniversity of Nairobi ISO 9001:2021 18Indications for PEPOccupational exposure (healthcare workers, police)After RTA where there has been exposure to other peoples bloodDiscordant couples following condom burstsRape PEPUniversity of Nairobi ISO 9001:2021 19AZ

16、T/3TC: 1 bd for 28 days TDF/3TC: 1 od for 28 daysAdd Alluvia/ Kaletra: 2 bd for 28 days in case of high riskGiven at earliest possible opportunity, within 1-72 hours of exposureUse fixed dose combination to enhance adherencePEP regimensUniversity of Nairobi ISO 9001:2021 20Studies carried out to evaluate efficacy iPrEx study Preexposure Prophylaxis InitiativeMultinational (Peru, Ecuador, South Africa, Brazil, Thailand, United State