HIV

1. TREATMENT OF HIV INFECTIONTREATMENT OF HIV INFECTION
BY…..SANJAY KR. CHAUDHARY.BY…..SANJAY KR. CHAUDHARY.
Final year student (M.B.B.S.) UPRIMS&RFinal year student (M.B.B.S.) UPRIMS&R

2.  GENERAL MEASURES-GENERAL MEASURES-
 Balanced dietBalanced diet
 Quit smoking and intake of alcohalQuit smoking and intake of alcohal
 Adequate restAdequate rest
 Practice of safer sex to avoid infection ofPractice of safer sex to avoid infection of

3. ANTIRETROVIRAL DRUGSANTIRETROVIRAL DRUGS
1.NUCLEOSIDE REVERSE TRANSCRIPTASE1.NUCLEOSIDE REVERSE TRANSCRIPTASE
INHIBITOR(NRTI)INHIBITOR(NRTI)
 MECHANISMMECHANISM-- these active nucleoside incorporate into viral DNAthese active nucleoside incorporate into viral DNA
and cause premature chain terminationand cause premature chain termination
 Eg- side effectEg- side effect
 Zidovudine anemia, hyperglycemia,nausea .Zidovudine anemia, hyperglycemia,nausea .
 LamivudineLamivudine
 Emtricitabine hepatotoxicity .Emtricitabine hepatotoxicity .
 Abacavir hypersensitivity reaction, fever etc.Abacavir hypersensitivity reaction, fever etc.
 Tenofovir osteomalacia.Tenofovir osteomalacia.

4.  Mechanism-Mechanism-it bind directly to reverseit bind directly to reverse
transcriptase enzyme and inhibit its functiontranscriptase enzyme and inhibit its function
 Highly active against HIV-1 but not against HIV-2Highly active against HIV-1 but not against HIV-2
 Eg- Side effectEg- Side effect
 Nevirapine skin rash, hepatotoxicity.Nevirapine skin rash, hepatotoxicity.
 Efavirenz rash, dysphoria, drowsiness.Efavirenz rash, dysphoria, drowsiness.
 Etravirine rash, nausea.Etravirine rash, nausea.
 Rilpivirine nausea, dizziness.Rilpivirine nausea, dizziness.

5. 4.PROTEASE INHIBITOR4.PROTEASE INHIBITOR
MECHANISMMECHANISM--inhibit protease enzyme, soinhibit protease enzyme, so
inhibit assembly of virus before its releaseinhibit assembly of virus before its release
Eg-Eg-
•IndinavirIndinavir
•RitonavirRitonavir
•LopinavirLopinavir
•SaquinavirSaquinavir
•NelfinavirNelfinavir
•SE-SE-
•hyperglycemiahyperglycemia
•raised cholesterolraised cholesterol

6. 5.CCR5 INHIBITORS5.CCR5 INHIBITORS
MechanismMechanism--bind to host cell throughbind to host cell through
CCR5 receptorsCCR5 receptors
Eg-Eg-
MaravirocMaraviroc
FUSION INHIBITORSFUSION INHIBITORS
Mechanism-Mechanism- block initial fusion of HIVblock initial fusion of HIV
with cell surface receptorswith cell surface receptors
Eg-Eg-
EnfuvirtideEnfuvirtide
Drawback-Drawback- not active against HIV-2not active against HIV-2

7. 6. INTEGRASE INHIBITOR6. INTEGRASE INHIBITOR
 Mechanism of action-Mechanism of action- act by blocking theact by blocking the
action of the HIV integrase enzyme.action of the HIV integrase enzyme.
 Eg. ToxicityEg. Toxicity
 Raltegravir Nausea,headache,diarrheaRaltegravir Nausea,headache,diarrhea
 Elvitegravir Diarrhea,nausea etc.Elvitegravir Diarrhea,nausea etc.
 Dolutegravir Insomnia,headache.Dolutegravir Insomnia,headache.

8. WHAT IS ARTWHAT IS ART

9. Antiretroviral Therapy (ART)Antiretroviral Therapy (ART)
 ART is the combination of different classes ofART is the combination of different classes of
ARV drugs.ARV drugs.
 - to achieve maximal & most durable- to achieve maximal & most durable
suppression of viral replication.suppression of viral replication.
 - to prevent emergence of drug resistant- to prevent emergence of drug resistant
mutants.mutants.
 - to improve survival & quality of life.- to improve survival & quality of life.

10. Before ART & after 1 year ARTBefore ART & after 1 year ART

11. GOALS OF ARTGOALS OF ART
GOALS PRINCIPLE
Clinical To prolong life & improve quality of life.
Virological Greatest possible reduction in viral load, as long as possible to
halt disease progression & to prevent or delay resistance.
Immunological Immune reconstitution is both :
1. Quantitative(CD4 within normal range)
2. Qualitative (Pathogen specific immune response)
Therapeutic Rational sequencing of drugs to achieve previous three goals
while :
1. Maintaining future therapeutic options.
2. Minimising drug toxicities & side effects.
3. Maximising treatment adherence.

12.  Use of highly active antiretroviral therapy isUse of highly active antiretroviral therapy is
successful in reducing morbidity in HIV patientssuccessful in reducing morbidity in HIV patients
and improving quality of lifeand improving quality of life
 HAART indicates combination of drugs so as toHAART indicates combination of drugs so as to
achieve the goalsachieve the goals
 Suppresion of viral loadSuppresion of viral load
 Restoration and preservation of immune functionRestoration and preservation of immune function

13. Indications for the Initiation of Antiretroviral Therapy in Patients with HIV Infection
I. Acute infection syndrome
II. Chronic infection
A. Symptomatic disease (including HIV-
associated nephropathy)
B. Asymptomatic disease
1. CD4+ T cell count <500/La
2. Pregnancy
III. Postexposure prophylaxis

21. COMBINATION FORMULA OFCOMBINATION FORMULA OF
ANTIRETROVIRAL DRUGSANTIRETROVIRAL DRUGS

22. MANAGEMENT DURINGMANAGEMENT DURING
PREGNANCYPREGNANCY EfavirenzEfavirenz - avoided in 1- avoided in 1stst
trimestertrimester
 Standard recommendation to prevent MCTCStandard recommendation to prevent MCTC
of HIV is use of oral ZDV throughout antenatalof HIV is use of oral ZDV throughout antenatal
period ( atleast from 28 weeks onwards)period ( atleast from 28 weeks onwards)
 Single doseSingle dose nevirapinenevirapine regimen administeredregimen administered
intrapartum to mother & withing 72 hrs ofintrapartum to mother & withing 72 hrs of
delivery to baby is not recommemded as itdelivery to baby is not recommemded as it
reduces MCTC by only abt 50%reduces MCTC by only abt 50%
 Anteretroviral prophylaxis should be offered toAnteretroviral prophylaxis should be offered to
reduce the chances of perinatal transmission.reduce the chances of perinatal transmission.

23. MANAGEMENT DURINGMANAGEMENT DURING
PREGNANCYPREGNANCY
Time of Administration Zidovudine Regimen
Antepartum 100 mg orally five times daily, initiated
at 14 to 34 weeks and continued
throughout the pregnancy.a
Intrapartum During labor, intravenous zidovudine in
a 1-hour initial dose of 2 mg/kg,
followed by a continuous infusion of 1
mg/kg/hr until delivery.b
Neonate Begin at 8 to 12 hours after birth, and
give syrup at 2 mg/kg every 6 hours for
6 weeks.c

24. PROPHYLAXIS IN AIDSPROPHYLAXIS IN AIDS
 Tetanus/diphtheria vaccine Tetanus/diphtheria vaccine
 Human papillomavirus vaccine for HIV-infectedHuman papillomavirus vaccine for HIV-infected
women age 26 years or less. women age 26 years or less.
 Haemophilus influenzae type b vaccination Haemophilus influenzae type b vaccination
 Papanicolaou smears every 6 months for womenPapanicolaou smears every 6 months for women
 Pneumocystis jiroveci prophylaxis Pneumocystis jiroveci prophylaxis
 Mycobacterium avium complex prophylaxis Mycobacterium avium complex prophylaxis
 CMV prophylaxisCMV prophylaxis
 For all cases of HIV NEUROPATHY-For all cases of HIV NEUROPATHY- START ARTSTART ART

26. GUIDELINES FOR PEPGUIDELINES FOR PEP
 A combination of two nucleoside analogueA combination of two nucleoside analogue
reverse transcriptase inhibitorreverse transcriptase inhibitor
Given for 4 weeks forGiven for 4 weeks for LESS SEVERELESS SEVERE
EXPOSURES.EXPOSURES.
 A combination of two NRTI + a third drugA combination of two NRTI + a third drug
Given for 4 weeks forGiven for 4 weeks for MORE SEVEREMORE SEVERE
EXPOSURES.EXPOSURES.

29. THANK
YOU