Treatment Modalities In HIV/AIDS Patients
People requiring treatment
- Adults,children and pregnant women with HIV infection
- CD4 counts of < 350 cells/mm3
- Regardless of presence or absence of clinical features
ART given
|
Patients |
Treatment options |
|
Adults and adolescents |
MT or TDF+ 3TC or FTC + EFV or NVP |
|
Pregnant women |
AZT + 3TC + EFV or NVP |
|
HIV/TB co infection |
AZT or TDF +3 TC or FTC +EFV |
|
HIV/HBV co infection |
TDF +3 TC or FTC +EFV OR NVP |
POST-EXPOSURE PROPHYLAXIS :
- Basic (2 drug) regimen (for low risk)
- Zidovudine 300 mg + Lamivudine 150 mg – Twice daily for 4 weeks
- Expended (3 drug) regimen (for high risk)
- Zidovudine 300 mg + Lamivudine 150 mg – Twice daily+ Indinavir 800 mg (or another PI) Thrice daily All for 4 weeks.
DRUGS AGAINST HIV:
Attachment inhibitor
- Dextrin 2 SO4 (D2S) Inhibit the binding of HIV-1 gp 120 with CD4 cells.
Coreceptor antagonists CCR5 is a coreceptor involved in the entry of the HIV virus into the cell
- Maraviroc binds to CCR5, preventing HIV from binding to this receptor.
- Vicriviroc
- Aplaviroc
Fusion inhibitors
- Enfuvirtide – targets multiple sites in gp 41 and gp 120.
- Tifuvirtide – 2nd generation HIV fusion inhibitor.
lntegrase inhibitors
- Raltegravir first integrase inhibitor (FDA approved)
- used in combination with other antiretroviral agents in treatment of patients with ongoing HIV-1 replicaiton
Elvitegravir
Maturation inhibitors
- Inhibit the development of HIV’s internal structures in a new virus.
- Bevirimat
- Vivecon
Zinc finger inhibitors
- Azodicarbonamide
Monoclonal antibodies
- Restrict HIV entry – CD4 blocker:
- Ibalizumab
Non-nucleoside reverse transcriptase inhibitor:
Efavirenz
Protease inhibitors:
- Potent inhibitors of CYP3A4
- Ritonavir and lopinavir
- Saquinavir is a weak inhibitor of CYP3A4
- Most HIV protease inhibitors are
- Substrates for P-glycoprotein drug transporter (P-gp)
- Efflux pump encoded by the mdr 1 gene
- Indinavir and atazanavir
- Can cause indirect hyperbilirubinemias with overt jaundice.
New drugs in HIV infection
- Etravirine is recently approved NNRTI.
- Second generation NNRTI
- Effective against HIV resistant to first generation NNRTI (Efavirenz, Delaviridine, Nevirapine).
Fusion inhibitors (Entry inhibitors)
Enfluviritide
- binds to Gp41 subunit of HIV envelop protein
- inhibits the fusion of viral and host cell membrane.
Maraviroc
- CCRS Co-receptor antagonist
- Only active against “CCR – 5 – tropic virus” which tends to predominate early in infection.
Treatment during Pregnancy
Zidovudine
- treatment from the beginning of second trimester through delivery
- of infant for 6 weeks following birth
- decreases the rate of transmission from 22.6% to < 5%.
Single dose of nevirapine(200 mg)
- given to the mother at the onset of labor
- Followed by a single dose(2 mg/kg)to the newborn within 72 hours of birth
- decreased transmission by 50%
Antiretroviral agents in pregnancy
Recommended Alternative
NRTIs
- Zidovudin
- Diadanosine
- Lamivudine
- Emtricitabine
- Stavudine
- Abacavir
NNRTIs
- Nepirapine
Pis
- Nelfinavir
- Indinavir
- Squinavir
- Lopinavir/ritonavir
TREATMENT MODALITIES FOR HIV RELATED DISEASES:
Drug of choice for diarrhea in AIDS :.
- Octreotide(Somatostatin analogue)
Interferon
- Glycoprotein, produced by many mammalian cells
- Used in the treatment of
- hepatitis
- papillomaviruses
- hairy-cell leukemia
- AIDS-related Kaposi’s sarcoma
AIDS patients with pulmonary tuberculosis:
- INH ,Ethambutol ,rifabutin & Pyrazinamide can be given
- Rifampicin is contraindicated as it induces metabolism of ritonavir, indinavir and saquinavir
AIDS with bronchiolitis:
- Antibiotics are not usually used in the treatment Bronchiolitis who are previously healthy
- But Ribavarin shortens the duration of treatment in patient who have →
- Immunodeficiency
- Congenital heart disease
- Chronic lung disease
AIDS patient presents with fistula – in- ano can be treated with seton
CMV infection in AIDS patients:
- It is usually treated by antivirals such as ganciclovir or foscarnet,
- Which can be taken orally, intravenously
- Injected directly into the eye (intravitreal injection).
- Fomivirsen is the first antisense drug as an intraocular injection for the treatment of cytomegalovirus retinitis.
Exam Question
- Octreotide is the drug of choice for diarrhea in AIDS
- Interferon is a Glycoprotein, produced by many mammalian cells, and used in the treatment of hepatitis, papillomaviruses, hairy-cell leukemia and AIDS-related Kaposi’s sarcoma
- Raltegravir is an integrase inhibitor which is used in combination with other antiretroviral agents in treatment of patients with ongoing HIV-1 replicaiton.
- The drug efavirenz inhibits HIV 1 reverse transcriptase
- Ritonavir, Didanosine, Zidovudine comes under anti-HIV agents
- Rifampicin is contraindicated in AIDS as it induces metabolism of ritonavir, indinavir and saquinavir
- Protease inhibitor in HIV is Potent inhibitors of CYP3A4
- Saquinavir is a weak inhibitor of CYP3A4
- All protease inhibitors are substrates for P glycoprotein coded by MDR gene.a
- Zidovudine given for HIV in preganancy because Decreases the risk of vertical transmission
- For the prevention of parent to child transmission of HIV, the NACO’s recommendation is to give Niverapine 200 mg in active about to mother and syrup niverapine 2 mg/kg body weight to newborn with 72 hours of delivery
- Ribavarin is the drug of choice for bronchitis with HIV
- AIDS patient presents with fistula – in- ano can be treated with seton
- The drug of choice for cytomegalovirus retinitis in HIV patients are ganciclovir or foscarnet
- Post exposure prophylaxis [PEP] for HIV should be given for a minimum period of 4 weeks
- Nevirapine drug is given as a single dose to prevent mother to child HIV transmissiona
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