antiretroviral therapy ppt presentation - university health ：抗逆转录病毒治疗ppt演示-大学健康

ANTIRETROVIRAL THERAPY,Dr. Samuel Mwaniki(BPharm., MSc TID, UoN),University of Nairobi ISO 9001:2008 1 Certified http:/www.uonbi.ac.ke,Treatment 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 from RNA via the Reverse Transcriptase enzyme,Definition of ART,University of Nairobi ISO 9001:2008 2 Certified http:/www.uonbi.ac.ke,NRTI (Nucleoside Reverse Transcriptase Inhibitors)NtRTI (Nucleotide Reverse Transcriptase Inhibitors)NNRTI ( Non-Nucleoside Reverse Transcriptase Inhibitors)PI (Protease Inhibitors)Entry InhibitorsIntegrase Inhibitors,Classification of Antiretroviral medicines,University of Nairobi ISO 9001:2008 3 Certified http:/www.uonbi.ac.ke,Abacavir (ABC)Didanosine (DDI)Emtricitabine (FTC)Lamivudine (3TC)Stavudine (D4T)Zidovudine (AZT)Tenofovir (TDF) - NtRTI,NRTIs,University of Nairobi ISO 9001:2008 4 Certified http:/www.uonbi.ac.ke,Efavirenz (EFV)Nevirapine (NVP)Etravirine Rilpivirine,NNRTIs,University of Nairobi ISO 9001:2008 5 Certified http:/www.uonbi.ac.ke,Atazanavir (ATV) Durunavir (DRV)Fosamprenavir (f-APV)Indinavir (IDV)Lopinavir (LPV)Nelfinavir (NFV)Ritonavir (RTV)Saquinavir (SQV)Tripranvir (TPV),PIs,University of Nairobi ISO 9001:2008 6 Certified http:/www.uonbi.ac.ke,Entry inhibitors: Enfuvirtide, MaravirocIntegrase inhibitors: Raltegravir, ElvitegravirMaturation inhibitors: Beviramat,Other ARVs,University of Nairobi ISO 9001:2008 7 Certified http:/www.uonbi.ac.ke,ART (Antiretroviral Therapy)PMTCT (Prevention of Mother To Child Transmission)PEP (Post Exposure Prophylaxis)PrEP (Pre Exposure Prophylaxis),Uses of ART,University of Nairobi ISO 9001:2008 8 Certified http:/www.uonbi.ac.ke,Combines at least 3 ARVs from at least 2 different classes.Why combination?SynergismReduced toxicityPrevent resistance,ART,University of Nairobi ISO 9001:2008 9 Certified http:/www.uonbi.ac.ke,2 NRTI + 1 NNRTI1 NRTI + 1 NtRTI + 1 NNRTI2NRTI + boosted PI1 NRTI + 1 NtRTI + boosted PI3 NRTI (One must be Abacavir),ART Combinations,University of Nairobi ISO 9001:2008 10 Certified http:/www.uonbi.ac.ke,Maximal 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 onward transmission of HIV infection,Goals of ART,University of Nairobi ISO 9001:2008 11 Certified http:/www.uonbi.ac.ke,Indicated 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 the CD4 count, HIV/HBV co-infection with evidence of active liver disease.,Indications of ART,University of Nairobi ISO 9001:2008 12 Certified http:/www.uonbi.ac.ke,Recommended first-line antiretroviral regimens in treatment of naive adults and adolescents are:TDF + 3TC + EFV or NVP or AZT + 3TC + NVP or EFV,First line ART regimens,University of Nairobi ISO 9001:2008 13 Certified http:/www.uonbi.ac.ke,Treatment failure ClinicalImmunological Virological Inability to tolerate a drug because of adverse effects,Changing to second line,University of Nairobi ISO 9001:2008 14 Certified http:/www.uonbi.ac.ke,Recommended second-line for patients failing first line therapy,Second line ART regimens,University of Nairobi ISO 9001:2008 15 Certified http:/www.uonbi.ac.ke,MTCT accounts for more than 90% of pediatric HIV infection.Risk factors for MTCT:Maternal (high viral load, 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),MTCT,University of Nairobi ISO 9001:2008 16 Certified http:/www.uonbi.ac.ke,Prevention of HIV Infection among all women of reproductive age group 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 families,Interventions to reduce MTCT,University of Nairobi ISO 9001:2008 17 Certified http:/www.uonbi.ac.ke,When 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)Infants: NVP, 3TC or AZT.,PMTCT ART regimens,University of Nairobi ISO 9001:2008 18 Certified http:/www.uonbi.ac.ke,Indications for PEPOccupational exposure (healthcare workers, police)After RTA where there has been exposure to other peoples bloodDiscordant couples following condom burstsRape,PEP,University of Nairobi ISO 9001:2008 19 Certified http:/www.uonbi.ac.ke,AZT/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 adherence,PEP regimens,University of Nairobi ISO 9001:2008 20 Certified http:/www.uonbi.ac.ke,Studies carried out to evaluate efficacy iPrEx study Preexposure Prophylaxis InitiativeMultinational (Peru, Ecuador, South Africa, Brazil, Thailand, United States)Effect of FTC/TDF compared with place