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Presented by: Siti Rohaizah bt Othman. Arv DRUGS AVAILABLE IN UMMC Combivir (Lamivudine + Zidovudine) Stocrin (Efavirenz 600mg) Kaletra (Lopinavir 200mg.

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Presentation on theme: "Presented by: Siti Rohaizah bt Othman. Arv DRUGS AVAILABLE IN UMMC Combivir (Lamivudine + Zidovudine) Stocrin (Efavirenz 600mg) Kaletra (Lopinavir 200mg."— Presentation transcript:

1 Presented by: Siti Rohaizah bt Othman

2 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 study Atazanavir (200mg)-under study

3 OVERVIEW What is HIV? What is AIDS? How do you get infected? How does treatment work? Treatment Options When to Start Patient Counselling

4 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.

5 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.

6 OPPORTUNISTIC INFECTIONS

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8 Transmission

9 Transmission YOU CANNOT GET HIV FROM; HUGGING, MOSQUITO BITES, SNEEZING, SHAKING HANDS AND SHARING FOOD

10 Nucleoside analog reverse transcriptase inhibitors (NRTIs) for HIV/AIDS Eg.Combivir,(Lamivudine/Zidovudine),d4T(Stavu dine).3TC(lamivudine), TEN_EM(tenofovir/emtricitabine) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV/AIDS E.G: Efavirenz, Nevirapine, HOW THE TREATMENTS WORK ?

11 Protease inhibitors (PIs) Eg. Indinavir Sulfate, Ritonavir Integrase Inhibitor Raltegravir Fusion Inhibitor Maraviroc, enfuvirtide

12 What to use in firstline therapy? 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

13 What to use in second-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

14 UMMC guidelines Examples of some possible combinations ◦ Stavudine +Lamivudine+Efavirenz ◦ Kaletra+Indinavir+ Ritonavir ◦ Combivir(Zidovudine+Lamivudine)+Efavirenz ◦ Combivir(Zidovudine+Lamivudine)+Indinavir +Ritonavir

15 Hiv Life cycle

16 When to start arv?

17 HIV Symptoms CD4 cells/ μ l Start Treatment YesAnyYes <350Yes No>=350Yes

18 Laboratory monitoring CD4 cell–count test HIVRNA (viral-load) Drug toxicity

19 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.

20 Anaemia Rash Liver damage-can be seen as dark colored stools or urine or yellow coloration of eye whites. Hyperglycemia and insulin resistance Lactic acidosis-nausea, vomiting, belly pain Dyslipidemia Osteonecrosis Fat redistribution

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22 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

23 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.

24 references The Sanford Guide To Antimicrobial Therapy 2010 Package insert http://www.aids.gov.nih.my UMMC guidelines


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