Antiretroviral Therapy: Dr. Samuel Mwaniki (Bpharm., MSC Tid, Uon)

ANTIRETROVIRAL
THERAPY
Dr. Samuel Mwaniki
(BPharm., MSc TID, UoN)
University of Nairobi
http://www.uonbi.ac.ke
ISO 9001:2008
Certified
Definition of ART
Treatment with antiretroviral medicines,

against the retrovirus (HIV), which
resides and multiplies within the human
body
HIV; etiological agent of AIDS
Hallmark of HIV; RNA virus that
transcripts DNA from RNA via the
Reverse Transcriptase enzyme
ISO 9001:2008
Certified
Classification of
Antiretroviral
medicines
NRTI (Nucleoside Reverse Transcriptase
Inhibitors)
NtRTI (Nucleotide Reverse Transcriptase
Inhibitors)
NNRTI ( Non-Nucleoside Reverse Transcriptase
Inhibitors)
PI (Protease Inhibitors)
Entry Inhibitors
Integrase Inhibitors
ISO 9001:2008
Certified
NRTIs
Abacavir (ABC)
Didanosine (DDI)
Emtricitabine (FTC)
Lamivudine (3TC)
Stavudine (D4T)
Zidovudine (AZT)
Tenofovir (TDF) - NtRTI
ISO 9001:2008
Certified
NNRTIs
Efavirenz (EFV)
Nevirapine (NVP)
Etravirine
Rilpivirine
ISO 9001:2008
Certified
PIs
Atazanavir (ATV)
Durunavir (DRV)
Fosamprenavir (f-APV)
Indinavir (IDV)
Lopinavir (LPV)
Nelfinavir (NFV)
Ritonavir (RTV)
Saquinavir (SQV)
Tripranvir (TPV)
ISO 9001:2008
Certified
Other ARVs
Entry inhibitors: Enfuvirtide,

Maraviroc
Integrase inhibitors:
Raltegravir, Elvitegravir
Maturation inhibitors:
Beviramat
ISO 9001:2008
Certified
Uses of ART
ART (Antiretroviral Therapy)

PMTCT (Prevention of Mother To
Child Transmission)
PEP (Post Exposure Prophylaxis)
PrEP (Pre Exposure Prophylaxis)
ISO 9001:2008
Certified
ART
Combines at least 3 ARVs from at

least 2 different classes.
Why combination?
Synergism
Reduced toxicity
Prevent resistance
ISO 9001:2008
Certified
ART Combinations
2 NRTI + 1 NNRTI
1 NRTI + 1 NtRTI + 1 NNRTI
2NRTI + boosted PI
1 NRTI + 1 NtRTI + boosted PI
3 NRTI (One must be Abacavir)
ISO 9001:2008
10 Certified
Goals of ART
Maximal and durable suppression of viral
replication to prevent development of HIV, drug
resistance and treatment failure
Restoration/ preservation of immunologic
function
Reduction of HIV-related morbidity and mortality
Improvement of the patients quality of life
Prevention of onward transmission of HIV
infection
ISO 9001:2008
11 Certified
Indications of ART
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.
ISO 9001:2008
12 Certified
First line ART

regimens
Recommended first-line
antiretroviral regimens in
treatment of naive adults and
adolescents are:
TDF + 3TC + EFV or NVP or
AZT + 3TC + NVP or EFV
ISO 9001:2008
13 Certified
Changing to second
line
Treatment failure
Clinical
Immunological
Virological
Inability to tolerate a drug
because
of
adverse
effects
ISO 9001:2008
14 Certified
Second line ART

regimens
Recommended second-line for patients
failing first line therapy
First-line
Second-line
TDF + 3TC + EFV or NVP
AZT + 3TC + LPV/r or

ATV/r
AZT + 3TC + EFV or NVP
TDF + 3TC + LPV/r or

ATV/r
d4T + 3TC + EFV or NVP
TDF + 3TC + LPV/r or

ATV/r
ISO 9001:2008
15 Certified
MTCT
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)
ISO 9001:2008
16 Certified
Interventions to
reduce MTCT
Prevention of HIV Infection among all women
of reproductive age group from getting HIV
Prevention of unintended pregnancies among
HIV-positive women
Effective 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
ISO 9001:2008
17
Certified
PMTCT ART regimens

When to start:
CD4 350 cells/mm3 irrespective of clinical
symptoms OR
WHO clinical stage 3 or 4 irrespective of CD4 cell
count
What to start:
As adult/adolescent first-line
AZT preferred but TDF acceptable
EFV included as a NNRTI option (not in first trimester)
Infants: NVP, 3TC or AZT.
ISO 9001:2008
18 Certified
PEP
Indications for PEP
Occupational exposure (healthcare
workers, police)
After RTA where there has been exposure
to other peoples blood
Discordant couples following condom
bursts
Rape
ISO 9001:2008
19 Certified
PEP regimens
AZT/3TC: 1 bd for 28 days

TDF/3TC: 1 od for 28 days
Add Alluvia/ Kaletra: 2 bd for 28 days in case
of high risk
Given at earliest possible opportunity, within
1-72 hours of exposure
Use fixed dose combination to enhance
adherence
ISO 9001:2008
20 Certified
PrEP
Studies carried out to evaluate efficacy

iPrEx study Preexposure Prophylaxis Initiative
Multinational (Peru, Ecuador, South Africa,
Brazil, Thailand, United States)
Effect of FTC/TDF compared with placebo on
reducing HIV acquisition among men and
transgender women who have sex with men
Disproportionately affected by the epidemic
ISO 9001:2008
21 Certified
Thank you
END
ISO 9001:2008
22 Certified

Antiretroviral Therapy: Dr. Samuel Mwaniki (Bpharm., MSC Tid, Uon)

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Antiretroviral Therapy: Dr. Samuel Mwaniki (Bpharm., MSC Tid, Uon)

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ANTIRETROVIRAL

Treatment with antiretroviral medicines,

Entry inhibitors: Enfuvirtide,

ART (Antiretroviral Therapy)

Combines at least 3 ARVs from at

First line ART

Second line ART

TDF + 3TC + EFV or NVP

AZT + 3TC + LPV/r or

AZT + 3TC + EFV or NVP

TDF + 3TC + LPV/r or

d4T + 3TC + EFV or NVP

TDF + 3TC + LPV/r or

PMTCT ART regimens

AZT/3TC: 1 bd for 28 days

Studies carried out to evaluate efficacy

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