HAARTs

Indications to Start Thearpy:

CD4 ~350 (500 for USMLE) and viral load ~500000 copies

symptomatic patients with any CD4 count or viral load

pregnant (all patients, any stage, any CD4)

needle-stick to infected patient

Typical Regimens:

Tenofovir + Emtricitabine + Efavirenz

Tenofovir + Emtricitabine + Atazanavir (or darunavir)*

• small amount of Ritonavir is added to boost the level of the other protease inhibitors

An ARV regimen for a patient who is treatment-naive generally consists of a dual NRTI regimen administered in combination with a third active ARV drug from one of three drug classes: an INSTI, an NNRTI or a PI with a PK enhancer.

ARVs

1st line classes

Nucleoside analogue reverse transcriptase inhibitors (NRTI)

• examples: zidovudine (AZT), didanosine, lamivudine, stavudine, zalcitabine, Emtricitabine, Abacavir, Tenofovir

SEs:

Zidovudine - major and dose-limiting side effect is hematotoxicity - anemia. Myopathy 20%(proximal muscle weakness with reduced DTR and intact sensory exam),  lactic acidosis, headache, GI symptoms and increase in transaminases are aslo quite often.

Stavudine and didanosine - peripheral neuropathy and pancreatitis