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Lecture 24

by: Nathaniel Bautz

Lecture 24 MICROBIO 160

Nathaniel Bautz
GPA 2.9
MICROBIO 160 - Biology of Cancer and AIDS
Mitchell Walkowicz

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About this Document

Here are the notes to lecture 25
MICROBIO 160 - Biology of Cancer and AIDS
Mitchell Walkowicz
Class Notes
25 ?




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This 3 page Class Notes was uploaded by Nathaniel Bautz on Monday April 20, 2015. The Class Notes belongs to MICROBIO 160 at University of Massachusetts taught by Mitchell Walkowicz in Spring2015. Since its upload, it has received 98 views. For similar materials see MICROBIO 160 - Biology of Cancer and AIDS in Biology at University of Massachusetts.


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Date Created: 04/20/15
LECTURE 25 TREATING AIDS 0 90 Goals of HIV Treatment gt HIV therapy should I Prolong life and improve quality of life I Suppress HIV levels below the limit of detection or as low as possible for as long as possible I Optimize and extend the use of current therapy I Minimize drug toxicity and manage side effects and drug interactions When to Start Antiretroviral Treatment gt What s happening with your HIV viral load gt What s happening with measures of your immune health particularly CD4 cell counts gt What s happening with your general health status such as symptoms of HIV disease or recurrent health conditions despite treatment gt Generally treatment is started when CD4 cells are lt3500mm3 and viral load is gt55000mm3 of blood although advice varies slightly between countries Major Classes of Antiretroviral Drugs gt Reverse transcriptase RT inhibitors I Nucleosidenucleotide RT inhibitors or analogues I Non nucleoside RT Inhibitors gt Protease inhibitors gt Entry and fusion inhibitors gt Integrase inhibitors gt Multidrug combination products Fusion or Entry Inhibitors gt Fuzeon gt Selzentry gt Vicriviroc amp PR0140 gt TNX355 Atripla Atripla is a tablet that contains three antiretroviral drugs ARVs used to fight HIV Atripla is taken as one tablet once a day Atripla was approved in 2006 as an ARV for adults with HIV infection The drugs in Atriple are a nonnucleoside reverse transcriptase inhibitor efavirenz and two nucleoside analog reverse transcriptase inhibitors emtricitabine and tenfovir What is Combination Therapy HAART gt Taking two or more antiretroviral drugs at the same time vastly reduces the rate at which resistance develops gt Highly Active Antiretroviral Therapy HAART is used to describe a combination of three or more antiHIV drugs gt The most common combination of drugs used in HAART today includes 2 NRTIs with 1 NNRTI or PI gt The number of pills can range from as few as 1 to as many as 16 I Various HAART Combinations VVVV 0 AZT I 3TC I Abacacir ABC 393 Possible side effects of HAART include VVVVVVVVVV Liver Problems Diabetes Anemia Abnormal Fat Distribution lipodystrophy syndrome High Cholesterol Increased bleeding in patients with hemophilia Decreased bone density Skin rash Pancreatitis in ammation of the pancreas Nerve Problems Life Expectancies in Patients Taking Combination Antiretrovirals gt gt HIV survival is improving in wealthy countries and a 20 year old starting combination antireoviral therapy can expect to live another 43 years according to an industryfunded Lancet study Using cohorts from Canada Europe and the US 43600 strong researchers found that the years of life remaining for a 20yearold starting therapy increased from 36 in the 199699 period to almost 50 years in the 200305 period However those acquiring HIV through inj ectiondrug use and those starting treatment at lower CD4 cell counts had much higher mortality rates Mother to Child Transmission MTCT gt gt gt gt gt In 2005 700000 children under 15 became infected with HIV mainly through MTCT 90 of these MTCT infections occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival Pregnant women who receive a course of the antiretroviral drug zidovudine AZT had a twothirds lower risk of transmitting HIV than those who tool a placebo UNAIDS 2012 report significant gains in reducing MTCT in several African countries A number of studies have shown that the protective benefit of AZT or HAART is diminished when babies continue to be exposed to HIV through breastfeeding Goals Quality of Life Issues gt gt gt gt Reducing viral load as low as possible preferably below the level of detection should be an important goal of therapy Successful longterm use of therapies is more important than shortterm gains The use of treatment that is only partly effective speeds the development of viral resistance Using a drug exactly as prescribed is critical to success I The ability to tolerate side effects I Drug interactions I The demands of a particular regimen 393 When is it Time to Change Therapies The Federal Guidelines recommend that people switch therapies when I Detectable HIV levels after being undetectable I HIV levels remain detectable after 46 months of starting antiHIV therapy I Persistent decreases in CD4 cell counts I Intolerable side effects occur I Adherence is poor I There is less than a 05075 log3to6fold reduction in HIV levels after four weeks or less than one log after eight weeks of staring antiHIV therapy I Symptoms of HIV disease occur andor I A threefold or greater increase in HIV levels from their lowest levels


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