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Highly Active Antiretroviral Therapy (HAART)
- - HIV as a chronic disease
- - Patient remains infectious
- - Requires three or four drugs to suppress virus and prevent resistant strains
- - compliance issues
- - goal is to suppress viral load to undetectable (below where lab can detect it)
- - requires management in HIV specialty clinic
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Nuceloside Reverse Transcriptase Inhibitors (NRTIs)
- - suppress synthesis of viral DNA
- - risk of lactic acidosis and hepatomegaly (symptoms include nausea, vomiting, abdominal pain, malaise, hyperventilation
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Zidovudine (Retrovir)(AZT)
- (NRTI)
- - can cause anemia and neutropenia requiring erythropoietin, granlocyte colony-stimulating factors
- - monitor CBC
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Didanosine (Videx)(DDI)
- (NRTI)
- - risk of pancreatitis, peripheral neuropathy
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Abacavir (Ziagen)
- severe hypersensitivity reactions
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Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- - Nevirapine (Viramune)
- - risk of rash (can evolve into Stevens-Johnson Syndrom)
- - Risk of hepatotoxicity (monitor ALT, AST, risk increased in chronic hepatitis pt)
- - induce CYP 450 Enzymes (reduces level of oral contraceptives, protease inhibitors)
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Protease Inhibitors
- Indinavir (Crixivan)
- - metabolic effects: hyperglycemia, fat redistribution, hyperlipidemia, osteoporosis
- - GI upset
- - CYP 450 Interactions:
- - levels increased by ketoconazole, clarithromycin, grapefruit juice
- - levels decreased by rifampin, phenytoin, carbamazipine, St Johns Wort
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