HIV

At least 3 antiretrovirals

Preferred choice;

2 NRTIs with an NNRTI

- tenofivir, emtricitabine & efavirenz

- abacavir, lamivudine & efavirenz

Alternative choice;

2 NRTIs with a boosted PI

- didanosine, lamivudine & lopinavir/ritonavir

- didanosine, emtricitabine & fosamprenavir/ritonavir

- zidovudine, lamivudine & aztanavir/ritonavir

3 NRTIs

Inhibit viral reverse transcriptase by acting as a substrate

Abacavir

Didanosine

Emtricitabine

Lamivudine

Stavudine

Tenofovir

Zidovudine

Lactic acidosis: rare but severe

Hepatic steatosis

Lipoatrophy and lipodystrophy syndrome: buffalo hump and paunch

Inhibit viral reverse transcriptase by binding to it's active site

Efavirenz

Nevirapine

Etravirine

Rash within first 2-6 weeks: treat with antihistamines and emollients

CNS disturbances: sedation, vivid dreams, worst in first 4 weeks, avoid driving if affected

Hepatitis: monitor LFTs every 2 week for first two months

Bind to the active site of the HIV protease enzyme to prevent maturation of the newly produced virions

Atazanivir

Darunavir

Fosamprenavir

Indinavir

Lopinavir

Nelfinavir

Ritonavir

Saquinavir

Tipranavir

Hyperglycaemia

Hyperlipidaemia

Lipodystrophy

• Enfuvirtide: fusion inhibitor - binds to gp41 HIV protein
• - s/c injection bd

• Maraviroc: binds to CCR5 a co receptor on CD4 cells
• - bd tabs

Insomnia

Headache

GI disturbances

Asthenia

Injection site reactions and hypersensitivity with enfuvirtide

Blocks integrase enzyme - prevents viral incorporation of DNA into host DNA

Raltegravir

GI disturbances

Lipodystrophy syndrome

Asthenia

Prevent/treat opportunistic infection

Improve quality and quantity of life

Prevent immune system deterioration

Restore immune function

Relieve symptoms where the underlying cause is unknown