Antivirals

• HAART when CD4+ <350-500 or Viral Load ≥ 55K
  • 2+1 Therapy (NRTI + Protease Inhibitor or NNRTI)
• Pre-Exposure Prophylaxis (PrEP): Tenofovir Disoproxil and Emtricitabine
• Post-Exposure Prophylaxis (PEP): AZT, Lamivudine and nelfinavir for 4 weeks
  • Emtricitabine + Tenofovir Disoproxil + (Darunavir or Dolutegravir)
• Pregnant
  • Efavirenz and TDF
• Nucleoside RTIs (NRTIs)
  • MOA: Inhibits HIV DNA synthesis from RNA template by terminating DNA chain elongation
    • Competitive nucleoside/tide RT inhibitor
  • Abacavir (ABC)
    • SE: Lethal if HLA-B5701, test them, SJS
  • Emtricitabine (FTC)
  • Lamivudine (3TC)
    • HBV activity but different dosing
    • Minimal toxicity
  • Stavudine (d4T) and Didanosine (ddl)
    • SE: Peripheral neuropathy and Pancreatitis
  • Tenofovir Disoproxil Fumerate (TDF)
    • HBV activity
    • SE: Nausea, Fanconi syndrome, Renal insufficiency, tubular nephrotoxicity, Osteoporosis
      • Get DEXA in Men ≥50, Post-menopausal, RF
  • Tenofovir Alafenamide (TAF)
    • Better than TDF
    • SE: Nausea, More weight gain, Less Renal insufficiency, Osteoporosis
      • Get DEXA in Men ≥50, Post-menopausal, RF
  • Zidovudine (AZT)
    • SE: Nausea, headache, anemia and Granulocytopenia, lactic acidosis, lipodystrophy, myopathy
• Nonnucleoside RTIs (NNRTIs)
  • MOA: Inhibits HIV DNA synthesis from RNA template by terminating DNA chain elongation
    • Allosteric RT Inhibitor
  • Nevirapine
    • Hypersensitivity, rash, hepatitis
  • Ertavirine
  • Efavirenz
    • SE: Sleep, confused, psychotic, vivid dreams, rash, dyslipidemia
  • Rilpivirine
    • CI: PPIs (needs food and gastric acid for absorption)
  • Doravirine
• Protease Inhibitors
  • MOA: Inhibits HIV polyprotein cleavage
    • General: Hyperlipidemia, Hyperglycemia
  • Atazanavir
  • Darunavir
  • Lopinavir
  • Indinavir
    • SE: Nephrolithiasis, hyperbilirubinemia
• Integrase Inhibitors
  • MOA: Inhibits HIV DNA integration into host genome
  • Dolutegravir
  • Elvitegravir
  • Bictegravir
  • Raltegravir
• Fusion Inhibitors
  • MOA: Inhibits HIV fusion with target cell membrane by binding to HIV gp41
  • Enfuvirtide
• CCR5 Antagonist
  • MOA: Inhibits HIV entry by allosteric blocking of HIV gp120 interaction with CCR5 (tropism testing required)
  • Maraviroc
• Pharmacokinetic Boosters
  • Ritonavir
    • Low dose added to boost other Protease Inhibitor drug level
      • (Darunavir or Dolutegravir)
  • Cobicistat