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