3.  The Life Cycle of HIV www.thebody.com

4.  Step 1: Binding and Fusion  Drugs which affect this: › Fusion inhibitors › CCR5 Inhibitors www.thebody.com

5.  Step 2: Reverse Transcription  Drugs which affect this: › (Nucleoside and Non-nucleoside) Reverse Transcriptase inhibitors www.thebody.com

6.  Step 3: Integration  Drugs which affect this: › Integrase Inhibitors www.thebody.com

7.  Step 4: Transcription › Drugs which work here- none www.thebody.com

8.  Step 5: Assembly  Drugs which work here: › Protease inhibitors www.thebody.com

9.  Step 6: Budding › Drugs which work here- none www.thebody.com

11.  Zidovudine in the 1990s  NRTIs? NNRTIs? PIs? Integrase Inhibitors?  Typical Regime: Backbone+agent

12.  Typical backbone › 2 NRTIs  Kivexa  Truvada  Typical third agent › 1 NRTI or 1 PI  Efavirenz  Darunavir/r, Lopinavir/r

13.  Depends on formulation....  Tenofovir+ Emtricitabine+ Efavirenz › 1 Tablet (Atripla) OD › 2 Tablets (Truvada+Sustiva) OD › 3 Tablets (all separate) OD

14.  Depends on regime...  Truvada + PI › Darunavir+ritonavir= 3 tablets in total OD › Lopinavir+ ritonavir= 3 OM, 2 ON

15.  Truvada (Tenofovir+ Emtricitabine) › Little felt by patient › Renal and bone toxicity  Kivexa (Abacavir+Lamivudine) › Hypersensitivity › Raised cardiovascular risk

16.  Nevirapine › Rash › Hepatic failure › Stevens Johnson  Efavirenz › Rash › Acute + long term CNS toxicity

17.  Ritonavir › Diarrhoea  In general › Rash › Nausea › Headache

19.  Who  Why & When  What

20.  4 risk categories › HIV +ve, suppressed viral load › HIV +ve, raised viral load › Unknown, high prevalence › Unknown, low prevalence

21.  No RCTs because of ethical concerns  From needle stick data, presumed 80% efficacious if started within 72 hours  Data do not support delayed seroconversion

22.  Truvada + Kaletra (Lopinavir+ ritonavir) › Expect diarrhoea and nausea, give loperamide and metoclopramide › Safe in pregnancy  Cautions › Where source patient is known to be resistant › Ritonavir is an enzyme inducer