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Current Concepts in HIV/AIDS A Pharmacy Perspective Carol Schneiderman, Pharm D Clinical Pharmacist, University of Arizona Objectives Discuss important clinical features of HIV disease in 2006 Identify the subclasses of antiretrovirals and list the primary approved combinations of antiretrovirals Identify common doses, food restrictions and adverse effects of the antiretroviral agents Interpret CD4 and viral load levels and correlate them with degree of illness and approach to treatment Discuss issues of adherence Acute Retroviral Syndrome Fever Fatigue Rash Headache Night Sweats Lymphadenopathy Pharyngitis Myalgia/Arthralgia GI Symptoms Oral Ulcers/Thrush Neurologic Symptoms 80-90% 70-90% 40-80% 32-70% 50% 40-70% 50-70% 50-70% 30-60% 10-20% 12% Treatment US DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents aidsinfo.nih.gov When to Treat With What? Antiretrovirals (ARVs) NRTI – Nucleoside/nucleotide reverse transcriptase Inhibitors NNRTI – Nonnucleoside Reverse Transcritase Inhibitors PI- Protease Inhibitors FI – Fusion Inhibitors Nucleosides/Nucleotides (NRTI) Retrovir Videx Zerit Epivir Hivid Ziagen Viread Emtriva Combivir Trizivir Truvada Epzicom zidovudine AZT didanosine ddI stavudine d4T lamivudine 3TC zalcitabine ddC abacavir ABC tenofovir TNF emtracitabine FTC Retrovir/Epivir Retrovir/Epivir/Ziagen Viread/Emtriva Ziagen/Epivir NRTIs All - Black Box warning – lactic acidosis Retrovir – nausea, headaches, muscle aches, anemia Videx – pancreatitis, peripheral neuropathy Zerit – lipodystrophy, peripheral neuropathy Ziagen – hypersensitivity syndrome Viread – nausea, headache, diarrhea Non-Nucleosides (NNRTI) Delavirdine – Rescriptor Nevirapine – Viramune Efavirenz - Sustiva NNRTIs All - Rash Viramune – increased incidence of acute hepatic events in women w/CD4 > 250 Sustiva - teratogenic in monkeys, CNS effects Some drug interactions Protease Inhibitors (PI) Saquinavir – Invirase/Fortovase Indinavir – Crixivan Ritonavir – Norvir Nelfinavir – Viracept Amprenavir – Lexiva Lopinavir/r – Kaletra Atazanavir – Reyataz Tipranavir – Aptivus TMC 114 PIs Fat Redistribution Hyperlipidemias Hyperglycemia GI Inolerance Elevated transaminase enzymes Increased bleeding in hemophilia Drug Interactions Reyataz – hyperbilirubinemia Aptivus® Tipranavir 500 mg bid with Norvir 100 mg bid Useful in salvage regimens Hepatic Events Rash – sulfonamide moiety Hyperlipidemia Hyperglycemia Fat Redistribution Multiple Drug Interactions Entry Inhibitors (EI) Fuzeon enfuvirtide (fusion inhibitor) T-20 EIs Injection Site Reactions Increased rate of bacterial pneumonia Hypersensitivity reaction The Past Why is it Hard to take ARVs? Adverse effects Pill Burden Consistency Drug Interactions Food Issues Food Issues Videx Sustiva Crixivan Viracept Invirase/Fortovase Kaletra Reyataz Aptivus Why is Adherence Important? Gotta Take Those Meds Resistance Patterns Adherence Strategies Assess Readiness Education Family/Friends Adherence Tools Pill Burden/Food Requirements Trust/Communication Monitoring AETC Clinical Consultants Stephen Klotz, MD Carol Schneiderman, PharmD 626-6887 Warmline 800 933-3413 PEPline 888 448-4911 Perinatal HIV Hotline 888 448-8765