count below 750 cells or down 50 from baseline therapy should be withdrawn o

Count below 750 cells or down 50 from baseline

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count below 750 cells or down 50% from baseline, therapy should be withdrawn. o Lactic acidosis with hepatomegaly and hepatic steatosis (fatty liver); nausea, vomiting, malaise, fatigue, anorexia, hyperventilation. Diagnosed with lactic acid level arterial. If high, to be d/c. o Myopathy: damage to muscle fibers with prolong use. o Hyperlipidemia, insulin resistance/diabetes, lipoatrophy. Lamivudine (Epivir): Use: analog of cytidine, a naturally occurring nucleoside, following uptake by cell it is converted to active form lamivudine triphosphate which then suppress HIV replication, causing premature
termination of DNA strand and competing for reverse transcriptase. It is approved for HIV 1 and Hepatitis B virus (HBV). best tolerated of all NRTIAdverse Effect: lactic acidosis, and in patients infected with Hepatitis B virus, withdrawal of lamivudine will cause severe acute exacerbation of hepatitis.Emtricitabine (Emmetriva):Use: fluorinated derivative of Lamivudine and is active agains tHIV-1 and Hept.B Virus (HBV). Following uptake in the cell it is converted Emtiricitabine triphosphate, active form, which inhibits DNA synthesis and competing with natural substance for binding to reverse transcriptase and promote premature termination of DNA polymerase.Adverse Effect: headache, nausea, vomiting, diarrhea, rash, unusual hyperpigmentation of palms and soles, lactic acidosis, hepatomegaly with steatosis and server exacerbation of hepatitis if d/c , since it suppress HBV (pts who are coinfected), just like lamivudine. b.NNRTI: Non-nuceloside reverse transcriptase inhibitorsi.Efavirenz (Sustiva): oMOA: directly binds to HIV reverse transcriptase and disrupt the center of enzyme. So enzyme activity is suppressed. It only inhibits HIV-1. Used as first line therapy for HIV infection, suppression of viral load, preserve immune function,reduction of HIV morb.morta oAdverse Effects: dizziness, insomnia, impaired consciousness, drowsiness, nightmares, hallucination, mild rash, itch, teratogenic, oLiver damage risk, so liver enzymes needs to be monitor especially in pt with hept B and C.c.PI: Protease Inhibitors: i.Lopinavir/ritonavir (Kaletra)ii.Darunavir (Prezista)oAdverse Effects: oHyperglycemia/Diabetes (new onset), exacerbation of existing diabetes, and diabetic ketoacidosis. oFat distribution, called lipodystrophy, pseudo cushing’s syndrome,(fat accumulation in abdomen), shoulder blades (buffalo hump; not cushing’s syndrome), can cause hyperlipidemia (high cholesterol and triglyceride), may increase risk of increased bleeding in pts with hemophilia, can reduce bone mineral density, can elevate serum transaminases (indicating liver injury), prolong PR interval and QT interval (in Kaletra)d.Othersi.Marivoric CCR5 Antagonist: pg. 1147/1166A.Maraviroc (Selzentry): cough, dizziness, rash, pyrexia, abdominal pain, musculoskeletal pain, upper respiratory tract infection, liver injury (seen in some patients), cardiovascular (during clinical trials) causing myocardial ischcemia.
ii. Raltegravir, An integrase Strand Transfer Inhibitor (INSTI) A. Rategravir ( Isentress): a. generally well tolerated. b. rarely sever hypersensitivity reaction (fever, blisters,

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