this is a topic that i present in one of the seminar in my university..if you find it useful, do not hesitate to download it..thanks!

1. HIV SEMINAR
PHARMACOLOGY

2. global

6. N ur al hi st or y of di sease
at
Onset of
Exposure symptoms
Incubation
period
Recovery,
Subclinical Clinical
susceptibility disability,
disease disease
death
Primary Secondary Te r t i a r y
prevention prevention prevention

9. Primary Prevention
• Encourage the use of condoms and promotion of proper use
• Increase information and prevention of HIV and other STI.
• Conduct training and awareness activities for HIV/AIDS and other STI
• Contribute to the improvement of the information on HIV and sexual health through various media
• Promote condom and hydro soluble lubricant use as a prevention method
• Elaborate informative materials on HIV prevention
• Gather written and audiovisual information on initiative studies and process experiences in HIV
• Increase public awareness of the epidemic and disseminate information about AIDS
Secondary Prevention
• Encourage the early detection of HIV/AIDS and other STI
• Encourage the early detection of HIV/AIDS and other STI in the affected person’s contacts
• Offer medical testing services for the detection of HIV and opportunistic diseases
Tertiary Prevention
• Ensure referral to medical services of individuals with positive diagnosis
• Provide information and advice on economic, training, social and legal aid.
• Provide information and advice on mental health issues
• Promote human rights, equality and liberty using cultural mediation
• Develop mutual help groups of peers and encourage creation of social networks
• Training of health and employment specialists
• Encourage and foster support for individuals with HIV regardless of their gender
• Promote and foster reintegration for seropositive individuals without economic resources
• Organize events with broad social impact and including the media (combat stigmatization and achieve
normalization)
• Contribute to the change of attitudes on treatment adherence and safe sex

10. Malaysia National Strategy
• National Strategic Plan on HIV and AIDS
• National Strategic Plan on HIV and AIDS 2006-
2010
• National Strategic Plan on HIV and AIDS 2011-
2015

11. Primary
prevention
Specific
General Health
Protective
Promotion
Measures

12. Specific Protective Measures
1. Pilot harm reduction projects
– Needle and syringe programmes (NSPs)
– Opiod substitution therapy (OST) and other drug dependence
treatment
– Antiretroviral therapy (ART)
– Prevention and treatment of sexually transmitted infections
(STIs)
– Condom programmes for people who inject drugs (PWID) and
their sexual partners
– Targeted information, education and communication for PWID
and their sexual partners

13. 2. Comprehensive package for HIV care among Malaysian
prisoners
• Provision of antiretroviral treatment
• Treatment for other HIV related opportunistic infections
• HIV/AIDS education and training for prison staff

14. 3. Mother-to-child transmission (PMTCT) Programme
– Antiretroviral (ARV) prophylaxis for the mother during
pregnancy and labour and for the infant during the
neonatal period
– Obstetric interventions to avoid infant exposure to
infected maternal secretions
– Complete avoidance of breast feeding

15. SECONDARY PREVENTION
• Prevent before progressing further through early detection
and intervention
• To reduce the prevalence of disease and disability
• To cure patient and reduce serious consequences

16. TERTIARY PREVENTION
• Reduce social, religious, cultural, gender, economic, legal and
political barriers that make people vulnerable to HIV/AIDS
• Increase access to care, support and treatment for people
infected, and support for those affected by HIV/AIDS.

17. Key challenges
• The rise in sexual transmission
• Sustainability of human, financial and
infrastructure resources
• Financial cost of providing increased ARV
treatment coverage
• Mobilizing most at risk populations and
vulnerable populations to access public HIV
healthcare services
• Stigma and discrimination

18. ANTIRETROVIRAL DRUGS
(HIV)

20. ATTACHMENT AND ENTRY INHIBITORS

21. MOA : MARAVIROC
Maraviroc bind specificity &
block entry CCR5-tropic HIV into
selectively to CCR5( coreceptor for
the cell
entrance of HIV into CD4+ cell)

22. MOA: ENFUVERTIDE
Enfuvertide interfere with entry HIV-1 into
host cell by inhibit fusion virus & cell
membrane
Viral surface glycoprotein gp120 must bind to
host CD4+ cell
viral glycoprotein gp41 undergoes change in
shape facilitating fusion of viral membrane
with cell
Enfuvertide bind to viral envelope glycoprotein
& prevent change in shape require for
membrane fusion & viral entry into target cell.

23. INHIBITION OF VIRAL GENOME
REPLICATION
-nucleoside reverse transcriptase inhibitors
(eg: Zidovudine)
-nonnucleoside reverse transcriptase inhibitors
(eg : Efavirence)
-HIV integrase inhibitors (eg : Raltegravir)

24. MOA: ZIDOVUDINE (NRTIs) and
EFAVIRENZ (NNRTIs)
Nucleoside inhibitor
Zidovudine Thymidine
Nonucleoside inhibitor
Efavirence

25. MOA : RALTEGRAVIR
1. Raltegravir inhibits integrase
Integrase enzyme
brings about the 2. Inhibit strand transfer
insertion of HIV DNA 3. Intefere with integration
into human DNA, pathway
thereby helping to hide
HIV's DNA inside the 4. Viral DNA cannot be passed to
host cell's DNA chromosome host cell’s DNA

26. INHIBITION OF VIRAL MATURATION

27. MOA : RITONAVIR
Act as protease
The production of The viral
inhibitor in which
the viral particle maturation is
block the action
is inhibited inhibited
of protease

28. Class of drug Adverse effect,contraindication and drug-drug
interaction
ENTRY INHIBITOR
Maraviroc Hepatotoxicity (increase in liver enzymes)
Enfuvertide Reactions at s.c injection sites
REPLICATION INHIBITOR
Zidovudine Myelosuppression,lipodystrophy
Efavirenz CNS effect,Steven Johnson syndrome
Raltegravir Rhabdomyolysis,myopathy
PROTEASE INHIBITOR
Ritonavir Peri-oral paraesthesia

29. GUIDELINES FOR
HIGHLY ACTIVE
ANTIRETROVIRAL THERAPY
(HAART):
HOW TO USE THE DRUGS?
Based on:
Rapid Advice: antiretroviral therapy for HIV infection in adults and adolescent
Guidelines For The Management Of Adult HIV Infection With Antiretroviral Therapy
http://www.who.int/hiv/pub/arv/rapid_advice_art.pdf

30. HAART?
Highly active antiretroviral therapy (ART) using 3 or more
active anti HIV drugs from at least 2 different class with the
aim of achieving durable viral suppression to undetectable
levels, the therapeutic goal under most clinical
circumstances.

31. BEFORE STARTING THE REGIMEN
Therapy is recommended for asymptomatic patients with a CD4 cell count
≤500/μL, for all symptomatic patients, and those with specific conditions and
comorbidities. History of the patient are taken,such as
Have you been on meds before.
Do you have any resistance to medications.
What is your current CD4 and viral load counts
Are you able to take meds several times each day or do you need a once per day
regimen(since the drug have side effects,we need to know whether the patient
could endure during the regimen).
Are you pregnant or thinking of becoming pregnant
What other illnesses and conditions do you have?
Start testing the patient whether the patients have already develop any resistance
towards drugs in the regimen( for patients that switch towards another regimen).

32. WHEN TO START?
• START ART in all HIV patients who have CD4 count <350
cells/mm3 irrespective of clinical symptoms
• CD4 testing is required to identify if patients with HIV and
WHO clinical stage 1 or 2* disease need to start antiretroviral
treatment
• Start antiretroviral treatment in all patients with HIV and
WHO clinical stage 3 or 4* irrespective of CD4 count
*please refer clinical staging table

33. WHAT TO START?
Principles for selecting the first-line regimen
1. Choose Lamivudine in all regimens
2. Choose one NRTI to combine with Lamivudine (Zidovudine or
Tenofovir or Stavudine)(1 NRTI + 1 NRTI = 2NRTIs = BACKBONE)
3. Choose one NNRTI (Neviparine or Efavirenz)
For example:
• Zidovudine (NRTI) + Lamivudine (NRTI) + Efavirenz (NNRTI)
• Zidovudine(NRTI) + Lamivudine (NRTI) + Nevirapine (NNRTI)
• Tenofovir (NRTI) + Lamivudine (NRTI) or Emtricitabine (NRTI) +
Efavirenz(NNRTI)
• Tenofovir (NRTI) + Lamivudine (NRTI) or Emtricitabine (NRTI) +
Nevirapine (NNRTI)

34. ART FOR HIV/TB CO-INFECTION
• Start ART in all HIV-infected individuals with active
tuberculosis (TB) irrespective of CD4 cell count
• Start TB treatment FIRST, followed by ART as soon as possible
after starting TB treatment
• Use efavirenz as the preferred NNRTI in patients starting ART
while on TB treatment.
Why??? Hint: TB drugs

35. ART FOR HIV/HBV CO-INFECTION
• Start ART in all HIV/HBV co-infected individuals who require
treatment for their HBV infection, irrespective of CD4 cell
count or WHO clinical stage
• Start tenofovir and lamivudine or emtricitabine (2 NRTIs =
BACKBONE) containing antiretroviral regimens in all HIV/HbV
co-infected individuals needing treatment

36. ART FOR PREGNANT WOMEN
• Start ART in all pregnant women with HIV and CD4 count <350
cells/mm3, irrespective of clinical symptoms
• CD4 testing is required to identify if pregnant women with HIV and
WHO clinical stage 1 or 2* disease need to start antiretroviral
treatment or prophylaxis
• Start ART in all pregnant women with HIV and WHO clinical stage 3
or 4*, irrespective of CD4 count
• Start ONE the ART regimens in ART-naive pregnant women eligible
for treatment
• DO NOT start efavirenz during the first-trimester of pregnancy.
Why??
*please refer clinical staging table

37. WHEN TO SWITCH ART
• Where available, use viral load (VL) to confirm treatment
failure.
• Where routinely available, use VL every 6 months to detect
viral replication
• A persistent VL above 5 000 copies/ml CONFIRMS treatment
failure
• When VL is not available, use immunological criteria
(<100cells/mm3 or return to/below the pretherapy baseline
CD4 count) to confirm clinical failure

38. SECOND-LINE ART
• Boosted protease inhibitors (PI) eg. Atazanavir and Ritonavir, plus
two nucleoside analogues (NRTIs) are recommended for
second-line ART
• Simplification of second NRTI options is recommended:
1. If Stavudine or Zidovudine “backbone” has been used in
first-line, use Tenofovir + Lamivudine as the NRTI
backbone in second-line
2. If Tenofovir “backbone” has been used in first-line, use
Zidovudine + Lamivudine as the NRTI backbone in
second-line

39. THIRD-LINE REGIMENS
• National programmes should develop policies for third-line
therapy that consider funding, sustainability and the provision
of equitable access to ART
• Third-line regimens should include new drugs likely to have
anti HIV activity such as integrase inhibitors (eg. Raltegravir)
and second generation NNRTIs (eg. Etravirine) and PIs (eg.
Darunavir)
• Patients on a failing second-line regimen with no new
antiretroviral options, should continue with a tolerated
regimen

40. VACCINE???
IS THERE ANY VACCINE AVAILABLE??
IS IT POSSIBLE TO MANUFACTURE ONE??