ft hiv

7/26/2019 FT HIV

1/30

FARMAKOTERAPI HIVOleh

Dr Nurmeilis, M.Si, Apt

7/26/2019 FT HIV

2/30

Human Immunodefciency Virus:(Retrovirus RNA) virus yang memperlemahkekebalan paa tubuh manusia. Orangyang terkena virus ini akan men!ai rentanterhaap in"eksi oportunistik ataupunmuah terkena tumor.

Acquired Immunodefciency Syndrome:

sekumpulan ge!ala an in"eksi yang timbulkarena rusaknya sistem kekebalan tubuhmanusia akibat in"eksi virus

#

DEFINISI

7/26/2019 FT HIV

3/30

SIKLUS HIDUP VIRUS HIV

Stages o" li"e $y$le Asorption

%irus bins to host $ell &enetration an un$oating Repli$ation an trans$ription Synthesis an assembly o" nu$leo$apsi

'apsi proteins sel" assemble an essentialDNARNA an proteins are taken up

%irion release uing is *hen the viral proteins are introu$e

to the host membrane an then pin$he o+.

7/26/2019 FT HIV

4/30

Siklus Hidup HIV dalam Limfosit-T!D"#

HIV

RNA

DNA

ds DNA

RT

I$t%&'as%

T'a$sk'ipsi

P'o(i'al DNA

Spli)%d mRNA

mRNA

*%$omi) RNA

Pol+p'ot%i$P'ot%i$

P'ot%as

,

. "

/

0

1

Vi'io$ Mata$&

7/26/2019 FT HIV

5/30

7/26/2019 FT HIV

6/30

&enularan apat ter!ai melalui:

hubungan intim (vaginal, anal, atau oral),

trans"usi arah,

!arum suntik an alat tusuk lainnya (alattinik) yang terkontaminasi,

antara ibu an bayi selama kehamilan,bersalin, atau menyusui,

Masa inkubasi -%: bulan / 012 tahun rata/rata #1 bulan paa anak/anak

2 bulan paa orang e*asa.

ETIOLO*I

7/26/2019 FT HIV

7/30

Dasar alam menegakkaniagnosa A-DS aalah :

1.Aanya -% sebagai etiologi(melalui pemeriksaanlaboratorium).

#.Aanya tana/tana-mmunoe3$ien$y.

4.Aanya ge!ala in"eksi

oportunistik. 5

MANIFESTASI KLINIK

7/26/2019 FT HIV

8/30

Sp%kt'um i$f%ksi HIV

-n"eksi akut6paa tahap serokonversi ari status antiboi negati" men!ai positi"

7e!ala umum: malaise, emam, iare, lim"aenopati, an ruammakulopapular.

apat tereteksi -% engan kaar tinggi i arah peri"er

8aar lim"osit 'D9 turun an kemuian kembali ke kaar seikiti ba*ah kaar semula untuk pasien yang bersangkutan

%irus mulai apat ieteksi kira/kira 4/ bulan sesuah in"eksi

;ase Asimtomatik6lim"osit 'D9 umumnya suah kembali menekati normal

kaar lim"osit 'D9 menurun se$ar bertahapvirus maupun antiboi virus itemukan i alam arah

;ase simtomatikhitung sel 'D9 pasien biasanya telah turun i ba*ah 422 sel

7/26/2019 FT HIV

9/30

Reduce HIV-related morbidity and prolong survival

Improve quality of life

Restore and preserve immunologic function

Maximally and durably suppress viral load

Prevent vertical HIV transmission

TU2UAN TERAPI ART

7/26/2019 FT HIV

10/30

,3Nu)l%osid% A$alo&u% R%(%'s% T'a$s)'iptas% I$4i5ito'sNRTI#pen$egahan protein reverse trans$riptase -% alammen$egah perpinahan ari viral RNA men!ai viral DNA'ontoh: A=>, l, ' ? 4>'

3No$6$u)l%osid% R%(%'s% T'a$s)'iptas% I$4i5ito'sNNRTI7s#memperlambat reprouksi ari -% engan ber$ampur enganreverse trans$riptase, suatu en@im viral yang penting. n@imtersebut sangat esensial untuk -% alam memasukan materiturunan kealam selBsel.

'ontoh: Nevirapine, elavirine (Res$ripta), e"aviren@a ..3P'ot%as% I$4i5ito's PI#mengtargetkan protein protease -% an menahannyasehingga suatu virus baru tiak apat ilepaskan anberkumpul paa sel host. Serta men$egah pematangan virusbaru

10

ANTIRETROVIRAL

7/26/2019 FT HIV

11/30

Current ARV mecanisms of action! "loc# reverse transcriptase to disrupt copying of HIV

genetic code $%R&Is' %%R&Is(

"loc# protease en)yme* preventing maturation of

ne+ virions $PIs( Prevent fusion of HIV +it cell membranes $,usion

inibitors(

"loc# CCR co-receptor $CCR antagonists(

Prevent integration of HIV .%A into te nucleus ofinfected cells $integrase inibitors(

7/26/2019 FT HIV

12/30

Current Antiretroviral Medications%R&IAbacavir

.idanosine/mtricitabine

0amivudine

1tavudine

&enofovir

2idovudine

%%R&I.elavirdine

/faviren)/travirine

%evirapine

PIAta)anavir

.arunavir,osamprenavir

Indinavir

0opinavir

%elfinavir

Ritonavir1aquinavir

&ipranavir

,usion Inibitor /nfuvirtide

CCR Antagonist Maraviroc

Integrase Inibitor

Raltegravir

,ixed-dose Combinations2idovudine3 lamivudine

2idovudine3lamivudine3abacavir

Abacavir3lamivudine

/mtricitabine3tenofovir

/faviren)3emtricitabine

3tenofovir

7/26/2019 FT HIV

13/30

O8AT PIL HARIAN DE9ASA#: EFEK SAMPIN*

R%(%'s%

T'a$s)'ipt

as%I$4i5ito

'RTI#;

A$alo&Nuk

l%osida

atau

Nukl%otida

4>'(lamivuine)

# (12mg: 1, #Ehari) atau 1(422mg6 1, 1Ehari)

Mual, muntah, kelelahan, sakit kepala

A'(aba$avir)

# (422mg: 1, #Ehari atau #. 1Ehari) Reaksi hiperpeka paa FGH pasien

A=>(@iovuine)

# (422mg: 1, #Ehari)6 atau (122mg: #, 4Ehari)

Anemia, mual, muntah, sakit kepala,kelelahan, sakit otot, kera$unansumsum tulang

9>

(stavuine)9> (=erit

IRJ)

1 untuk =erit IR, atau # (eratbaan () K2kg6 92mg, F2kg42mg6 1, #Ehari)

Neuropati peri"er, sakit kepala, panas/ingin ? emam, iare, mual

'(@al$itabine)

4 (2,5mg: 1, 4Ehari)Neuropati peri"er, ruam, seria*an, sakittenggorokan, batuk

-(ianosine)

- (%ieE/'J)

erat baan () 02kg:"'(emtri$itabine)

1 (#22mg6 1Ehari) Sakit kepala, iare, mual, ruam

>eno"ovir(>D;)

1 (422mg: 1, 1Ehari)"ek samping ringan6 seikit mual,muntah, hilang na"su makan

Human immunodeficiency virus -

Acquired immunodeficiency syndrome 13

NRTI

*

Jikaadapilihandosis

,yangpertamabiasa

nyayangdiusulkan

olehWHO

7/26/2019 FT HIV

14/30


No$$u)l%osi

d%RTINNRTI#

Delavirine (DL%)1# (122mg6 9, 4Ehari)atau (#22mg6 #, 4Ehari)

Ruam, mual, iare, muntah,sakit kepala, kelelahan

"aviren@ (;%)4 (#22mg6 4, 1Ehari)

atau 1 (22mg6 1, 1Ehari)

-mpian !elasaneh, gelisah,ruam, mual, pusing, iare,

sakit kepala ? insomnia

Nevirapine (N%&)

1 (#22mg6 1, 1Ehariuntuk # minggu pertama)kemuian # (#22mg6 1,#Ehari)

Ruam, emam, sakit kepala,mual aspaa masalah hati

14

NNRTI

*

Jikaadapilihandosis

,yangpertamabiasa

nyayangdiusulkan

olehWHO

7/26/2019 FT HIV

15/30


P'ot%as%

I$4i5ito

'

Amprenavir (A&%)G (12mg6 9, #Ehari) ritonavir #(122mg6 1,#Ehari)6 atau 1 (12mg6 G,#Ehari)

Mual, iare, muntah, ruam, matirasa ekat mulut, sakit perut

Ata@anavir# (#22mg6 #, 1Ehari untuk orang yangbaru pakai AR>) atau 4 (12mg6 #, 1E122mg ritonavir, 1Ehari)

>ingkat bilirubin yang tinggi. Mual,sakit kepala, ruam, sakit perut,muntah, iare, semutan, epresi.&erubahan enyut nai

;osamprenavir9 (522mg6 #, #Ehari) atau # (522mg6## ritonavir, 1Ehari6 atau 522mg6 11ritonavir #Ehari)

Mual, iare, muntah, ruam, matirasa ekat mulut, sakit perut

-ninavir (-D%)

9 (922mg6 #, #Ehari) ritonavir #(122mg6 1, #Ehari)6 atau (922mg: #,setiap G !am, tiak 4Ehari) or (444mg64 setiap G !am)

Sakit kepala, mual, sakit perut,batu gin!al

Lopinavirritonavir(L&%r)

(144mg lopinavir 44mg ritonavir: 4,#Ehari)

Diare, kelelahan, sakit kepala,mual

Nel3navir (N;%) 12 (, #Ehari)6 atau (#2mg6 4,4Ehari)

Diare, mual, gas, sakit perut, lesu

Sauinavir (SP%):-nviraseJ (-N%6 7')6;ortovaseJ (;>%6S7')

12 (#22mg -N% atau ;>%: , #Ehari) ritonavir # (122mg6 1, #Ehari)6 1G(#22mg ;>% sa!a6 , 4Ehari)

Seikit mual, iare, perut tiaknyaman

Ritonavir (R>%)1# (122mg: , #Ehari)6 osis ke$ilipakai sebagai booster untukmenekankan protease inhibitor lain

Mual, muntah, iare, kesemutan ?mati rasa ekat mulut

15

PROTEASE INHI8ITOR

*

Jikaadapilihandosis

,yangpertamabiasa

nyayangdiusulkan

olehWHO

7/26/2019 FT HIV

16/30

Lamivudine

juga dikenal sebagai Epivir atau 3TDapat mengurangi resistansi paa A=>

Human immunodeficiency virus -

Acquired immunodeficiency syndrome 16

LAMIVUDINE

7/26/2019 FT HIV

17/30

!ba"avirB #u"leoside analog reversetrans"riptase inhibitor(NAR>- atau NR>-)Dalam seiaan tablet ikenal engan namapi@i$om

17

A8A!AVIR

7/26/2019 FT HIV

18/30

$idovudin %!&idotimidin isingkat!$T'

Dalam seiaan tablet ikenal engan nama>ri@ivir

18

A=T

7/26/2019 FT HIV

19/30

Nevirapine terseia engan bentuk pil berisi#22mg.aspaa masalah hati

19

NEVIRAPINE

7/26/2019 FT HIV

20/30

4ene terapies- bloc# HIV genes

Maturation inibitors- inibit development of HIV5s

internal structures in ne+ virions

2inc finger inibitors- brea# apart structures olding

HIV inner core togeter

ART D'u&s i$ !li$i)al T'ials; !lass%sa$d M%)4a$isms of A)tio$ ,#

7/26/2019 FT HIV

21/30

Comorbidity

Patient aderence potential

Convenience $e6g6* pill burden* dosing frequency*and food and fluid considerations(

Potential adverse drug effects and drug interactions+it oter medications

Fa)to's to !o$sid%' i$ S%l%)ti$&I$itial ART R%&im%$ ,#

7/26/2019 FT HIV

22/30

Pregnancy potential

Results of genotypic drug resistance testing

4ender and pretreatment C.7 &-cell count ifconsidering nevirapine

H0A "89:; testing if consideringabacavir

Fa)to's to !o$sid%' i$ S%l%)ti$&I$itial ART R%&im%$ #

7/26/2019 FT HIV

23/30

Rationales beind regimen

simplification are

to improve te patient5s quality of life improve medication aderence

avoid long-term toxicities

reduce te ris# of virologic failurePanel on Clinical Practices for &reatment of HIV Infection6 $)atio$ #

7/26/2019 FT HIV

24/30

All patients +it a istory of an AI.1-

defining illness or +it a C.7 count >?:

C.7@ & cells3mm

?

data supporting tis recommendation are

stronger for tose +it a C.7 &-cell count >

7/26/2019 FT HIV

25/30

Regardless of C.7 count* AR& sould beinitiated in

Pregnant +omen

Patients +it HIV-associated nepropaty

Patients co-infected +it Hepatitis " +en H"V treatment isindicated $treat +it fully suppressive drugs active against

bot HIV and H"V(

Panel on Clinical Practices for &reatment of HIV Infection6 $

7/26/2019 FT HIV

26/30

In patients +it C.7 count ?: cells3mm?

+o do not meet any of te specific

conditions listed previously

Bptimal time to initiate terapy is not +elldefined

Patient scenarios and comorbidities sould be

considered


7/26/2019 FT HIV

27/30

Maintain iger C.7 and prevent potential

irreversible damage to te immune system

.ecrease ris# for HIV-associated complications$&b*non-Hodg#in5s lympoma*1* periperal

neuropaty* HPV-associated malignancies* and HIV-

associated cognitive impairment(

Panel on Clinical Practices for &reatment of HIV Infection6 $ts of Ea'l+ ART ,#

7/26/2019 FT HIV

28/30

.ecrease ris# of non-opportunistic conditions

$CV.* renal disease* liver disease* and nonDAI.1-

associated malignancies and infections(

.ecrease ris# of transmission to oters

Panel on Clinical Practices for &reatment of HIV Infection6 $ts of Ea'l+ ART #

7/26/2019 FT HIV

29/30

.evelopment of treatment-related side

effects3toxicities

.evelopment of drug resistance

0ess time to learn about HIV and its treatment and

less time to prepare for aderencePanel on Clinical Practices for &reatment of HIV Infection6 $

7/26/2019 FT HIV

30/30

Increased total time on medication* +it greatercance of treatment fatigue

Premature use of AR& before development of more

effective* less toxic* better studied combinations

&ransmission of drug-resistant virus


ft hiv

Documents