Medicine an Surgery notes

Apr 24th, 2015
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HAART IN PREGNANCYDr.John KinuthiaMedical specialist, KNH What is HAART? Generally only 10-20% of PMTCT clientsneed treatment with HAART Global policy- Increasing access to ARVsHAART Highly active anti retroviral therapy Gold standard of anti-retroviral therapy Combination of three or more anti-retroviraldrugs These ARVs fall in three different classesand work at different sitesClasses of ARVS Nucleoside analogue reverse transcriptaseinhibitors act by incorporating themselves into theDNA of the virus thereby stopping the buildingprocess. (NRTI).(zidovudine,stavudine,lamivudine) Non-nucleoside reverse transcriptase inhibitorsstop HIV production by binding directly ontoreverse transcriptase preventing conversion ofRNA to DNA (NNRTI) (nevirapine) Protease inhibitors which prevent HIV virus frombeing successfully assembled and released (PI)Structure of HIVHIV Replication cycleFusionCD4 receptor in host cellgp120DNARNA HIVProteaseenzymeHIV RNAPIReversetranscriptaseinhibitor enzyme-Sequanavir-RetinavirHIV DNAIntergrase enzymeHIV + Host cellsDNART 1-NRT1 AZT ,3TC-NNRT1 - NVPThe WHO first line regimen(d4T or AZT) + 3TC+ NVPZidovudine (AZT)Stavudine (d4T)Lamivudine (3TC)Nevirapine(NVP)300mg twice daily40mg twice daily or30mg if less than 60kg150mg twice daily or300mg once daily200mg once daily for 14days, then 200mg twicedailyGoals of HAART Maximal and dura

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