hep C virus and HIV therapies

NS5A inhibitors (hep C virus)

ex: ledipasvir, elbasvir

how it works: inhibit NS5A, which is involved in viral replication and assembly

think: NS5A= replication + assembly blocker

NS5B polymerase inhibitors (hep C virus)

ex: sofosbuvir

how it works: inhibits NS5B RNA-dependent RNA polymerase, terminating viral replication

Ledipasvir/sofosbuvir is a combo medication used to treat hep C, genotypes 1,4,5 and 6

Ledipasvir/sofosbuvir is contraindicated in clients who have a GFR less than 30 mL/min or who have end-stage renal disease

second-generation protease inhibitors (hep C virus)

ex: grazoprevir

how it works: block the actions of the N3S/4A protease enzymes in the virus

Elbasvir/grazoprevir is contraindicated in clients who have active hepatic impairment or a history of hepatic decompensation

viral entry inhibitors (HIV)

ex: CCR5 viral entry inhibitors (maraviroc)

how it works: target CCR5 receptors on CD4 cells to prevent viral entry

think: blocks the doorway into the CD4 cell

side effects: cough, fever, upper respiratory tract infections, muscle pain, abdominal pain, nausea, and rash

adverse effects: cognitive, neurological, and mental health disorders, infectious disorders, rhabdomyolysis and osteonecrosis

enzyme inhibitors 2 (HIV)

1) nucleoside reverse transcriptase inhibitors NRTIs

ex: zidovudine

how it works: inhibits reverse transcriptase

side effects: weakness, severe headache, nausea, and vomiting. In ped clients, anemia and granulocytopenia are common

adverse effects: lactic acidosis and severe hepatomegaly with steatosis

2) non-nucleoside transcriptase inhibitors NNRTIs

ex: efavirenz

how it works: prevents HIV’s replication of its DNA by binding to the reverse transcription enzyme of the virus

adverse effects: suicidal ideations, insomnia, elevated liver function values, hyperlipidemia, neutropenia, and hyperglycemia

protease inhibitors PI (HIV)

ex: ritonavir

how it works: blocks the action of protease, an enzyme needed fro HIV replication

side effects: abdominal pain, altered taste, anorexia, diarrhea, nausea, vomiting, atypical thinking, and weakness

adverse effects: heart block, orthostatic hypotension, PR interval prolongation, syncope, rash, hyperglycemia, renal impairment, fat redistribution, hyperlipidemia

antiretroviral therapies (HIV)

ex: integrase strand transfer inhibitor INSTI - cabotegravir

how it works: prescribed for pre-exposure prophylaxis PrEP to block the action of the enzyme integrase to keep HIV from replicating and reduce the risks for HIV infections in people who may be a risk

contraindications: history of hypersensitivity reactions to cabotegravir, unknown or positive HIC status

side effects: rash, redness, pain, and itching at the injecting site, diarrhea, headache, fever, fatigue, and problems sleeping

adverse effects: hepatoxicity; increased risks for upper respiratory tract infections, depression and suicidal ideation