Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.
Antiretroviral Drugs
Dr. Mayur A. Chaudhari
Assistant Professor
Department of Pharmacology
Government Medical College, Sur...
Objectives
 Life cycle of HIV
 NRTIs and NNRTIs
 Protease Inhibitors
 Fusion Inhibitors
 CCR5 inhibitor
 Integrase i...
History : HIV
 Was reported to be a new and unique disease to CDC
in 1981 with no name
 Cases were diagnosed as Kaposi’s...
History: Drug Development
 1985 – Research on anti-viral medication begins
 1987 – First drug Zidovudine produced (NRTI)...
History: Drug Development
 1995 – first protease inhibitor Sequinavir FDA
approved
 Low Bioavailability led to the devel...
HIV
 Retrovirus
 Cell Has RNA as a genetic material
 HIV-1, the most prevalent worldwide, and
 HIV-2, the most common ...
Life cycle of HIV
Classification
 Nucleoside reverse transcriptase inhibitors (NRTIs)
Purine Analogue
1)Adenosine analogue – Didanosine, T...
Classification
 Nonnucleoside reverse transcriptase inhibitors
(NNRTIs) – Nevirapine, Efavirenz, Delavirdine
 Protease i...
NRTIs
 Competitively inhibit HIV1 and HIV2
 Activated by triple phosphorylation in cytoplasm
 Incorporates into growing...
Zidovudine/Azidothymidine (AZT)
 Selective inhibition of viral reverse transcriptase
 Gets incorporated into growing vir...
AZT:Pharmacokinetics
 Rapid oral absorption, 65% Bioavailability
 T1/2 only 1hour
 Crosses placenta and secreted in milk
AZT: Adverse Effects
 Anaemia and neutropenia - dose related
 Nausea, anorexia, abdominal pain, headache
 insomnia and ...
AZT: Drug Interaction
 Paracetamol increases AZT toxicity
 Azoles increase AE due to AZT
 Other nephrotoxic and myelosu...
AZT : Uses
Progressive increase in CD4 counts
Improved immunity and lessen opportunistic
infection
Sense of well being ...
Stavudine (d4T)
 Same as Zidovudine
 Comparable efficacy to Zidovudine
 Peripheral Neuropathy
 Pancreatitis
 Lipodyst...
Didanosine
 Compete with ATP for incorporation in Viral DNA
 Activity similar to Zidovudine
 Acid Labile, t1/2 only 90 ...
Lamivudine (3TC)
 Inhibits HIV reverse transcriptase and HBV DNA
polymerase
 Human DNA Polymerase not affected
 Resista...
3TC: Adverse Effects
 Headache, fatigue, nausea
 Anorexia, abdominal pain. Pancreatitis and
 Neuropathy are rare.
 Hem...
Tenofovir
 Requires only double phosphorylation
 Competitive inhibitor of reverse transcriptase
 Bioavailability increa...
Tenofovir: AE and Uses
 Nausea, Vomiting, Flatulence and Diarrhoea
 Headache, asthenia and Osteomalacia
 Precaution sho...
Abacavir
 More effective than other NRTI
 2-3 concomitant mutation required to develop
resistance
 Good oral absorption...
Non-Nucleoside Reverse
Transcriptase Inhibitors
 Active drugs- Do not require phosphorylation
 Directly combine with HIV...
Nevirapine
 Potent against HIV1 but no activity against HIV2
 Resistance develop easily and rapidly if used alone
 Cros...
Drug Interactions
 Reduces concentration of Protease inhibitors
 Reduces the concentration of methadone
 Contraception ...
Clinical Uses
 HIV And Aids
 Single Intrapartum dose of 200mg to mother f/b
 2mg/kg orally single dose to newborn to pr...
Efavirenz
 Oral absorption 50% and peak effect in 3-5 hours
 T1/2 is 40-50 hours, highly Plasma Protein bound
 Metaboli...
Entry/Fusion Inhibitor
(Enfuvirtide)
 Synthetic polypeptide active against HIV1 not 2.
 Inhibit HIV mediated membrane fu...
CCR5 Inhibitor - Maraviroc
 Blocks CCR5 receptor and prevent entry into host cell
 Oral absorption is rapid but variable...
Maraviroc – Adverse Effects
 Cough, URTI, Diarrhoea, Muscle and Joint pain, Sleep
disturbances
 Increase in hepatic tran...
Protease Inhibitors
 Ritonavir
 Atazanavir
 Indinavir
 Nelfinavir
 Saquinavir
 Amprenavir
 Lopinavir
Protease Inhibitors
Mechanism of Action
Resistance
 Development of resistance delayed
 Requires 4-5 mutations
 Cross resistance
 Combined with other class of ...
Pharmacokinetics
 Variable Bioavailability by oral route
 Metabolized by CYP3A4 except Nelfinavir (CYP2C19)
 T1/2 2-10 ...
Adverse Effects
 Nausea, Vomiting and Diarrhoea – Common
 Headache, Dizziness, Tingling and numbness of face
and limbs
...
Interactions
 Ritonavir is most potent inhibitor of CPY3A4
 In presence of inducer concentration of PI reduced
 Low Dos...
Atazanavir
 Active against HIV1 and HIV2
 Rapid oral absorption with peak in 2 hours
 T1/2 7 hours and 90% PPB
 Unconj...
Indinavir
 10 time more sensitive for HIV1
 Rapid oral absorption with peak in 60 mins, 60% PPB
 Metabolized by CYP3A4 ...
Nelfinavir
 Slower absorption, ↑ with fatty food
 Metabolized through CYP2C19, CYP3A4 and CYP2D6
 Activity of metabolit...
Ritonavir
 More active on HIV1
 ↑ absorption with meal
 AE- Nausea, Diarrhoea, Paresthesias, fatigue and
lipid abnormal...
Saquinavir
 Active on HIV1 and HIV2
 Hard gel capsule with ritonavir
 Soft gel capsule – 3 times Bioavailability
 Pill...
Lopinavir
 More activity on HIV1
 Extensive first pass metabolism, always used with
ritonavir
 Dose needs to be increas...
Integrase inhibitor: Raltegravir
Raltegravir
 Well absorbed
 Rifampicin reduces concentration
 Used in multidrug resistant patients
 Resistance not rep...
Antiretroviral Drugs: Some
facts
 Most drugs affect Host cells – Unacceptable toxicity
 Most Drugs inhibit viral replica...
Drug Treatment
• Pneumocystis Jiroveci
• Mycobacterium avium complex
• Cytomegalovirus retinitis
• Fungal infections
• Pro...
Problems of Treatment
 Cost of Drugs
 High Toxicity
 Resistance
 Adherence to multidrug therapy
 Pill Load
 Complex ...
Decision to start therapy
 Individualized
 CD4 cell count
 Plasma HIV1 RNA concentration
 Symptomatology
Decision to Start Therapy
Clinical
Symptoms
CD4 Count/
µl
Plasma HIV
RNA/ml
Treatment
Status
Asymptomatic > 350 cells < 10...
Selection of Drugs
 Combination drugs are selected based on potency,
Susceptibility, Safety, Interactions, tolerability,
...
Highly Active AntiRetroviral Therapy
 Level of HIV RNA may be undetectable by HAART
 Success depend on life long treatme...
Common Regimens
2NRTI+1 NNRTI 2NRTI+1PI 3NRTI
Lamivudine+Zidovudine+
Efavirens
Lamivudine+Zidovudine+Lop
inavir/Ritonavir
...
Change in Regimen
 Avoid known resistant drugs, Cross resistance should
be considered
 Change whole regimen, should cont...
Combinations to be avoided
Combination Reason for
avoiding
Zidovudine+Stavudine
Zalcitabine+Lamivudine
Mutual Antagonism
A...
Post exposure Prophylaxis
 Persons involved in patient care when exposed to
infectious material
 Exposures are categoriz...
Post exposure Prophylaxis
Category Low Risk Source High Risk Source
Criteria • HIV +ve but
asymptomatic, Low
HIV-RNA titer...
Perinatal Prophylaxis
 Transmission can occur through placenta, During
delivery and through milk
 Avoid breastfeeding if...
Drugs in Pregnancy
Class Preferred Drug Alternate Drug
NRTI Zidovudine,
Lamivudine
Didanosine, Stavudine,
Emtricitabine, A...
Summary
Life cycle of HIV
NRTI, NNRTI, PI, Integrase Inhibitor, Fusion
Inhibitors
HAART
Post exposure prophylaxis
Mot...
Próxima SlideShare
Cargando en…5
×

58

Compartir

Antiretroviral drugs

Medical Undergraduate Lecture slides on Pharmacotherapy of HIV-AIDS. These slides include life cycle of HIV. Classification of available drugs based on target site. Individual Drugs with Mechanism of action, PK, AE and drug interactions. Treatment principles and guidelines for HIV-AIDS based on NACO(National Aids Control Organisation, India) Guidelines.

Audiolibros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo

Antiretroviral drugs

  1. 1. Antiretroviral Drugs Dr. Mayur A. Chaudhari Assistant Professor Department of Pharmacology Government Medical College, Surat
  2. 2. Objectives  Life cycle of HIV  NRTIs and NNRTIs  Protease Inhibitors  Fusion Inhibitors  CCR5 inhibitor  Integrase inhibitor  HIV Treatment Principles and Guidelines
  3. 3. History : HIV  Was reported to be a new and unique disease to CDC in 1981 with no name  Cases were diagnosed as Kaposi’s sarcoma, Pneumocystis Jiroveci Pneumonia with low immunity  Common in Homosexuals, IV drug Users, Hemophiliacs  In 1983 virus was named as Human Immunodeficiency Virus.
  4. 4. History: Drug Development  1985 – Research on anti-viral medication begins  1987 – First drug Zidovudine produced (NRTI)  Early life extending properties except only temporarily worked as patients became immune  Mid-1990s – Protease Inhibitors and NNRTIs
  5. 5. History: Drug Development  1995 – first protease inhibitor Sequinavir FDA approved  Low Bioavailability led to the development of a second protease inhibitor Ritonvir  1996 first NNRTI, Nevirapine approved by FDA  March 2003 – First Fusion Inhibitor Enfuvirtide approved by FDA
  6. 6. HIV  Retrovirus  Cell Has RNA as a genetic material  HIV-1, the most prevalent worldwide, and  HIV-2, the most common in western Africa
  7. 7. Life cycle of HIV
  8. 8. Classification  Nucleoside reverse transcriptase inhibitors (NRTIs) Purine Analogue 1)Adenosine analogue – Didanosine, Tenofovir 2) Guanine analogue – Abacavir Pyrimidine analogue 1) Thymidine analogue – Zidovudine, Stavudine 2) Cytosine analogue – Lamivudine, Emtricitabine
  9. 9. Classification  Nonnucleoside reverse transcriptase inhibitors (NNRTIs) – Nevirapine, Efavirenz, Delavirdine  Protease inhibitors – Ritonavir, Atazanavir, Indinavir, Nelfinavir, Saquinavir, Lopinavir  Fusion Inhibitor – Enfuvitride  CCR5 Inhibitor – Maraviroc  Integrase inhibitor - Raltegravir
  10. 10. NRTIs  Competitively inhibit HIV1 and HIV2  Activated by triple phosphorylation in cytoplasm  Incorporates into growing viral DNA to cause termination  Inhibit mitochondrial DNA polymerase gamma  Lactic Acidosis, Hepatic steatosis  Elevated hepatic transaminase
  11. 11. Zidovudine/Azidothymidine (AZT)  Selective inhibition of viral reverse transcriptase  Gets incorporated into growing viral DNA and terminates chain formation  Zidovudine prevents infection of new cells  No effect on already infected host cell  Resistance occur by altered reverse transcriptase enzyme
  12. 12. AZT:Pharmacokinetics  Rapid oral absorption, 65% Bioavailability  T1/2 only 1hour  Crosses placenta and secreted in milk
  13. 13. AZT: Adverse Effects  Anaemia and neutropenia - dose related  Nausea, anorexia, abdominal pain, headache  insomnia and myalgia  Myopathy, lactic acidosis, hepatomegaly  convulsions and encephalopathy
  14. 14. AZT: Drug Interaction  Paracetamol increases AZT toxicity  Azoles increase AE due to AZT  Other nephrotoxic and myelosuppresive drugs increase toxicity  Probenecid also increases toxicity  Stavudine and Zidovudine inhibit each other
  15. 15. AZT : Uses Progressive increase in CD4 counts Improved immunity and lessen opportunistic infection Sense of well being and weight gain Reduces neurological manifestation of AIDS Slow the progression of HIV to AIDS Reduces mortality nonresponsive state After few months to years Used for post exposure prophylaxis
  16. 16. Stavudine (d4T)  Same as Zidovudine  Comparable efficacy to Zidovudine  Peripheral Neuropathy  Pancreatitis  Lipodystrophy
  17. 17. Didanosine  Compete with ATP for incorporation in Viral DNA  Activity similar to Zidovudine  Acid Labile, t1/2 only 90 minutes  Do not cause myelosuppresion  Pancreatitis and Neuropathy dose related  Nausea, Abdominal pain and Diarrhoea – Side effects
  18. 18. Lamivudine (3TC)  Inhibits HIV reverse transcriptase and HBV DNA polymerase  Human DNA Polymerase not affected  Resistance due to altered enzyme  High Oral Bioavailability  Plasma t1/2 – 8 hours, Intracellular t1/2 – 12 hours  Excreted unchanged in urine
  19. 19. 3TC: Adverse Effects  Headache, fatigue, nausea  Anorexia, abdominal pain. Pancreatitis and  Neuropathy are rare.  Hematological toxicity does not occur
  20. 20. Tenofovir  Requires only double phosphorylation  Competitive inhibitor of reverse transcriptase  Bioavailability increased with fatty food  T1/2 12-15 hours – once a day  Eliminated by glomerular filtration and tubular secretion
  21. 21. Tenofovir: AE and Uses  Nausea, Vomiting, Flatulence and Diarrhoea  Headache, asthenia and Osteomalacia  Precaution should be taken in patients of reduced renal function
  22. 22. Abacavir  More effective than other NRTI  2-3 concomitant mutation required to develop resistance  Good oral absorption with t1/2 of 1.5 hours  Hypersensitivity reaction  Should be avoided in cardiac disease
  23. 23. Non-Nucleoside Reverse Transcriptase Inhibitors  Active drugs- Do not require phosphorylation  Directly combine with HIV1 Reverse transcriptase and DNA Polymerase  Binds at different site than NRTIs  Substrate for CYP3A4.  Nevirapine Inducer  Delavirdine Inhibitor  Efavirenz – Inducer and Inhibitor
  24. 24. Nevirapine  Potent against HIV1 but no activity against HIV2  Resistance develop easily and rapidly if used alone  Cross resistance is very common  Well absorbed, Crosses placenta and secreted in milk  Metabolized by CYP3A4 and CYP2B6, Induces own metabolism  AE – rashes, Hepatitis, Nausea, Fever, Fatigue, Headache  Rarely SJ syndrome
  25. 25. Drug Interactions  Reduces concentration of Protease inhibitors  Reduces the concentration of methadone  Contraception failure  Should be started with small dose and increased gradually to prevent rashes
  26. 26. Clinical Uses  HIV And Aids  Single Intrapartum dose of 200mg to mother f/b  2mg/kg orally single dose to newborn to prevent transmission
  27. 27. Efavirenz  Oral absorption 50% and peak effect in 3-5 hours  T1/2 is 40-50 hours, highly Plasma Protein bound  Metabolized by CYP3A4 and CYP2B6.  CNS side effects in 50% individuals – Dizziness, Insomnia, Headache  Confusion, Agitation, Delusion and Nightmares  Skin rashes  Nausea, Vomiting, Diarrhoea and Elevated liver enzymes  Teratogenic – Neural Tube defects
  28. 28. Entry/Fusion Inhibitor (Enfuvirtide)  Synthetic polypeptide active against HIV1 not 2.  Inhibit HIV mediated membrane fusion – prevent virus entry into host cells  Only Antiretroviral used by parenteral route (SC)  t1/2 is 4 hours.  At Injection site – Pain, erythema and induration. Nodule or cyst (80%)  Lymphadenopathy and pneumonia  Used in resistant cases
  29. 29. CCR5 Inhibitor - Maraviroc  Blocks CCR5 receptor and prevent entry into host cell  Oral absorption is rapid but variable  Achieves high concentration in Cervicovaginal secretions  Chances of resistance are less  Reserve when other fails
  30. 30. Maraviroc – Adverse Effects  Cough, URTI, Diarrhoea, Muscle and Joint pain, Sleep disturbances  Increase in hepatic transaminase  Reduced immunity – Chances of Lymphoma  Substrate for CYP3A4 – Concentration reduced with phenytoin, Carbamazepine and Rifampin, Efavirenz.
  31. 31. Protease Inhibitors  Ritonavir  Atazanavir  Indinavir  Nelfinavir  Saquinavir  Amprenavir  Lopinavir
  32. 32. Protease Inhibitors
  33. 33. Mechanism of Action
  34. 34. Resistance  Development of resistance delayed  Requires 4-5 mutations  Cross resistance  Combined with other class of drugs
  35. 35. Pharmacokinetics  Variable Bioavailability by oral route  Metabolized by CYP3A4 except Nelfinavir (CYP2C19)  T1/2 2-10 hours
  36. 36. Adverse Effects  Nausea, Vomiting and Diarrhoea – Common  Headache, Dizziness, Tingling and numbness of face and limbs  Redistribution of body fat- Central obesity, buffalo hump, Peripheral and facial wasting, Breast enlargement  ↑ triglycerides, LDL levels  Glucose intolerance and insulin resistance
  37. 37. Interactions  Ritonavir is most potent inhibitor of CPY3A4  In presence of inducer concentration of PI reduced  Low Dose Ritonavir (100-200mg) is used in combination with other PIs  To inhibit first pass metabolism and systemic metabolism  Better oral Bioavailability and longer elimination half life.
  38. 38. Atazanavir  Active against HIV1 and HIV2  Rapid oral absorption with peak in 2 hours  T1/2 7 hours and 90% PPB  Unconjugated hyperbilirubineamia and ↑ bilirubin  No effect on Blood glucose and insulin sensitivity  Given in combination with ritonavir
  39. 39. Indinavir  10 time more sensitive for HIV1  Rapid oral absorption with peak in 60 mins, 60% PPB  Metabolized by CYP3A4 in liver, Short Half life  Causes crystalluria – Renal Colic and Nephrolithiasis  Hyperbilirubineamia, Lipodystrophy syndrome, fat accumulation  Hyperglycemia, Insulin resistance  Hair loss, Dry skin, Dry and cracked lips
  40. 40. Nelfinavir  Slower absorption, ↑ with fatty food  Metabolized through CYP2C19, CYP3A4 and CYP2D6  Activity of metabolite is 40%  Induces own metabolism  AE – Diarrhoea, Glucose intolerance, ↑ cholesterol and TG
  41. 41. Ritonavir  More active on HIV1  ↑ absorption with meal  AE- Nausea, Diarrhoea, Paresthesias, fatigue and lipid abnormality  Used for Boosting other PI in Sub therapeutic doses
  42. 42. Saquinavir  Active on HIV1 and HIV2  Hard gel capsule with ritonavir  Soft gel capsule – 3 times Bioavailability  Pill load is higher  AE – Nausea, Vomiting, Diarrhoea and abdominal discomfort
  43. 43. Lopinavir  More activity on HIV1  Extensive first pass metabolism, always used with ritonavir  Dose needs to be increased if used with NVP or EFV  AE – Nausea, Vomiting and Diarrhoea  ↑ Cholesterol and ↑ TGs
  44. 44. Integrase inhibitor: Raltegravir
  45. 45. Raltegravir  Well absorbed  Rifampicin reduces concentration  Used in multidrug resistant patients  Resistance not reported yet  AE headache, Dizziness, Nausea, Diarrhoea  Not yet available in India
  46. 46. Antiretroviral Drugs: Some facts  Most drugs affect Host cells – Unacceptable toxicity  Most Drugs inhibit viral replication  Replication starts again when drug is discontinued.  Good host immunity is essential  Failure of therapy in immunocompromised pts and drug resistant variants  Current drugs do not affect dormant virus
  47. 47. Drug Treatment • Pneumocystis Jiroveci • Mycobacterium avium complex • Cytomegalovirus retinitis • Fungal infections • Protozoal infections Opportunistic Infections • Kaposi’s Sarcoma • Cervical carcinoma • Lymphoma Malignancy To prevent viral replication, prevent depletion of CD4 cells Treat opportunistic infections and malignancies
  48. 48. Problems of Treatment  Cost of Drugs  High Toxicity  Resistance  Adherence to multidrug therapy  Pill Load  Complex Drug interactions
  49. 49. Decision to start therapy  Individualized  CD4 cell count  Plasma HIV1 RNA concentration  Symptomatology
  50. 50. Decision to Start Therapy Clinical Symptoms CD4 Count/ µl Plasma HIV RNA/ml Treatment Status Asymptomatic > 350 cells < 100000 Defer treatment Asymptomatic 200-350 Any Value Treatment Asymptomatic < 200 Any Value Treatment AIDS defining illness Any Value Any Value Treatment
  51. 51. Selection of Drugs  Combination drugs are selected based on potency, Susceptibility, Safety, Interactions, tolerability, convenience and Patient compliance  Life long treatment  Preferred regimen – 2NRTI+1NNRTI/1PI and 3NRTI  Three drug from 2 groups  Addition of 4th drug do not add benefit- can be used in resistant cases  3 Drugs from 3 different groups reserved for resistant cases
  52. 52. Highly Active AntiRetroviral Therapy  Level of HIV RNA may be undetectable by HAART  Success depend on life long treatment  Combinations are used for 1) To increase antiviral activity 2) Reduced dose of individual drug 3) Reduced risk of toxicity 4) Reduced risk of resistance
  53. 53. Common Regimens 2NRTI+1 NNRTI 2NRTI+1PI 3NRTI Lamivudine+Zidovudine+ Efavirens Lamivudine+Zidovudine+Lop inavir/Ritonavir Zidovodine+ Lamivudine +Abacavir Lamivudine+Stavudine+Ef avirenz Lamivudine+Zidovudine+Indi navir Lamivudine+Abacavir+Efa virenz Lamivudine+Abacavir+Lopin avir/Ritonavir Lamivudine+Zidovudine+ Nevirapine Lamivudine+Abacavir+Nelfin avir Lamivudine+Stavudine+N evirapine Lamivudine+Stavudine+Riton avir Lamivudine+Abacavir+Ne virapine
  54. 54. Change in Regimen  Avoid known resistant drugs, Cross resistance should be considered  Change whole regimen, should contain which were not used previously for pt.  Regimen can be changed if fall in CD4 count or increase in viral load  If condition of patient deteriorates  If patient develops serious opportunistic infection
  55. 55. Combinations to be avoided Combination Reason for avoiding Zidovudine+Stavudine Zalcitabine+Lamivudine Mutual Antagonism Abacavir+Tenofovir+Lamivudine High rate of poor response Zalcitabine+Didanosine+Stavudine Atazanavir+Indinavir Peripheral neuropathy Hyperbilirubinemia
  56. 56. Post exposure Prophylaxis  Persons involved in patient care when exposed to infectious material  Exposures are categorized depending on source  All exposure do not need prophylaxis 1. Contamination on intact skin 2. Brief period on mucus membrane 3. If source is HIV Negative
  57. 57. Post exposure Prophylaxis Category Low Risk Source High Risk Source Criteria • HIV +ve but asymptomatic, Low HIV-RNA titer, High CD4 Count • Minor exposure • Symptomatic, High HIV-RNA titer, Low CD4 Count • Major exposure Regimen Zidovudine 300mg+Lamivudine 150mg BD for 1 month Zidovudine 300mg + Lamivudine 150mg BD + Indinavir 800mg TDS for 1 month
  58. 58. Perinatal Prophylaxis  Transmission can occur through placenta, During delivery and through milk  Avoid breastfeeding if mother is HIV+  Treat mother with standard 3 drug regimen from 2 groups or Zidovudine after 1st trimester till delivery  Put neonate on 6 weeks prophylaxis  Nevirapine Crosses placenta and secreted in milk
  59. 59. Drugs in Pregnancy Class Preferred Drug Alternate Drug NRTI Zidovudine, Lamivudine Didanosine, Stavudine, Emtricitabine, Abacavir NNRTI Nevirapine - PI Nelfinavir, Saquinavir Lopinavir+ Ritonavir, Indinavir, Ritonavir
  60. 60. Summary Life cycle of HIV NRTI, NNRTI, PI, Integrase Inhibitor, Fusion Inhibitors HAART Post exposure prophylaxis Mother to Child Transmission
  • imn12345

    Jun. 30, 2021
  • SamairaArora3

    Jun. 13, 2021
  • docuzmamehar

    Apr. 27, 2021
  • VokeIsire

    Apr. 7, 2021
  • SukithraKumar

    Mar. 1, 2021
  • OnyinyechiEmmanuella

    Feb. 22, 2021
  • Zayyadnuhu

    Feb. 14, 2021
  • UmarYahayaAdamu

    Feb. 10, 2021
  • ssusereb3eac

    Dec. 30, 2020
  • JanaviMotwani

    Dec. 20, 2020
  • RichaRanjan8

    Nov. 4, 2020
  • josephmuthomi1

    Oct. 16, 2020
  • TendaiSamkange1

    Sep. 30, 2020
  • AishatZurakat

    Aug. 21, 2020
  • AmudhaSankaralingam

    Jun. 8, 2020
  • IdahosaOghogho

    May. 16, 2020
  • chetankumar390

    May. 11, 2020
  • NawalKishore27

    May. 11, 2020
  • MallinathNimbale

    May. 3, 2020
  • DeepanshuGupta163

    Apr. 4, 2020

Medical Undergraduate Lecture slides on Pharmacotherapy of HIV-AIDS. These slides include life cycle of HIV. Classification of available drugs based on target site. Individual Drugs with Mechanism of action, PK, AE and drug interactions. Treatment principles and guidelines for HIV-AIDS based on NACO(National Aids Control Organisation, India) Guidelines.

Vistas

Total de vistas

11.596

En Slideshare

0

De embebidos

0

Número de embebidos

16

Acciones

Descargas

0

Compartidos

0

Comentarios

0

Me gusta

58

×