HIV lifecycle and antiretroviral drug classes: mechanisms, toxicity and interactions
Each step of the HIV replication cycle and the drug class that blocks it, from CCR5 antagonists and NRTIs to integrase and capsid inhibitors, with the class and drug-specific toxicities (HLA-B*57:01, tenofovir tubulopathy, OCT2 creatinine rise), barrier to resistance, hepatitis B overlap and the CYP3A4 interactions of pharmacokinetic boosters.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- HIV is a retrovirus: RNA is reverse-transcribed to DNA, integrated into the host genome, transcribed, then assembled and matured by a protease. Every step is a drug target.
- Standard ART combines drugs from at least two classes. Preferred initial regimens in Australia are an integrase inhibitor (bictegravir or dolutegravir) with tenofovir plus emtricitabine or lamivudine, or dolutegravir with lamivudine alone when hepatitis B is absent and baseline resistance is excluded.
- Exams test the mechanism of a toxicity: HLA-B*57:01 with abacavir, proximal tubulopathy with TDF, the OCT2 creatinine rise, unconjugated hyperbilirubinaemia with atazanavir, and boosted regimen interactions.
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Sources
- HIV management in Australasia, a guide for clinical careAU/NZASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), online, checked November 2026
- Guidelines for the use of antiretroviral agents in adults and adolescents with HIVUS Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents, current online edition, checked November 2026
- Liverpool HIV Drug Interactions CheckerUniversity of Liverpool, online, accessed November 2026
- TGA approves registration of lenacapavir for pre-exposure prophylaxis (PrEP) for HIV (Yeytuo)AU/NZTherapeutic Goods Administration, December 2025
- HLA-B*5701 screening for hypersensitivity to abacavir (PREDICT-1). N Engl J Med 2008;358:568-79Mallal et al., 2008
- Long-term follow-up studies confirm the stability of the latent reservoir for HIV-1 in resting CD4+ T cells. Nat Med 2003;9:727-8Siliciano et al., 2003
- TIVICAY (dolutegravir) prescribing information, revised August 2026 (metformin interaction, Tables 8 and 11)US National Library of Medicine DailyMed, 2026
- Last updated
- 14 November 2026
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