Chapter 6: ART Flashcards
What is the importance of monitoring CD4+T cell count
Assess the status of immune system.
Indicate when prevention or treatment of opportunistic infections should start or stop.
Indicate when to start ART
What is the importance of a viral load test
Assess how severe HIV infection is.
Measure response of patient to ART.
Detect ART resistance.
What are the primary goals of ART?
1.virological goal:reduce HIV viral load as much as possible.
2. Immunological goal: to restore and preserve immunological function and delay onset of AIDS
3. Therapeutic goal: to improve quality of an HIV positive person
4. Epidemiological goal: reduce HIV related sickness and death.
What is the purpose of ART?
To treat HIV infection
Prevent HIV transmission
What do we know about viral enzymes
Reverse transcriptase enzyme: vital for completing early stages of HIV replication by transforming viral RNA into proviral DNA.
Protease enzyme: required for assembly of new viral RNA and viral proteins.
Integrase enzyme: assist with HIV DNA integration into nucleas of CD4+T cell.
What are the four classes of antiretroviral drugs?
Nucleoside and nucleotide reverse transcriptase inhibitors.
Non-nucleoside reverse transcriptase inhibitors
Interrupt lifecycle of HIV by interfering with the reverse transcriptase enzyme during early replication of virus preventing the virus from changing RNA into proviral DNA.
Protease inhibitors
Inhibit creation of new viruses by paralysing protease enzyme preventing newly replicated HIV from the infected cell from being assembled and released.
Integrase inhibitors
Interfere with integrase enzyme and prevent HIV DNA to integrate into nucleus of CD4 T cell making virus unable to replicate as it can’t be integrated into host cells DNA.
Entry inhibitors.
Stop HIV from entering host cell by affecting the integration between virus and cell. It binds to viral protein p41 which stops these viral proteins from forming stable interactions with CD4 T cells.
What is ART resistance
Occurs when medication can no longer prevent the resistant virus from replicating.
When should an HIV positive person start ART
Immediately when CD4+T cell count is higher than 500 cells/mm^3.
What aspects are involved in HIV counseling
Provide info of HIV:
Transmission
Pathogenesis
Prognosis
Info on ART:
It is a life long treatment
ART has side effects
Safe sex and reproductive health
Condom use
Contraceptive
Prevention of mother to child transmission
Encourage HIV status with partner
Finding a treatment Buddy
Formulate treatment plan with patient Storage of medicine Strategies for missed days Integration into daily life Follow up visits
What are the available ART drug regimes
Individualised drug regime:
Medication prescribed for a specific individual’s needs in mind.
Standardised drug regime: where a group decides which medications to prescribe a group based on similar circumstances.
Give some side effects of ART
Diarrhoea
Dizziness
Nausea
Vomiting
Serious side effects Lactic acidosis Hepatitis Kidney toxicity Drug rash Pancreatitis
What is immune reconstitution inflammation syndrome IRIS
Is a condition in which the immune system begins to recover but respond with massive inflammatory response to an opportunistic infections worsening the symptoms of infection.
When should ART be changed
When patient shows intolerance of the medication.
When drug toxicity occurs
When virological failures occur
When viral load increases
Provide reasons for non-adherence
Person centred or psychosocial barriers: forgetfulness, alcohol abuse, denial depression
Relationship between patients and health care worker: lack of healthcare support, lack of info provided to patients
Practical problems: transport problems, insufficient food to eat to make medicine
Work related issues: unable to go for checkups during working hours.
Medication related issues: difficult regime to follow
Service related barriers: not enough stock at health care facilities.
Stigma
Health control
Cultural aspect
Conflict of opinion
Give strategies for improving adherence to ART
Evaluate person’s ability and intension to adhere.
Simplify treatment regimens by providing FDC
Identify relevant barriers or challenges to adherence
