HIV Flashcards
1
Q
Background
A
- HIV- Human Immunodeficiency Virus
- AIDS- Acquired Immunodeficiency Syndrome
- AIDS- Advanced stage of HIV
- AIDS very rare now thanks to the development of medications
- Prior to medication- very high mortality rate
- No current cures or vaccines, only option is medication to control the virus and prevent AIDS
2
Q
Background CD4 and infection
A
3
Q
Starting medication
A
- Key blood results- CD4 count, HIV viral load, HIV viral resistance
- Patient factors- shock acceptance, stigma
- Other factors- age, co-infections (TB, HepB,C), malignancy, Pregnancy, partner status (TasP)
- Other medications- interactions
- Other medical conditions- renal, liver, CVD
4
Q
Which combination
A
- Various abbreviation
- ARV’s- Anti Retrovirals
- ART- Anti Retroviral Therapy
- HAART- Highly Active Anti Retroviral Therapy
- cART- Combination Anti Retroviral Therapy
- BHIVA- British HIV Association
- Responsible for guidelines relating to HIV treatment and are part of NICE
5
Q
Which combination
A
6
Q
Treatment goals
A
- Aiming for patient to have an undetectable HIV viral load and for this to be maintained
- CD4 count to increase. In most cases this will increase to be in the range of the non-infected population so patient will no longer be immunocompromised
- Patients need to be fully adherent to their HIV medication in order to have an undetectable viral load and prevent any complications (Infection/cancer/nephropathy)
7
Q
Adherence
A
- Adherence to medicines is defined as the extent to which the patient’s action matches the agreed recommendations
- Non-adherence may limit the benefits of medicines, resulting in lack of improvement, or deterioration, in health
8
Q
Adherence
What this means for HIV patients
A
- Take your medication everyday at the same time(s)
- Do not miss any doses
- Nothing less than 100% adherence is acceptable
- Missing your medication will lead to resistance developing
- This can mean needing to take more medication, more often and dealing with more side effects as well as more interactions.
9
Q
Barriers to adherence
A
- Acceptance
- Knowledge/understanding
- Side effects
- Drug interactions
- Language barriers
- Medication factors
- Disclosure
- Stigma
10
Q
Acceptance
A
- Patients struggle to comes to terms with diagnosis
- They can be in shock, denial or fell they are being persecuted
- Scenario 1- Patient refused to accept he was HIV positive. When shown his blood results, he claimed they were somebody else’s and we had mixed up the sample labels. He therefore refused to take medication for a condition he didn’t think he had. Further blood tests and input from clinic staff later convinced him
11
Q
Acceptance
Scenario 2
A
- Patient was routinely tested during pregnancy and found to be HIV positive. Patient looked and felt well so the result came as a major shock. She accepted that she was HIV positive, but the hospital had given it to her as part of a conspiracy to ensure clinic staff have jobs and drug companies make money selling HIV medication. Took 2 years to convince her otherwise with help from support groups and social workers
12
Q
Knowledge/understanding
A
- Patients not aware of what HIV is or that treatment is available which will improve their health and prevent deterioration if taken properly
- Some still think being diagnosed with HIV is a death sentence
- Some think taking HIV meds is like taking a course of antibiotics-
- Other think they can stop once their viral load is undetectable- because they are cured
- We provide information leaflets for all meds, booklets on HIV treatment, show demo pulls and links to reliable websites as standard counselling
13
Q
Side effects
A
- The biggest concern from patients when starting medication.
- Leads to anxiety when being experienced but also when not being experienced as patients feel the medication isn’t working.
- Efavirenz- feeling dizzy, drowsy, depressed and having odd dreams (4D’s). Component of Atripla.
- Rilpivirne- bloating and flatulence
- Darunavir- nausea and diarrhoea
- Atazanavir- raised bilirubin, jaundiced look-see image. Patients don’t like looking in the mirror or being approached by people saying ‘you don’t look right’
14
Q
Side effects scenario
A
- Are the symptoms improving?
- Side effects
- Is the patient observing the 2 hour food time window?
- What kind of food is the patient taking e.g. high fat content
- How much Atripla is the patient taking?
- Has the patients work pattern changed?
- Any social/domestic changes recently?
- Any other drugs-OTC/GP/Herbal/Recreational?
15
Q
A
- These side effects are common when first taking Atripla/Efavirenz
- The fact that they are resolving is a good sign and advise patient to carry on taking it
- Continue taking Atripla with a banana, despite two hour food time window
- Patient to be given doctors appointment should the side effects continue to be troublesome for a month
- Arrange follow up appointment with a pharmacist
17
Q
PI boosting example
A
20
Q
Interactions
Antivirals and recreational drugs
A
22
Q
A
23
Q
A
25
Q
Medication factors
A
27
Q
Disclosure
A
28
Q
A
