HIV and AIDS-related drugs Flashcards
The use of HIV medications to treat HIV infection. Recommended for everyone infected with HIV regardless of CD4+ count.
anti-retroviral therapy (ART)
AKA HAART for highly active anti-retroviral therapy
There is a higher urgency to start ART when a person has
-a high viral load
-pregnant
-AIDS
-has coinfections such as Hep B
-serodiscordant couples
ART is a life-long treatment that helps people with HIV live longer,
healthier lives. But effective ART depends on
adherence
__________ __________ can cause HIV treatment to fail.
A person can initially be infected with drug-resistant HIV or
develop drug-resistant HIV after starting HIV medicines.
Adherence to an effective HIV treatment regimen reduces the risk
of drug resistance. Adherence means taking HIV medicines every
day and exactly as prescribed.
Drug resistance
Goals of ART
- Reduce HIV-associated morbidity and mortality
- Prolong the duration and quality of life
- Restore and preserve immunologic function
- Maximally and durably suppress plasma HIV viral load
- Prevent HIV transmission
MOST COMMON HIV RELATED
OPPORTUNISTIC INFECTIONS/DISEASES
Bacterial
* TB, bacterial pneumonia, septicemia
Protozoal
* PCP, toxoplasmosis, cryptosporidosis, leishmaniasis
Fungal
* Candidiasis, crytococcosis
Viral
* Cytomegalovirus, herpes simplex, herpes zoster
HIV
* Associated malignancies: Kaposi’s sarcoma, lymphoma,
squamous cell carcinoma
Current guidelines for ART
Initial therapy of two nucleoside reverse transcriptase inhibitors (NRTIs) in combination with a third active antiretroviral (ARV) drug for
one of three drug classes:
- Integrase strand transfer inhibitor (INSTI)
- Nonnucleoside reverse transcriptase
inhibitor (NNRTI) - Protease inhibitor (PI)
Blocks reverse transcriptase to prevents viral DNA synthesis. Virus then can’t replicate.
Treat symptoms of HIV combined with other drugs
Prevents maternal HIV transmission; Post-exposure prophylaxis for HIV-exposed healthcare workers
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)
Ex: Zidovudine
Side effects and adverse effects of zidovudine
Side Effects:
* GI sx (nausea, vomiting, anorexia; diarrhea and/or constipation), CNS effects (headaches, dizziness, neuropathy), rash is a common hypersensitivity reaction, lipoatrophy
Adverse effects:
bone marrow suppression (anemia common, also neutropenia), hepatotoxicity, pancreatitis
Caring for patients on ART
- Monitor plasma HIV RNA (viral load) assays, CD4 counts, CBC, liver and renal profiles, glucose
- Assess for bone marrow suppression, liver toxicity, and Stevens Johnson syndrome
- Patients should not drive or perform hazardous activities until medication reactions are known (due to CNS effects)
- Be aware of conditions and drugs that are problematic with antiretroviral therapy
- Teach patients how to practice blood and body fluid precautions
SUGGESTIONS TO PROMOTE PATIENT ADHERENCE
Adherence is important to prevent resistance and progression of the disease
- Patient understanding of each medication’s purpose
- Food and fluid recommendations
- Storage of medications
- Appropriate recording sheet
- Contact person for questions
- Individuals at high risk for HIV, takes regimen daily
- Highly effective for preventing HIV
- Truvada (contains two drugs- tenofovir and emtricitabine)
- Must be HIV negative to start regimen
- Side effects: headache, abdominal pain, weight loss
- Adverse effects: Nephrotoxic, lactic acidosis, hepatotoxic
PRE-EXPOSURE PROPHYLAXIS (PrEP)
- Regimen should be initiated within hours
of the event and continued for 4 weeks. - Health care workers taking PEP have reported
adverse reactions at rates of 17% to 47%, with
the most common reactions being nausea,
malaise, and fatigue
POSTEXPOSURE PROPHYLAXIS (PEP)
