1. HIV- and AIDS-Related Drugs
Chapter 35
HIV- and AIDS-Related Drugs
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2. HIV Infection Pathophysiology
HIV is an RNA retrovirus.
HIV is unable to survive and replicate unless it is inside a living human cell.
HIV destroys CD4+ T cells.
The destruction of CD4 cells by HIV results in immune deficiency.
The CD4 cell count is an indicator for immune function in those with HIV.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

3. The Life Cycle of the Human Immunodeficiency Virus.
HIV Life Cycle
The Life Cycle of the Human Immunodeficiency Virus.
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4. HIV Transmission
HIV is spread via intimate contact with blood, semen, vaginal fluids, and breast milk.
Sexual contact
Direct blood contact
Mother to child
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5. Laboratory Testing CD4 T-cell count
Plasma HIV RNA quantitative assay (or viral load [VL] test)
HIV resistance testing
Additional laboratory evaluation
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6. Classification Staging and classification systems
U. S. Centers for Disease Control and Prevention (CDC)
CD4 cell counts
Presence of specific HIV-related conditions
System is based on the lowest documented CD4 cell count (nadir CD4) and on previously diagnosed HIV-related conditions.
World Health Organization (WHO)
Classifies HIV disease on the basis of clinical manifestations that can be recognized by clinicians in diverse settings and those with varying levels of HIV expertise and training
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7. Treatment 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
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8. Indications for Antiretroviral Therapy
HIV-infected individuals
HIV-infected pregnant patients
Patients with a history of an AIDS-defining illness
Patients with HIV-associated nephropathy, or HIV and hepatitis B coinfection
Serodiscordant couples
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9. Antiretroviral Agents
Reverse transcriptase inhibitors
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
Action
Take NRTIs with food (except didanosine should be taken 1 hour ac or 2 hours pc).
Side effects, adverse effects
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

10. Antiretroviral Agents (Cont.)
Reverse transcriptase inhibitors
Non-nucleoside analogues (NNRTIs)
Action
Adverse effects
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11. Antiretroviral Agents (Cont.)
Protease inhibitors
Currently FDA approved
Action
Side effects, adverse effects
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

12. Antiretroviral Agents (Cont.)
Entry (fusion) inhibitors
Enfuvirtide (Fuzeon): only agent approved in this class
Action
Administration
Side effects, allergic reactions
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13. Antiretroviral Agents (Cont.)
CCR5 Antagonists
Maraviroc
Action
Side effects
Upper respiratory infection, cough, pyrexia
Adverse effects
Hepatotoxicity
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14. Antiretroviral Agents (Cont.)
Integrase inhibitors
Raltegravir
Action
Side effects
Headache, pyrexia, nausea, diarrhea
Integrase inhibitors action: inhibits insertion of HIV DNA into human DNA, limiting replication.
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15. Immune Reconstitution Inflammatory Syndrome (IRIS)
Related to specific opportunistic pathogens
Experienced by a low percentage of patients early in ART
Two distinct entities
Paradoxical IRIS, which is an exacerbation of treated (successful or partial) opportunistic infection (OI)
Unmasking IRIS, a response to undiagnosed or subclinical OI
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16. Nurse’s Role in Antiretroviral Therapy
Drug regimen adherence
Nonadherence results
HIV viral replication
Increased viral loads
Immune system deterioration
Drug resistance
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17. Adherence Suggestions to promote patient adherence
Patient understanding of each medication’s purpose
Food and fluid restrictions
Recommended food choices
Storage of medications
Appropriate recording sheet
Contact person for questions
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18. Nursing Process: Antiretroviral Therapy
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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19. 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
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20. Antiretroviral Drug Therapy In Pregnancy
Timing of initiation of treatment and the selection of regimens for pregnant patients may differ from those for nonpregnant adults or adolescents.
Goal is to prevent mother-to-child transmission.
A patient infected with HIV can transmit the virus during pregnancy, labor, and delivery, and through breastfeeding.
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21. Occupational Exposure to HIV and Postexposure Prophylaxis
Postexposure prophylaxis regimens (PEP)
PEP 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.
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22. Practice Question #1
A patient asks the nurse what part of the body is most affected by the HIV virus. The nurse informs the patient that HIV primarily affects which system?
Cardiovascular
Immune
Renal
Hepatic
Answer: B
Rationale: HIV damages the immune system by destroying CD4 T-cells
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23. Practice Question #2
When providing teaching for the patient being discharged home on antiretroviral therapy for HIV, which statement will the nurse include?
Do not eat raw fish.
Limit food intake to proteins only.
Avoid ingesting bananas.
Applesauce may cause you to experience side effects of the medication.
Answer: A
Rationale: Dietary teaching for the patient taking ART should include advising the patient to eat a variety of foods and to avoid ingesting raw eggs and raw fish and cooking of meats to advised temperature. Advise patient how to minimize side effects (e.g., take specific drug with food) and discuss diet of banana, rice, applesauce, and toast for management of diarrhea.
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24. Practice Question #3
The nurse identifies which condition as a common bacterial opportunistic infection seen in patients with HIV?
Cytomegalovirus
Candidiasis
Toxoplasmosis
Tuberculosis
Answer: D
Rationale: Tuberculosis is a bacterial infection. Cytomegalovirus is a virus. Candidiasis is a fungal infection. Toxoplasmosis is a protozoal infection.
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25. Practice Question #4
A health care provider has been exposed to HIV while caring for a patient. Following the postexposure prophylaxis regimen (PEP), the health care provider will most likely receive treatment for how long?
1 week
2 weeks
3 weeks
4 weeks
Answer: D
Rationale: Many PEP regimens are available, with varying degrees of tolerability and probability of patients completing 4 weeks of treatment.
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