Rapid Antibody Testing Procedures

HIV & AIDS Drugs

• The presentation covers various drugs used in treating HIV/AIDS.
• The presentation includes information on different drug classes used in the treatment of HIV/AIDS.
• The presentation includes information on groups and individual members who presented.
• The presentation provides information on the group members in different groups who worked on the presentation.

How does HIV and AIDS form in the body?

• HIV attacks the immune system, specifically targeting CD4 cells.
• HIV enters the body through contact with infected body fluids like blood or semen through unprotected sex, sharing needles, or from mother to child during childbirth or breastfeeding.
• HIV replicates in CD4 cells, weakening the immune system over time.
• Without treatment, the virus continues to destroy CD4 cells.
• When the CD4 count falls below 200 cells/mm^2, the infection progresses to AIDS.

Possible Symptoms for Acute HIV (Primary Infection)

• Fever
• Headache
• Muscle aches and joint pain
• Rash
• Sore throat
• Painful mouth sores
• Swollen lymph glands
• Diarrhea
• Weight loss
• Cough
• Night sweats

Symptoms When HIV Progresses to AIDS

• Sweats
• Chills
• Recurrent fever
• Ongoing diarrhea
• Swollen lymph glands
• Constant white spots or lesions on the tongue
• Constant fatigue
• Weakness
• Rapid weight loss
• Skin rashes or bumps

HIV Pathophysiology

• HIV infection (RNA retrovirus)
• Target: CD4+ T cells
• Destruction of CD4+ T cells
• Immune system weakening
• Immune response
• Initial replication
• CD4+ count (indicator of immune function)
• Early symptoms
• Ongoing replication
• Acute Retroviral/Primary HIV infection
• HIV RNA Test
• HIV primarily targets CD4+ T cells.
• The virus attaches to the CD4 receptor and co-receptors (CCR5 or CXCR4).
• Allows it to enter and infect them.
• Once inside the cell, HIV uses reverse transcriptase to convert its RNA into DNA.
• Integrated into the host cell's genome by the enzyme integrase.
• The infected cell then produces new viral particles.
• Bud off and infect other CD4+ T cells.
• Continuous replication of HIV leads to a significant reduction in the number of CD4+ T cells.
• This depletion weakens the immune system, making the body more susceptible to opportunistic infections and certain cancers.
• Without treatment, HIV infection progresses to AIDS.
• Characterized by a CD4+ T cell count below 200 cells/mm^2 or the presence of specific opportunistic infections or cancers.

HIV Life Cycle

• Binding and fusion: HIV binds to a CD4 receptor and one of two co-receptors.
• The virus fuses with the host cell. After fusion, the virus releases RNA into the host cell.
• Reverse transcription: An HIV enzyme called reverse transcriptase converts the single-stranded HIV RNA to a double-stranded HIV DNA.
• Integration: The newly formed HIV DNA enters the host cell's nucleus, where an HIV enzyme called integrase "hides" the HIV DNA within the host cell's own DNA—the integrated HIV DNA is called a provirus.
• Transcription: The provirus uses a host enzyme called RNA polymerase to create copies of the HIV genomic material.
• Assembly: An HIV enzyme called protease cuts the long chains into smaller, individual proteins to assemble a new virus particle..
• Budding: The newly assembled virus pushes out from the host cell, stealing part of the cell's outer envelope which is studded with protein/sugar combinations called HIV glycoproteins.
• Maturation: The protease enzyme finishes cutting HIV protein chains, combining to make a new working virus.

HIV Transmission

• Intimate contact with blood, semen, vaginal fluids, and breast milk
• Sexual contact (oral, vaginal, and anal sex)
• Direct blood contact (including intravenous drug use with shared needles, or shared drug works, and shared personal care items such as razors or Blood transfusion (now extremely rare in the United States)
• Mother-to-child contact (shared maternal-fetal blood circulation, contact during delivery, breastfeeding)

HIV/AIDS Tests

• HIV Antibody Tests

• These tests look for antibodies to HIV in the blood or oral fluid. It typically takes several weeks for antibodies to develop after infection.

• Types: ELISA, Western Blot Test, Window Period

• HIV Antigen/Antibody Tests

• These tests detect both HIV antibodies and antigens (specifically the p24 antigen) produced by the virus.

• HIV Nucleic Acid Tests (NATs)

• NAT detects the actual virus in the blood.

• HIV RNA blood test

Rapid Tests

• Provide rapid results, useful for community settings, clinics, or at home.

CD4 Count

• Measures the number of CD4 T-cells in the blood.
• Helps determine the stage of HIV infection.
• A lower CD4 count indicates a more severe immune deficiency.

Viral Load Tests

• Measures the amount of HIV RNA in the blood.
• Helps assess how well antiretroviral therapy is working and the level of viral replication.

Testing Procedures

• Sample collection (venipuncture or fingerstick and oral fluid tests)
• Laboratory processing
• Counseling and follow-up

HIV Classification

• CDC staging system (revised in 2014)
• World Health Organization (WHO) system (revised in 2015)

Indications for Antiretroviral Therapy

• Due to undiagnosed HIV or improper monitoring, only 3 in 10 achieve adequate viral suppression.
• All HIV-infected individuals regardless of CD4+ count
• Significantly improved the health and survival of people with HIV
• To reduce HIV-related morbidity, mortality, and transmission.

What Does the Initial Treatment Involve?

• Two NRTIs and a third drug from either the INSTI, NNRTI, or PI classes.
• Active TB: ART and TB treatments should be started together

Prophylaxis of HIV

• Pre-exposure Prophylaxis (PrEP) • Taking medicine to prevent getting HIV • Highly effective for preventing HIV when taken as prescribed
• Post-Exposure Prophylaxis (PEP) • Taking anti-HIV drugs shortly after possible exposure • Must be started within 72 hours
• Preventive Measures • Using condoms • Regular HIV testing • Safe needle practices • Ensuring blood safety

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

• A class of antiretroviral drugs primarily used to treat HIV
• NRTIs prevent HIV from making copies of itself, slowing the progression of infection.

NRTI Common Complications

• Lactic acidosis, hepatomegaly, steatosis
• Zidovudine: bone marrow suppression, lipodystrophy
• Didanosine and stavudine: bone marrow suppression, pancreatitis (boxed warning), peripheral neuropathy
• Lamivudine, tenofovir, and emtricitabine: hepatitis B exacerbations in clients co-infected with HIV and HBV
• Tenofovir: osteomalacia
• Emtricitabine: skin hyperpigmentation, immune reconstitution syndrome
• Abacavir: increased risk of myocardial infarction, immune reconstitution syndrome, severe hypersensitivity reactions.

The 7 NRTIs

• Zidovudine (AZT)
• Didanosine (ddl)
• Stavudine (d4T)
• Lamivudine (3TC)
• Abacavir (ABC)
• Tenofovir (TDF)
• Emtricitabine (FTC)

Zidovudine (AZT)

• The first drug approved to treat HIV.
• Cornerstone in HIV treatment, but replaced by newer drugs due to side effects.
• Side effects: Nausea, headache, and fatigue

Didanosine (ddl)

• An older HIV drug.
• Side effects: Diarrhea, nausea, and rash.

Stavudine (d4T)

• Similar to Zidovudine.
• Side effects: Peripheral neuropathy, Nausea

Lamivudine (3TC)

• A cytosine analogue.
• Effective against hepatitis B.
• Side effects include: headache, nausea, fatigue, and diarrhea.

Abacavir (ABC)

• A guanine analogue.
• Side effects: Nausea, headache, and fatigue
• Important to note the HLA-B*5701 allele is screened before use

Tenofovir (TDF)

• A nucleotide analogue.
• Side effects include: Nausea, diarrhea, and headaches.

Emtricitabine (FTC)

• A cytosine analogue. Well-tolerated and a common choice for first-line therapy.
• Side effects: Nausea, diarrhea, and headaches.

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Bind to and block reverse transcriptase enzymes while stopping HIV viral reproduction.

The 5 NNRTIs

• Efavirenz (EFV)
• Etravirine (ETR)
• Delavirdine (DLV)
• Nevirapine (NVP)
• Rilpivirine (RPL)

Efavirenz (EFV)

• First choice drug within the NNRTI class.
• Penetrates the cerebrospinal fluid (CSF).
• Inhibits viral RNA-directed DNA polymerase/reverse transcriptase.
• Reduces viral replication.
• Side effects: Rash, Nausea, diarrhea, dizziness, insomnia, abnormal dreams, impaired concentration, and anxiety.

Etravirine (ETR)

• Second generation NNRTI.
• Binds to and inhibits reverse transcriptase.

Delavirdine (DLV)

• Inhibits reverse transcriptase.
• Side effects: Rash, increased transaminase levels, headaches, nausea, and diarrhea.

Nevirapine (NVP)

• Lowers HIV levels in the blood by inhibiting viral replication.
• Side effects: Rash, including Stevens-Johnson syndrome, as well as symptomatic hepatitis.

Rilpivirine (RPL)

• Taken once daily, preferred for lower resistance compared to other NNRTIs
• Side effects: Rash, depression, headache, insomnia

Protease Inhibitors (PIs)

The 8 PIs

• Ritonavir (RTV)
• Saquinavir (SQV)
• Tipranavir (TPV)
• Darunavir (DRV)
• Amprenavir (APV)
• Atazanavir (ATV)
• Fosamprenavir (FOS)
• Indinavir (IDV)

Fusion (Entry) Inhibitors

• Antiviral drugs preventing HIV from entering human cells.
• These drugs block the virus from merging with the cell's membrane and injecting its genetic material.

Enfuvirtide

• Works by blocking the fusion of HIV-1 with the host cell membrane.
• Prevents replication.

Chemokine Coreceptor Antagonists

• Block the CCR5 receptor.
• Prevent the virus from replicating.

Maraviroc (MVC)

• Blocks the CCR5 receptor on immune cells preventing HIV from binding to the cell.
• Effective against CCR5-tropic strains of HIV.

Integrase Strand Transfer Inhibitors (INSTIs)

• Develop to inhibits integrase, preventing the transfer and insertion of viral DNA into host cell DNA.
• Used to reduce the amount of HIV in the body to undetectable levels.

Dolutegravir, Elvitegravir, and Raltegravir

• Antiretroviral drugs used to primarily treat HIV infections.

Opportunistic Infections (OIs)

• As HIV progresses, individuals become more susceptible to cancers and opportunistic infections.
• The use of ART has significantly lowered the occurrence of Ols.
• Some of the most frequent Ols include pulmonary tuberculosis (TB), pneumococcal pneumonia, Cryptosporidium, fungal infections, Kaposi sarcoma, toxoplasmosis, histoplasmosis, and cytomegalovirus (CMV).

Antiretroviral Therapy (ART) for Pregnancy

• Optimal drug therapy should be used for women of reproductive age.
• Goals of treatment identical to other adults and adolescents.
• The timing of initiation and selection can differ because of preventing HIV transmission to the fetus.
• Consider the timing of initiation of treatment and selection of regimens for pregnant patients.
• Necessary considerations during pregnancy: • Neural tube defects • Viral load • Pre-existing conditions

Occupational HIV Exposure and Postexposure Prophylaxis (PEP)

• PEP is a treatment regimen after percutaneous exposure to HIV.
• For emergency situations only.
• Should be taken promptly within 72 hours.
• Duration: 4 weeks or 28 days.

Patient Adherence

• Educate patients thoroughly on the medication's purpose, how it works, detail possible side effects.
• Develop a medication routine: daily schedules, reminders.
• Foster supportive relationships: encourage family/friends and establish nurse-patient connections.
• Make a follow-up plan: regular check-ins and positive reinforcement.
• Address barriers: side effects management, financial and access support, and misunderstandings.
• Monitor and adjust the plan as needed: regular blood work helps measure effects on health.