HIV Treatment and Prevention PDF

HIV Treatment and Prevention Nursing 498 Self Study Module  Antiretroviral drugs (ART): indicated specifically for the treatment of infections caused by HIV. Antiretrov Goals: Viral suppression (the primary purpose iral of ART...

HIV Treatment and Prevention Nursing 498 Self Study Module  Antiretroviral drugs (ART): indicated specifically for the treatment of infections caused by HIV. Antiretrov Goals: Viral suppression (the primary purpose iral of ART is to suppress the HIV viral load, Therapy protect the immune system, and prevent progression to AIDS). (ART) Immune restoration (help CD4 cell recovery). Prevention of resistance (through combination therapy). Improved quality of life (reduce HIV-related morbidity and mortality). Prevention of transmission (undetectable = untransmittable (U=U)).  Antiretroviral Therapy (ART) Combination Therapy: The use of multiple antiretroviral drugs (ARVs) from at least two different drug classes to suppress HIV replication effectively. Why Combination Therapy? Reduces viral replication. Decreases the risk of drug resistance. Synergistic effects suppress viral replication more effectively. Lifelong Treatment: ART is not a cure; adherence is critical for long-term success. Standard Regimen: Typically, a combination of three active drugs.  Class Examples Mechanism of Action Block reverse Tenofovir (TDF, TAF), Nucleoside Reverse transcriptase by Emtricitabine (FTC), Transcriptase mimicking natural Abacavir (ABC), Inhibitors (NRTIs) nucleotides, stopping HIV Lamivudine (3TC) DNA synthesis. Block integrase, Integrase Strand Dolutegravir (DTG), preventing integration of Drug Transfer Inhibitors Bictegravir (BIC), viral DNA into the host (INSTIs) Raltegravir (RAL) genome. Classes in Inhibit the protease ART Protease Inhibitors (PIs) Atazanavir (ATV), Darunavir (DRV) enzyme, preventing maturation of infectious viral particles. Non-Nucleoside Efavirenz (EFV), Bind directly to reverse Reverse Rilpivirine (RPV), transcriptase enzyme, Transcriptase Doravirine (DOR) inhibiting its activity. Inhibitors (NNRTIs) Additional drug classes exist for individuals with resistance to first-line therapies. Typically, 2 NRTIs Different Classes of HIV Drug need to be taken so there are co-formulations (i.e., s First-Line Regimen First-Line Recommendation Preferred Regimen for Adults and Adolescents: Dolutegravir (DTG) combined with a nucleoside reverse transcriptase inhibitor (NRTI) backbone (e.g., tenofovir/lamivudine or abacavir/lamivudine) for first-line ART (WHO, 2021). Key Points HIV treatment is NOT curative: Drug therapy suppresses but does not eliminate the virus. Daily adherence to ART is essential to achieve and maintain viral suppression.  Drug Class System Adverse Effects NRTIs Allergic Nausea, headache, (Nucleoside Reactions, Liver, kidney toxicity (with RTIs) Metabolic Tenofovir Disoproxil Fumarate), hypersensitivity reactions (with Abacavir). INSTIs Allergic Rash, flu-like symptoms. (Integrase Reactions, Rare: Respiratory Inhibitors) Respiratory effects like pneumonia. Adverse NNRTIs (Non- Mental Health, CNS effects: Mood Effects Nucleoside RTIs) CVS changes, depression, vivid dreams (with Efavirenz). Dizziness, tachycardia. PIs (Protease Allergic Jaundice, gallstones Inhibitors) Reactions, Liver, (with Atazanavir). Renal, CVS Kidney stones. Lipid abnormalities (e.g., lipodystrophy), tachycardia. Long-Term ART Bone Possible osteoporosis demineralization Treatment includes  Drug Class Notes Interactions Minimal drug Safe with most medications NRTIs interactions. as they are not (Nucleoside metabolized by CYP450 RTIs) enzymes. INSTIs Interactions with Separate dosing by 2–6 (Integrase antacids, calcium, hours to avoid reduced Inhibitors) magnesium, iron absorption. supplements. Cabotegravir: No Drug interaction. Injectable avoids these issues. Interacti NNRTIs (Non- Nucleoside Interact with CYP3A4 substrates, Acid-reducing agents: Avoid PPIs with RPV ons RTIs) inducers, and inhibitors (e.g., (requires acidic stomach environment). rifampin, Rifampin and anticonvulsants, anticonvulsants: May PPIs). reduce NNRTI effectiveness. PIs (Protease Extensive CYP3A4 Protease inhibitors Inhibitors) interactions with (e.g., darunavir) and statins, boosters increase statin anticoagulants, levels. Dose adjustments anticonvulsants, may be required. and Monitor INR with warfarin;  CBC: Hgb (anemia), platelets (thrombocytopenia), and WBC (neutropenia) Kidney Function: creatinine, BUN, and creatinine clearance (nephrotoxicity) Lab Liver Function Tests: AST, ALT, GGT, Values to Alk Phos, Bili (due to metabolization of medication in the liver) Monitor Serum calcium levels (monitor for osteoporosis and bone density changes) Serum cholesterol levels, triglycerides and blood glucose levels (increased cholesterol levels and insulin intolerance)  Medication Management: Explain that ART is not a cure for HIV but helps to suppress viral replication and improve immune function. Emphasize that strict adherence to ART is crucial to prevent viral resistance and maintain viral suppression. Discuss lifestyle integration, use of pill organizers, alarms, or Nursing reminders. Considerati Assess for and address factors such as stigma, mental health issues, or complex regimens that may hinder adherence. ons for ART Check for interactions with other prescribed medications, over-the-counter drugs, and herbal supplements. Educate patients about specific timing and food requirements (e.g., some drugs need to be taken with food). Adhere to and educate patients about safe medication preparation and administration (i.e., hazardous medications) Monitor viral load and CD4 counts regularly to assess treatment effectiveness.  Management of Adverse Effects: Prepare patients for potential side effects and how to manage them (e.g., nausea, headache, or diarrhea). Watch for signs of hepatotoxicity, nephrotoxicity, and other adverse effects. Nursing Educate about and monitor for long-term risks, such as lipid abnormalities, insulin resistance, or osteoporosis. Considerati ons for ART Pregnancy and Postpartum Considerations: Educate that ART is indicated for all pregnant and postpartum women living with HIV to decrease the risk of transmission to infant. Discuss formula feeding is recommended due to the risk of transmission through breastfeeding.  TasP refers to the use of antiretroviral Preventio therapy (ART) in people living with HIV n: to reduce their viral load to undetectable Treatment levels, which prevents the transmission of HIV to others. as Undetectable = Untransmittable (U=U) Prevention ART reduces the amount of HIV in the (TasP) blood to undetectable levels Consistent use of ART is critical to maintaining an undetectable viral load. Regular viral load testing ensures TasP effectiveness.  Pre-Exposure Prophylaxis (PrEP) is the use of HIV medications by someone who is HIV-negative, in advance of possible exposure to HIV Preventio to prevent infection. n: Pre- When taken at least 4 times per Exposure week, PrEP is 99% effective at Prophylaxis preventing HIV infection. (PrEP) Provides protection from HIV acquired through sexual contact or injection drug use. PrEP typically consists of a combination pill containing: Tenofovir Disoproxil Fumarate (TDF), Emtricitabine (FTC) Example: Truvada  When taken consistently, PrEP Preventio reaches sufficient concentrations in the n: Pre- body, acting as a chemical shield: Exposure Prevents HIV from copying itself after exposure. Prophylaxis Blocks HIV from establishing a (PrEP) permanent infection. Alberta PrEP Guidelines  People living with HIV who are undiagnosed or untreated may progress to AIDS. Risks of The Centers for Disease Control and Prevention (CDC) defines AIDS based on Untreated the presence of certain opportunistic infections or conditions that occur when or Late- the immune system is severely compromised due to untreated or Stage HIV advanced HIV infection. AIDS is the most advanced stage of HIV infection, and it is diagnosed when: CD4+ T-cell count falls below 200 cells/µL, or The individual develops one or more AIDS-defining conditions (many of which are opportunistic infections).  Opportunistic Prophylaxis and Treatment Infection Esophageal or oral Prophylaxis: Nystatin. candidasis Treatment: Fluconazole or Nystatin. Herpes simplex Prophylaxis and Treatment: Antiviral virus therapy (Acyclovir or Valacyclovir). Opportuni stic Hepatitis B (HBV) Prophylaxis: HBV vaccine for prevention. Infections Treatment: Tenofovir Disoproxil Fumarate (TDF), Tenofovir Alafenamide (TAF), or Entecavir for chronic HBV. Influenza virus Prophylaxis: Annual inactivated influenza vaccine. Treatment: Supportive therapy Varicella –zoster Prophylaxis: varicella vaccine for virus (VZV) patients who have previously had chicken pox Treatment: antiviral (acyclovir,  Opportunistic Prophylaxis and Treatment Infection Pneumocystis jiroveci Prophylaxis: Trimethoprim- pneumonia (PJP) Sulfamethoxazole (TMP-SMX) when CD4