Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Introduction to ARV therapy HAIVN Havard Medical School AIDS Initiative in Vietnam 1 Learning objectives By the end of this session, participants should be able to: Present the goals of ARV therapy Outline ARV drugs used in Viet Nam Instruct patients on medication adherence Recognize common and/ or significant side effects of ARV drugs 2 What are the goals of ARV therapy? Why do we use ARV drugs knowing they don’t eliminate HIV? 3 Goals of ARV therapy Ultimately: Improve patient’s quality of life Reduce HIV replication in patient: • Reduce viral load • Lessen attack of the virus on the immune system Create opportunities for the immune system to recover: • Help increase the number of CD4 cells 4 Relationship between CD4 count and viral load HIV RNA (viral load) = Speed of train Slow: <5,000 Fast: 50,000+ CD4 count = Distance to crash 5 Results of decrease in viral load and increase in CD4 count Prevent the progression from HIV to AIDS Prevent opportunistic infections Increase survival rate Decrease HIV transmission 6 Effect of ARV HIV uses CD4 cell as a “factory” to produce HIV ARV goes into the “factory” and reduces its ability to “produce” HIV When patient takes ARV, virus production can be minimized CD4 Why do we have to combine drugs in treatment? Each patient is infected with different strains of HIV Each strain of HIV is sensitive to some but not all ARV drugs To achieve the best and the longest effect, patient has to take at least 3 different ARV drugs 8 Progression to AIDS according to ARV therapy 30 25 20 % 15 10 5 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Non therapy Non therapy Mono therapy Mono therapy Dual therapy Dual therapy Triple therapy Triple therapy Month 9 15 ARV drugs currently available in Viet Nam Nucleoside/ Nucleotide RTI AZT / Zidovudine Protease inhibitors RTV / Ritonavir IDV / Indinavir d4T / Stavudine LPVr / Lopinavir + ritonavir 3TC / Lamivudine ddI / didanosine Non-nucleoside RTI ABC / Abacavir NVP /Nevirapine TDF / Tenofovir EFV / Efavirenz First line ARV regimens in Viet Nam Lamivudine (3TC) Tenofovir (TDF) Zidovudine (AZT) + Efavirenz (EFV) Nevirapine (NVP) Stavudine (D4T) is no longer recommended as a first line ARV drug Modified and Supplemented from Guidelines for Diagnosis and Treatment of HIV/AIDS,11/2011 Side effects of ARV 12 Side effects of ARV (1) Side effects can happen when taking ARVs • Usually in the first weeks of therapy • improve over time or with symptomatic management Side effects can be mild or severe Some side effects relate to dosage and/or drug interactions 13 Side effects of ARV (2) Common side effects: • Peripheral neuropathy • Diarrhea • Rash • Nightmare Uncommon but severe side effects : • Pancreatitis • Bone marrow suppression • Severe rash • hypersensitivity Nurse should instruct patients to recognize side effects of ARV 14 Some examples of side effects of ARV 15 Allergy to Nevirapine (1) rash Allergy to Nevirapine (2) Stevens-Johnson syndrome Allergy to Nevirapine (3) Stevens-Johnson syndrome Allergy due to Efavirenz Hội chứng Stevens-Johnson Allergy to Cotrimoxazole (1) Allergy to cotrimoxazole may cause erythematous rash, flat or slightly elevated lesions on the trunk and extremities Allergy to Cotrimoxazole (2) Rash Adherence 22 Adherence Adherence means taking the correct medications, in proper doses and on time To achieve the best effect with ARV therapy, adherence rate is required to be above 95%. • Example: If medications are prescribed 2 times a day, don’t forget more than 2 doses a month. 23 Non adherence to ARV therapy is common Assessments of rates of non adherence to treatment range from 20% to 80%, with the average rate of 50%. Adherence rate in IDUs (40% - 80%) and non-IDUs (30% - 70%) are similar. 24 Common levels of adherence Three types of patient’s adherence Very good adherence Adherence 100% Reduced adherence Non adherence 0% 0 12 24 Treatment time (month) Howard AIDS 2002; Ickovics Antiviral Ther 2002; Moss CID 2004 Common reasons for non adherence to ARV Reason % Simply forgot or were busy 66% Not at home 57% Had a change in daily routine 51% Slept through dose time 40% Sick 28% Sad, sorrowful 18% Individual problems 14% Side effects 12%26 Factors influencing non adherence to HIV treatment Medications interfere with daily life Drinking alcohol or using drugs Sad mood, stress Pessimistic about HIV Treatment is less effective than desired 27 Goals of adherence to ARV drugs Maximizes inhibition of viral load Reduces drug resistance Increases time of exposure to effective medication Above all, helps: • Delay progression to AIDS • Prolong survival • Improve quality of life 28 Components of adherence Take medicine on time Maintain regular check up Maintain “healthy lifestyle with HIV” • Eat healthy food • Exercise regularly • Do not smoke tobacco or drink alcohol 29 Nurse should pay attention to 30 Learn about the patient (1) Find out attitudes, knowledge and beliefs of the patient by asking questions : About medication generally: • For example: Did you take medication before? Tell me about that. About HIV/AIDS: • For example: Can HIV be cured? 31 Learn about the patient(2) About ARV drugs: • Do you know someone who is on ARV therapy? • How is his/ her health after taking ARVs? • What would happen if you take ARV drugs? Patient’s desires: • benefit and cost of treatment • changes in appearance (or not) • side effects 32 Learn about the life circumstances of the patient (1) Has patient ha disclosed his / her HIV status to anyone? Who is the main support person for the patient? • Does s/he know that the patient has HIV? • What does s/he know about ARV drugs? 33 Learn about the life circumstances of the patient (2) Life circumstance • Have a house? • Is anyone in the family aware of the patient's diagnosis? • Are there any children at home? Daily living • work? • child care? 34 The role of nurses in ARV therapy groups (1) Instruct patients on ARV therapy purposes Understand how ARV impacts patients’ lives Collaborate with physicians and pharmacists in ARV therapy group to give patients the best care 35 The role of nurses in ARV therapy groups (2) Ensure that patients: • understand how to take medicine before leaving the clinic • have plans to remember to take medicine Instruct patients on: • possible side effects • what to do if side effects occur Give patients and their families a message of: HOPE 36 Key points The goal of ARV treatment is to reduce viral load and increase CD4 count and ultimately to increase quality of life A 3-drug combination is most effective The role of nurses is to help patients adhere to treatment to obtain the best results from ARVs 37 Thank you Question? 38