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Chapter 35
HIV- and AIDS-Related Drugs
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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HIV Infection Pathophysiology
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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.
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HIV Life Cycle
The Life Cycle of the Human Immunodeficiency Virus.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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HIV Transmission
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HIV is spread via intimate contact with blood,
semen, vaginal fluids, and breast milk.
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Sexual contact
Direct blood contact
Mother to child
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Laboratory Testing
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CD4 T-cell count
Plasma HIV RNA quantitative assay (or viral
load [VL] test)
HIV resistance testing
Additional laboratory evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Classification
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Staging and classification systems
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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 HIVrelated conditions.
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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
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Treatment Goals of ART
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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
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Indications for Antiretroviral Therapy
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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
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Agents
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Reverse transcriptase inhibitors
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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.
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Antiretroviral Agents (Cont.)
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Reverse transcriptase inhibitors
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Non-nucleoside analogues (NNRTIs)
Action
Adverse effects
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Agents (Cont.)
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Protease inhibitors
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Currently FDA approved
Action
Side effects, adverse effects
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Agents (Cont.)
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Entry (fusion) inhibitors
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Enfuvirtide (Fuzeon): only agent approved in this
class
Action
Administration
Side effects, allergic reactions
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Agents (Cont.)
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CCR5 Antagonists
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Maraviroc
Action
Side effects
• Upper respiratory infection, cough, pyrexia
Adverse effects
• Hepatotoxicity
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Agents (Cont.)
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Integrase inhibitors
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Raltegravir
Action
Side effects
• Headache, pyrexia, nausea, diarrhea
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Immune Reconstitution Inflammatory
Syndrome (IRIS)
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Related to specific opportunistic pathogens
Experienced by a low percentage of patients
early in ART
Two distinct entities
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Paradoxical IRIS, which is an exacerbation of
treated (successful or partial) opportunistic
infection (OI)
Unmasking IRIS, a response to undiagnosed or
subclinical OI
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nurse’s Role in Antiretroviral
Therapy
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Drug regimen adherence
Nonadherence results
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HIV viral replication
Increased viral loads
Immune system deterioration
Drug resistance
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Adherence
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Suggestions to promote patient adherence
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Patient understanding of each medication’s
purpose
Food and fluid restrictions
Recommended food choices
Storage of medications
Appropriate recording sheet
Contact person for questions
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nursing Process: Antiretroviral
Therapy
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Assessment
Nursing diagnoses
Planning
Nursing interventions
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Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Most Common HIV-Related
Opportunistic Infections/Diseases
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Bacterial
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Protozoal
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Candidiasis, crytococcosis
Viral
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PCP, toxoplasmosis, cryptosporidosis,
leishmaniasis
Fungal
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TB, bacterial pneumonia, septicemia
Cytomegalovirus, herpes simplex, herpes zoster
HIV
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Associated malignancies: Kaposi’s sarcoma,
lymphoma, squamous cell carcinoma
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Antiretroviral Drug Therapy In
Pregnancy
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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.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Occupational Exposure to HIV and
Postexposure Prophylaxis
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Postexposure prophylaxis regimens (PEP)
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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.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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?
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B.
C.
D.
Cardiovascular
Immune
Renal
Hepatic
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Practice Question #2
When providing teaching for the patient being
discharged home on antiretroviral therapy for
HIV, which statement will the nurse include?
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B.
C.
D.
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.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Practice Question #3
The nurse identifies which condition as a
common bacterial opportunistic infection seen
in patients with HIV?
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B.
C.
D.
Cytomegalovirus
Candidiasis
Toxoplasmosis
Tuberculosis
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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?
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B.
C.
D.
1 week
2 weeks
3 weeks
4 weeks
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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