Chapter 29

HIV- and AIDS-Related Drugs

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 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.
 Destruction of CD4 cells by HIV results in
immune deficiency.
 CD4 cell count indicates immune function in
those with HIV.

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 HIV Life Cycle

The Life Cycle of the Human Immunodeficiency Virus.

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 HIV Infection
 HIV infection symptoms
 Occur 2-12 weeks after HIV exposure
 Range from mild to severe
 Symptoms
• Fever, fatigue
• Headache, pharyngitis
• Myalgia, arthralgia
• Night sweats
• Lymphadenopathy

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 HIV Transmission
 HIV is spread by intimate contact with:
 Blood
 Semen, vaginal fluids
 Breast milk
 Means of transmission
 Sexual contact
 Direct blood contact
 Mother to child

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 Laboratory Testing
 CD4 T-cell count
 Plasma HIV RNA quantitative assay (or viral
load [VL] test)
 HIV resistance testing

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 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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 Treatment Goals of
Antiretroviral Therapy
 Reduce HIV-associated morbidity and mortality
 Restore and preserve immunologic function
 Decrease inflammation and immune activation
 Prevent HIV transmission

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 Antiretroviral Therapy
 Antiretroviral drugs
 Nucleoside/nucleotide reverse transcriptase inhibitors
(NRTIs)
 Nonnucleoside reverse transcriptase inhibitors
(NNRTIs)
 Protease inhibitors (PIs)
 Fusion (entry) inhibitors
 CCR5 antagonists
 Integrase strand transfer inhibitors (INSTIs)

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 Antiretroviral Drugs
 Nucleoside/nucleotide reverse transcriptase
inhibitors (NRTIs)
 Action
• Inhibit viral replication by interfering with HIV viral RNA-
dependent DNA polymerase
 Can take NRTIs without regard to food
 Didanosine should be taken 30 minutes ac or 2 hours
pc
 Side effects/adverse effects
• Nausea, diarrhea, rash, peripheral neuropathy
• Pancreatitis, lipoatrophy, myopathy

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 Antiretroviral Drugs (Cont.)
 Nonnucleoside reverse transcriptase inhibitors
(NNRTIs)
 Action
• Binds directly to transverse transcriptase blocking RNA and
DNA-dependent DNA polymerase activities including HIV-1
replication
 Side effects/adverse effects
• Rash, nausea, diarrhea
• Dizziness, insomnia
• Neuropathy
• Liver failure

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 Antiretroviral Drugs (Cont.)
 Protease inhibitors
 Action
• Inhibits protease activity causing formation and release of
immature, defective, and noninfectious virus particles
 Side effects/adverse effects
• Rash, nausea, vomiting, diarrhea
• Dyslipidemia
• Insulin resistance
• Hemolytic anemia
• Stevens-Johnson syndrome

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 Antiretroviral Drugs (Cont.)
 Fusion (entry) inhibitors
 Action
• Prevents HIV entry into healthy cells by inhibiting fusion of
the virus to healthy cell membranes
 Side effects, allergic reactions
• Rash, diarrhea
• Injection site reactions
• Anaphylaxis, fever, hypotension

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 Antiretroviral Drugs (Cont.)
 CCR5 Antagonists
 Action
• Prevents viral replication by blocking CCR5 coreceptor
needed for CCR5-tropic HIV entry into immune cells
 Side effects/adverse effects
• Upper respiratory infection, cough, pyrexia
• Rash, dizziness
• Abdominal pain
• Hepatotoxicity

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 Antiretroviral Drugs (Cont.)
 Integrase strand transfer inhibitors (INSTIs)
 Action
• Limits ability of virus to replicate and infect new cells by
interfering with integrase (enzyme needed for HIV to multiply
and divide)
 Side effects
• Nausea, diarrhea
• Rash, insomnia, headache, pyrexia
• Myopathy, hepatic damage
• Rhabdomyolysis

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 Immune Reconstitution
Inflammatory Syndrome (IRIS)
 Related to specific opportunistic pathogen
inflammatory response in patients with
antiretroviral therapy being initiated or changed
 Two distinct entities
 Paradoxical IRIS, which is an exacerbation of treated
opportunistic infection
 Unmasking IRIS, a response to undiagnosed or
subclinical opportunistic infection

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 Immune Reconstitution
Inflammatory Syndrome (IRIS)
(Cont.)
 Risk factors
 Low CD4+ cell count
 High baseline HIV RNA

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 Nurse’s Role in Antiretroviral
Therapy
 Nurse’s role
 Assessment of patient’s physiologic and psychosocial
health needs
 Patient teaching
 Assess patient’s side effects/adverse effects
 Drug regimen adherence
 Nonadherence results
 HIV viral replication
 Potentiate drug resistance

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 Patient Adherence
 Suggestions to promote patient adherence
 Drug organizers
 Mobile devices alarm
 Drug map with pictures
 Drug diary
 Support system
 Patient education

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 Nursing Process: Antiretroviral
Therapy
 Assessment
 Assess readiness to learn and discern the preferred
method of instruction.
 Nursing diagnoses
 Health Management, Ineffective related to complex
drug management
 Fear related to perceived stigma of HIV diagnosis
 Planning
 The patient will adhere to the drug regimen and will
report any difficulties related to adherence.

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 Nursing Process: Antiretroviral
Therapy (Cont.)
 Nursing interventions
 Provide information on the necessity of adhering to
the drug regimen and regular health care.
 Provide opportunities for the patient and/or support
persons to verbalize feelings.
 Evaluation

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 Opportunistic Infections
 Tuberculosis infection
 Usually affects lungs, may affect other organs
 Kaposi sarcoma
 Dark blue lesions in skin, mucous membranes, GI
tract, lungs, or lymph nodes
 Pneumocystis jiroveci pneumonia
 Fungal infection in the lungs
 Toxoplasmosis
 Encephalitis due to protozoan found in uncooked
meat and cat feces

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 Opportunistic Infections (Cont.)
 Cryptosporidiosis
 Infection usually in bowel mucosa due to protozoan
parasite
 Mycobacterium avium complex
 Blood infection due to bacteria related to M.
tuberculosis
 Cytomegalovirus
 Infection due to virus infecting entire body especially
as retinitis leading to potential blindness

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 Antiretroviral Drug Therapy in
Pregnancy
 Timing
 Timing of initiation of treatment and the selection of
regimens for pregnant patients may differ from those
for nonpregnant adults or adolescents.
 Goal
 Achieve maximal and sustained viral suppression
during pregnancy to prevent perinatal transmission.
 Transmission
 HIV-infected patients can transmit the virus during
pregnancy, labor, delivery, and breastfeeding.

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Occupational Exposure to HIV and
Postexposure Prophylaxis
 Postexposure prophylaxis regimens (PEP)
 PEP regimen should be initiated within 72 hours of
the event and continued for 4 weeks.
 Health care workers taking PEP have reported
adverse reactions with the most common reactions
being nausea, malaise, and fatigue.

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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?

A. Cardiovascular
B. Immune
C. Renal
D. Hepatic

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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?

A. Do not eat raw fish.

B. Limit food intake to proteins only.
C. Avoid ingesting bananas.
D. Applesauce may cause you to experience side effects
of the medication.

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 Practice Question #3
The nurse identifies which condition as a common
bacterial opportunistic infection seen in patients
with HIV?

A. Cytomegalovirus
B. Candidiasis
C. Toxoplasmosis
D. Tuberculosis

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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?

A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks

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