HIV AIDS Drug Therapy

Highly Active Anti-Retroviral Therapy (HAART)

Anti-Retroviral Therapy (ART)

Combination Anti-Retroviral Therapy (cART)

• Goal of HAART, ART, or cART

  • Increase CD4 cell counts & decreased viral load

  • Decreased risk of opportunistic infection

  • Increased life of patient

• Remember: Antiretroviral therapy (ART) only inhibits viral replication & does not kill the virus

• Patient will still be contagious while taking meds

Drug Therapy Decisions

• Should be initiated upon diagnosis regardless of CD4 counts

• Pregnancy: Women should be tested during 1st prenatal visit

  • If positive, start ART as early as possible

• HBV (Hepatitis B) co-infection

• Patient must be ready!

• Long-term Nonprorgessors:

  • Maintain low viral loads without ART (Genetics)

  • Elite controller

Types of Antiretroviral Drugs

• Reverse Transcriptase Inhibitors

  • Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

  • Non-nucleoside reverse Transcriptase Inhibitors (NNRTIs)

• Protease Inhibitors (PIs)

• Integrase Strand Transfer Inhibitors (INSTIs)

• Fusion Inhibitors

• CCR5 Antagonist

• Attachment Inhibitor

• Post-attachment Inhibitor

• Capsid Inhibitors

Types of Antiretroviral Drugs Continued

• Reverse Transcriptase Inhibitors

  • NRTIs: Prevent conversion RNA to DNA

  • NNRTIs: Prevent enzymatic conversion of RNA to DNA

• PI: Prevent cutting long protein strands into new, mature viral cell

• INSTIs: Prevents insertion of HIV DNA → stops HIV replication

• Fusion inhibitor**: Prevent virus fusing with CD4 cell membrane

• CCR5 Antagonist**: Chemokine Receptor 5 (CCR%): Prevents cellular fusion between the virus & host cell. Blocks CCR5 cell surface receptors

Types of Antiretroviral Drugs Continued 2

• Attachment Inhibitor**: Binds to glycoprotein on HIV surface & prevents interaction with CD4 receptor on host cell

• Post-attachment Inhibitor**: Binds with different part of the CD4 receptor than attachment inhibitors

• Capsid Inhibitors: Blocks the virus’ protein shell, preventing it from replicating

• Monoclonal Antibody: Blocks CD4 receptors on the surface of certain cells so HIV cannot enter. For adults failing current regimen

• Pharmacokinetic Enhancers: Used to boost the effectiveness of HIV medications. Interferes with the breakdown allowing drugs to remain in the body longer at higher concentrations

Protease Inhibitors (PIs)

• Prevent HIV maturation by blocking the HIV enzyme protease

  • Immature = non-infectious

• Must be given with > or equal to 1 NRTI or NNRTI

• At least ten PIs available for HIV: common in all are hyperglycemia, lipodystrophy, hyperlipidemia

Nursing Considerations (Meds)

• Monitor lab results

  • CBC, WBC, liver function tests, amylase, lipase

  • Antiretroviral meds may ↑ ALT, AST, bilirubin, HDLs, total cholesterol, & triglycerides

• Patient education

  • Side effects & ways to ↓ the severity

  • Adherence & tolerability is the key!!!!!

  • Need to take medications on a regular schedule & to not miss doses

• HIV virus can replicate & lead to drug resistance

Monitoring Response to Therapy

• Increasing CD4 count

• Viral load testing to determine response to therapy

  • Goal = undetectable viral load

  • Don’t do within 2 weeks of vaccinations or illness

• Usually 2 tests before deciding to change therapy

Nucleoside Analog Reverse Transcriptase Inhibitors (NRTIs)

• Combination of 2 meds that can be used for HIV treatment or PrEP

  • Emtricitabine (Emtriva)

  • Tenofovir (Viread)

Doxy PrEP & PEP

• Doxycycline (200 mg) PEP within 24 hrs of condomless sex to reduce syphilis, chlamydia, & gonorrhea

• “Morning after pill” for STIs

• PrEP: Ongoing treatment before & after exposure to prevent transmission

• Can be taken w/ HIV PrEP