Pharm: Exam 3- HIV and AIDS

Antiretroviral therapy (ART)

What has dramatically improved morbidity and mortality in HIV patients?

Minimize the risk of contracting HIV

What can prophylactic HIV treatment do for HIV-negative partners?

Because the virus mutates quickly, leading to drug resistance

Why can’t HIV patients skip ART doses?

HIV DNA strands

What allows HIV to mutate from drug-sensitive to drug-resistant forms?

When viral load becomes overwhelming and symptoms appear

When is HIV considered AIDS?

Yes, it is considered a chronic illness

Is AIDS now considered chronic?

• Reduce HIV morbidity/mortality

• Prolong life and improve quality

• Restore/preserve immune function

• Suppress viral load

• Prevent transmission

Goals of HIV therapy include:

RNA retrovirus

what type of virus is HIV?

CD4+ T cells (helper T lymphocytes)

What cells does HIV destroy?

500–1200 cells/mm³

Normal CD4 count range:

The immune system weakens; patient becomes susceptible to infections

What happens when CD4 drops below 400?

CD4+ T cell count, plasma HIV RNA (viral load), and HIV resistance testing

What are the key lab tests for monitoring HIV?

To achieve and maintain viral load below 20–40 copies/mL

What is the goal of ART therapy in terms of viral load?

CDC and WHO

What are the two major HIV classification systems?

Based on CD4 count and diagnosed HIV-related conditions

How does the CDC classify HIV?

For all HIV-infected individuals, regardless of CD4 count

When is ART recommended for patients with HIV?

300 mg twice daily or 600 mg once daily

What is the usual dose for Abacavir?

Avoid in cardiovascular disease; risk of hepatotoxicity and lactic acidosis

What are key precautions for Abacavir?

400 mg daily (>60 kg) or 250 mg daily (<60 kg)

What is the usual dose for Didanosine (DDI)?

Not first-line; risk of pancreatitis; take on an empty stomach

What are key precautions for Didanosine (DDI)?

200 mg once daily

What is the usual dose for Emtricitabine?

Minimal toxicity; may be taken without regard to meals

What are key precautions for Emtricitabine?

300 mg once daily or 150 mg twice daily

What is the usual dose for Lamivudine?

Minimal toxicity; can be taken with or without meals

What are key precautions for Lamivudine?

30–40 mg every 12 hours

What is the usual dose for Stavudine?

Crosses the blood-brain barrier

What is a unique feature of Stavudine?

Preventing mother-to-child transmission of HIV during pregnancy

What is Zidovudine (Retrovir) used for?

Bone marrow suppression and anemia

What are adverse effects of Zidovudine?

Yes, with or without food

Can Zidovudine be taken with food?

400 mg three times daily

What is the dose for Delavirdine?

Acidic foods

What improves absorption of Delavirdine?

600 mg at bedtime on an empty stomach

What is the dose and timing for Efavirenz?

Vivid dreams and dizziness

What are common side effects of Efavirenz?

200 mg twice daily after meals

What is the dose for Etravirine?

Grapefruit juice, carbonated, or warm drinks

What beverages should be avoided with Etravirine?

Rash, Stevens-Johnson syndrome

What are major risks with Etravirine?

200 mg daily for 14 days, then 200 mg twice daily

What is the Nevirapine dosage schedule?

In patients with hepatic impairment

When should Nevirapine be avoided?

25 mg once daily with food

What is the Rilpivirine dose?

Depression and insomnia

What should patients on Rilpivirine be monitored for?

300 mg plus ritonavir 100 mg daily

What is the dose for Atazanavir?

Jaundice, AV block, hyperglycemia

What are side effects of Atazanavir?

600–800 mg twice daily with food

What is the dose for Darunavir?

Rash, Stevens-Johnson syndrome

What are risks of Darunavir?

700 mg with ritonavir 100 mg twice daily

What is the dose for Fosamprenavir?

No, it can be taken with or without food

Does Fosamprenavir require food?

800 mg every 12 hours on an empty stomach

What is the dose for Indinavir?

Stay hydrated (1.5 L/day)

What important teaching should be given with Indinavir?

400/100 mg twice daily or 800/200 mg once daily

What is the dosing for Lopinavir/Ritonavir?

Pancreatitis, hyperglycemia, hyperlipidemia, GI intolerance

What are adverse effects of Lopinavir/Ritonavir?

1250 mg or 750 mg three times daily with food

What is the dose for Nelfinavir?

It contains phenylalanine

Why should patients with PKU avoid Nelfinavir powder?

Ritonavir, Saquinavir, Tipranavir

Name other protease inhibitors.

90 mg subcutaneously twice daily

What is the dose for Enfuvirtide?

Injection site reactions (pain, erythema, nodules)

What is a common side effect of Enfuvirtide?

2000 mg IV once, then 800 mg IV every 2 weeks

What is the dosing for Ibalizumab?

For multi-drug resistant HIV

When is Ibalizumab used?

150–600 mg twice daily

What is the dose for Maraviroc?

CCR5-tropic HIV only

For what type of HIV is Maraviroc used?

Hepatotoxicity, orthostatic hypotension, dizziness, abdominal pain

What are key adverse effects of Maraviroc?

50 mg once daily

What is the dose for Dolutegravir?

Headache, insomnia, liver injury

What are adverse effects of Dolutegravir?

85–150 mg daily with food

What is the dose for Elvitegravir?

May cause suicidal ideation in those with psychiatric history

What major precaution is associated with Elvitegravir?

400 mg twice daily

What is the dose for Raltegravir?

Rhabdomyolysis, GI symptoms, insomnia, headache

What are adverse effects of Raltegravir?

An inflammatory response after starting or changing ART

What is IRIS?

Paradoxical (worsening of treated infection) and unmasking (newly revealed infection)

What are the two types of IRIS?

Low CD4 count, high viral load, starting ART too soon after OI treatment

What are risk factors for developing IRIS?

Patient condition, lab results, and side effects

What should nurses assess before and during ART?

Medication adherence

What is the main challenge in ART management?

Purpose of each drug, dosing schedule, food/fluid needs, and storage instructions

What should be included in ART patient education?

Opportunistic infections

What is the leading cause of morbidity and mortality in HIV patients?

To prevent mother-to-child transmission of HIV

Why is ART recommended during pregnancy?

In all HIV-positive pregnancies, regardless of CD4 count or viral load

When should ART be initiated in pregnant patients?

Zidovudine (Retrovir)

What is the key ART drug used in pregnancy?

Post-exposure prophylaxis after potential HIV exposure

What is PEP?

Within 72 hours of exposure

When should PEP be started?

4 weeks

How long should PEP be continued?

Nausea, malaise, fatigue

What are common side effects of PEP therapy?