HIV and AIDs Medications

zidovudine

Class: Nucleoside reverse transcriptase inhibitors

MOA: Blocks addition of further nucleosides and terminates viral replication

Use: Treatment of HIV in combination therapy, pregnant women take a monotherapy to prevent transmission to fetus

Admin: PO, IV

Adverse effects: <!> blackbox - blood dycrasias/bone marrow hypoplasia, <!> blackbox - lactic acidosis and severe hepatomegaly, malaise, N/V, anorexia

Nursing considerations: administer around the clock to maintain serum concentrations, monitor CD4 and blood dyscrasia labs, monitor for opportunistic illnesses

efavirenz

Class: Nonnucleoside reverse transcriptase blocks HIV-1 replication

MOA: Binds to reverse transcriptase and blocks HIV-1 replication

Use: Treatment for HIV-1 infection in combination with other antiretroviral agents

Admin: PO

Adverse effects: CNS depression, depression, hematuria, Stevens-Johnson syndrome/ toxic epidermal necrolysis

Contraindications: suicidal ideation, pregnancy or breastfeedin

Nursing considerations: avoid high-fat meals around administration, do not discontinue suddenly, may take at bedtime, caution with other CNS depressants

saquinavir mesylate

Class:protease inhibitors

MOA: inhibits HIV enzyme protease. Prevents cleavage of polyproteins to produce immature noninfectious viral particles

Use: Treatment for HIV-1 infection in combination with other antiretroviral agents

Admin: PO

Adverse effects: CV - chest pain, prolonged QT, CNS effects - including suicidal ideation, blood dyscrasias, fat maldistribution, GI intolerance

Contraindications: prolonged QT interval, hepatic impairment, hypokalemia or hypomagnesemia

Nursing considerations: Obtain EKG prior to initiation and 3-4 days after initiation, measure serum electrolytes, monitor labs

raltegravir

Class: integrase strand transfer inhibitors

MOA: blocks HIV-1 integrase which prevents formation of provirus to decrease viral load and increase active CD4 cells

Use: treatment-experienced adults, HIV-1 strains resistant to multiple antiretroviral drugs

Admin: PO

Adverse effects: rhabdomyolysis, GI effects

enfuvirtide

Class: Fusion protein inhibitors

MOA: inhibits HIV virus from binding to, fusing with, and entering the human cell

Use: treatment-experienced patients, combination in treatment of HIV-1

Admin: SQ

Adverse effects: GI upset, injx site reactions, fatigue, insomnia

Nursing considerations: rotate injx sites, inject in upper arm, abdomen, anterior thigh

maraviroc

Class: CCR5 antagonists

MOA: blocks receptor site to prevent HIV from entering the cell and replicating

Use: combination therapy for HIV-1, detectible CCR5-tropic HIV-1 with viral replication evidence

Admin: PO

Adverse effects: <!> blackbox warning - drug-induced hepatotoxicity, fever, rash, CNS depression

Contraindications: renal impairment, potent CYP34A inhibitor medication use

cobicistat

Class: Cytochrome P450 Inhibitor

MOA: inhibits cytochrome P450 3A mediated metabolism and therefore increases systemic exposure of CYP3A substrates

Use: boosting agent to increase antiretroviral activity

Admin: PO

Nursing considerations: must be used with other antiretroviral drugs, multiple drug interactions

bictegravir, emtricitabine, tenofovir, alafenamide (Biktarvy)

Class: Combination regimen

MOA: inhibits viral replication

Use: HIV-1 treatment; complete regimen - new or replacemetn regimen in HIV-1 RNA <50 copies/mL

Admin: PO once daily

Adverse effects: <!> blackbox: severe acute HBV exacerbations in coinfected patients with medication discontinuation, increased serum bilirubin

Nursing considerations: monitor hepatic function

cabotegravir and rilpivirine (Cabenuva)

Class: combination regimen

MOA: inhibits viral replication

Use: HIV-1 treatment, replace ART regimen if HIV-1 RNA <50 copies/mL

Admin: IM once monthly → ventrogluteal IM administration, take PO formulations of medications prior to switching to IM

Adverse effects: Injx site reaction/pain, fever

Nursing considerations: monitor hepatic function

tenofovir, disoproxil, fumarate and emtricitabine (Truvada)

Class: combination regimen

MOA: pre-exposure prophylaxis, nucleoside reverse transcriptase inhibitors

Use: preexposure prophylaxis → not infected at high risk for sexual acquisition, persons who inject drugs; HIV-1 infection in combination with ART

Admin: PO

Adverse effects: decreased bone mineral density, headache, N/D, stomach pain, potential renal toxicity with longterm use

Nursing considerations: educate on medication compliance, use in combination with safe sex practices, follow up and monitor (HIV, STIs, creatinine, medication adherence/side effects, risk behaviors, pregnancy, consider calcium and vitamin D supplementation

Tenofovir alafenamide and emtricitabine (Descovy)

• similar to truvada

• safer for those with osteoporosis or kidney disease