Antiretrovirals

Commonly Prescribed Drugs

See Mechanism of Action of Select Antiretrovirals table.

Pharmacologic Profile

General Use

The goal of antiretroviral therapy in the management of HIV infection is to improve CD4 cell counts and ↓ viral load. If accomplished, this generally results in slowed progression of the disease, improved quality of life, and ↓ opportunistic infections. Perinatal use of agents also prevents transmission of the virus to the fetus. Postexposure and pre-exposure prophylaxis with certain antiretrovirals is also recommended.

General Action and Information

MECHANISM OF ACTION OF SELECT ANTIRETROVIRALS

DRUG	MECHANISM
Lamivudine, tenofovir alafenamide, and zidovudine	Nucleoside reverse transcriptase inhibitors (NRTIs)
Cabotegravir and dolutegravir	Integrase strand transfer inhibitors (INSTIs)
Darunavir and ritonavir	Protease inhibitors
Lencapavir	Capsid inhibitor
Rilpvirine	Non-nucleoside reverse transcriptase inhibitor (NNRTI)

Contraindications

Hypersensitivity. Because of highly varying toxicities among agents, see individual monographs for more specific information.

Precautions

Many agents require modification for renal impairment. Protease inhibitors may cause hyperglycemia and hyperlipidemia and should be used cautiously in patients with diabetes and patients at increased risk for cardiovascular disease. Hemophiliacs may also be at risk of bleeding when taking protease inhibitors. See individual monographs for specific information.

Interactions

There are many significant and potentially serious drug-drug interactions among the antiretrovirals. Many of these interactions involve the cytochrome P450 system. See individual agents.

Nursing Implications

Assessment

Assess patient for change in severity of symptoms of HIV and for symptoms of opportunistic infections throughout therapy.
Lab Test Considerations: Monitor viral load and CD4 counts prior to and periodically during therapy.

Implementation

Administer doses around the clock.

Patient/Family Teaching

Instruct patient to take medication exactly as directed. Emphasize the importance of complying with therapy, not taking more than prescribed amount, and not discontinuing without consulting health care provider. Missed doses should be taken as soon as remembered unless almost time for next dose; patient should not double doses.
Inform patient that antiretroviral therapy does not cure HIV and does not ↓ the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom during sexual contact and to avoid sharing needles or donating blood to prevent spreading the HIV virus to others.
Advise patient to avoid taking any Rx, OTC, or herbal products without consulting health care provider.
Emphasize the importance of regular follow-up exams and blood counts to determine progress and to monitor for side effects.

Evaluation/Desired Outcomes