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. Post-exposure and pre-exposure prophylaxis with certain antiretrovirals is also recommended.

General Action and Information

Because of the rapid emergence of resistance and toxicities of individual agents, HIV infection is almost always managed by a combination of agents. Selections and doses are based on individual toxicities, underlying organ system disease, concurrent drug therapy, and severity of illness.

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. They are affected by drugs that alter metabolism; some agents themselves affect metabolism. See individual agents.

Nursing Implications

Assessment

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

Potential Nursing Diagnoses

• Risk for infection (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)
• Noncompliance (Patient/Family Teaching)

Implementation

• Administer doses around the clock.

Patient/Family Teaching

• Instruct patient to take medication exactly as directed, around the clock, even if sleep is interrupted. Emphasize the importance of complying with therapy, not taking more than prescribed amount, and not discontinuing without consulting health care professional. Missed doses should be taken as soon as remembered unless almost time for next dose; patient should not double doses. Inform patient that long-term effects are unknown at this time.
• Instruct patient that antiretrovirals should not be shared with others.
• 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 AIDS virus to others.
• Advise patient to avoid taking any Rx, OTC, or herbal products without consulting health care professional.
• Emphasize the importance of regular follow-up exams and blood counts to determine progress and to monitor for side effects.

Evaluation/Desired Outcomes

• Decrease in viral load and increase in CD4 counts in patients with HIV.