Abesha Care Initiative "ARVs"

1.What is the primary goal of antiretroviral therapy?

The primary goal of antiretroviral therapy is to improve the health and prolong the life of
the HIV-infected child or adult. This is achieved by interfering with the ability of the virus
to replicate or reproduce inside the body. When the virus is unable to replicate, damage
to the immune system is minimized. Because the immune system is functioning more
normally, the treated individual is less susceptible to opportunistic infections,
malignancies, and other illnesses.
HIV-infected patients receiving antiretroviral therapies also are less likely to develop
other complications associated with HIV/AIDS, such as wasting syndrome and
encephalopathy (a disorder of the brain). Most patients taking effective antiretroviral
therapy will live longer than they would without medications.

2. When should antiretroviral therapy begin?

Antiretroviral therapy is not necessarily started when a patient is first infected with HIV.
Although some evidence suggests that starting medications before a patient is
symptomatic can prolong life, there are many obstacles to such early treatment.
Antiretroviral therapy can be costly. Also, the virus can develop resistance to these
medications, in much the same way that bacteria can become resistant to the effects of
antibiotics. The medications can be difficult to take, causing many side effects. Patients
who do not feel ill from their disease may not be motivated to take medicines. Once
antiretroviral medications are started, they need to be taken consistently, according to
instructions, every day. Patient motivation is important to ensure that medication
schedules are followed precisely.

With these caveats in mind, most clinicians who treat adults follow standard criteria for
starting medications, which may include the following:

Symptoms of HIV infection, such as candidiasis or weight loss
Viral load (HIV RNA) of more than 55 000 copies/mL of plasma
CD4+ count of less than 350 cells/uL of blood

3. What strategy should be flowed in regard to Adherence HIV Treatment
Regimens?

Treatment success is highly dependent of patient’s ability to adhere to their medication
schedule. Strict scheduling guidelines, side effects, and the need to take multiple (at
times unpalatable) medications make it difficult for adults and children to take their
medications at the right time and in proper coordination with their meals. Yet adhering to
the medication schedule is critical to prevent the development of resistant forms for HIV.
The health care team, family, and friends are vital components in the patient’s success
in adhering to treatment.

Adherence needs to be discussed at every clinic visit and does not depend solely on the
patient’s ability to remember to take his or her medications. Barriers to adherence can
include lack of access to refills, insufficient food and water with which to take the
medications, inability to get to the clinic for scheduled appointments because of
problems with transportation, and lack of personal support system. These are all issues
that should be discussed with the patient. It is just as important for children to adhere to
their antiretroviral medication schedule as it is for adults.

4. What are the specific medication therapy groups available for HIV?

There are three gropes of antiretroviral drugs available.
Nuclcoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Protease Inhibitors (PIs)

Nuclcoside Reverse Transcriptase Inhibitors (NRTIs)
NRTIs were the first class of antiretroviral medications approved by U.S and European
regulatory agencies, starting with zidovudine (ZDV, AZT) in 1987. NRTIs work by
blocking an HIV protein called reverse transcriptase thus preventing HIV RNA from
changing into DNA. This is critical point in the life cycle of HIV. NRTIs in combinations
with one another and with other classes of drugs are the cornerstone therapy for HIV-
infected children and adults.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs also work by blocking the HIV protein reverse transcriptase, but they do so in a
slightly different way than NRTIs. These drugs have been used in combination with
NRTIs and PIs and have been found to be generally well-tolerated and safe.

Protease Inhibitors (PIs)
PIs are antiretroviral drugs that work differently from NRTIs and NNRTs. PIs prevent the
protease enzyme from cleaving large HIV precursor proteins into smaller functional units,
a process that causes the production of defective virus particles incapable of infecting
CD4+ cells and replicating. PIs are very powerful, but when they are taken alone, the
virus quickly becomes resistant to their anti-HIV effects, and the benefit of therapy is
short-lived. For this reason, PIs are always combined with other anti-HIV medications.
Taking P I s in the correct dose and exactly on time is very important. Missed does can
lead to viral resistance and drug failure.

5. What are the major side effects of the medications?

Many of these medications have potentially serious side effects, which are summarized
in Treatment page. Many of them also have interactions with other medications therefore
your health care provider would described the best medications for you.
When beginning antiretroviral therapy, patients should be advised not to stop their
medications without first speaking with a health care provider. Many times, side effects
can be minimized with simple interventions. Stopping one or two of the medications can
increase the likehood that the patients’ HIV will become resistant to treatment.

6. What are certain drugs that should NOT be taken by pregnant women

Quiz
1, The primary goal of antiretroviral therapy is to:
a.        Kill the virus
b.        Improve the patient’s health and prolong his or her life
c.        Improved the host’s immune system
d.        Prevent encephalopathy

2, Ideally, when is antiretroviral therapy initiated in infants (<1 year of age)?
a.        At diagnosis
b.        After the first opportunistic infection
c.        When they are failing to thrive
d.        None of the above