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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the routes of transmission for HIV and its natural disease progression.

  2. Identify typical and atypical signs and symptoms of acute and chronic HIV infection.

  3. Identify the desired therapeutic outcomes for patients with HIV infection.

  4. Recommend appropriate first-line pharmacotherapy interventions for patients with HIV infection.

  5. Recommend appropriate second-line pharmacotherapy interventions for patients with HIV infection.

  6. Describe the components of a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for HIV infection.

  7. Educate patients about the disease state, appropriate lifestyle modifications, and drug therapy required for effective treatment.

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KEY CONCEPTS

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  • Image not available. The treatment goals for HIV infection are to maximally and durably suppress HIV replication, avoid the development of drug resistance, restore and preserve immune function, prevent opportunistic infections, and minimize adverse effects.

  • Image not available. HIV RNA plasma concentrations and CD4+ T-cell counts are used to assess risk of progression to AIDS (or risk for opportunistic infection) and to monitor efficacy and durability of treatment.

  • Image not available. Effective and complete treatment of HIV infection involves a multidisciplinary approach, which includes pharmacists, other clinicians, and social workers.

  • Image not available. Treatment with two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI) or an integrase stand transfer inhibitor (INSTI) is the mainstay of initial treatment for HIV infection.

  • Image not available. All patients with HIV infection relapse if medication is withdrawn. Therefore, long-term maintenance treatment is required.

  • Image not available. HIV mutates easily, and strict adherence to the drug regimen and avoidance of deleterious drug interactions is critical to preventing the development of drug resistance and treatment failure.

  • Image not available. The majority of antiretroviral medications are metabolized by the cytochrome P-450 enzyme system (CYP). Therefore, it is important to review patient medication profiles for drugs that may interact with antiretroviral drugs.

  • Image not available. Most antiretroviral medications cause acute and chronic adverse effects. Patients should be closely monitored for these toxicities so that interventions can occur quickly.

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The acquired immune deficiency syndrome (AIDS) was first recognized in 1981 and was described in a cohort of young homosexual men with significant immune deficiency. Since then, human immunodeficiency virus type 1 (HIV-1) has been clearly identified as the major cause of AIDS. HIV-2 is much less prevalent than HIV-1, but also causes AIDS. HIV primarily targets CD4+ lymphocytes, which are critical to proper immune system function. If left untreated, patients experience a prolonged asymptomatic period followed by rapid, progressive immunodeficiency. Therefore, most complications experienced by patients with AIDS involve opportunistic infections and cancers.

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HIV is primarily transmitted by sexual contact, by contact with blood or blood products, and from mother to child during gestation, delivery, or breast-feeding. The prevalence and incidence of HIV is rising globally, and to date there are no treatments that eradicate HIV from the body. Combinations of potent antiretroviral agents (called highly active antiretroviral therapy, or HAART) can suppress HIV ...

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