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PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES

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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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INTRODUCTION

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Human immunodeficiency virus type is the major cause of 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. AIDS occurs when a patient with HIV has a CD4 cell count below 200 cells/mm3 (200 × 106/L), a CD4 cell percentage of total lymphocytes less than 14% (0.14), or one of the Centers for Disease Control (CDC) AIDS defining conditions.1

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EPIDEMIOLOGY AND ETIOLOGY

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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. Although the global incidence of HIV has fallen 33% since 2001, HIV prevalence has increased, largely due to life-extending antiretroviral therapy. Combination antiretroviral therapy (cART) has increased both the length and quality of life for HIV-infected patients, however, to date, there are no treatments that eradicate HIV from the body.2

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As of 2012, approximately 35.3 million people are infected with HIV worldwide. Approximately 70% of these cases are in Sub-Saharan Africa, with a prevalence of approximately 5%. Central Asia, Eastern Europe, North Africa, and the Middle East are also seeing rapidly rising infection rates.2

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In 2012 alone, approximately 1.6 million people worldwide died from AIDS and 2.3 million people were newly infected with HIV. Most of these infections were acquired through heterosexual transmission. As of December 2012, women accounted for 45.6% of all people living with HIV worldwide. Young adults, aged 15 to 24 years, accounted for approximately 39% of new HIV infections worldwide.2

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In the United States, at the end of 2011, an estimated 1.2 million persons (aged 13 years or older) were living with HIV/AIDS. Approximately 14% of these are undiagnosed and unaware of their HIV infection and could be unknowingly transmitting the virus to others.3

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In 2010, HIV/AIDS rates for African American men were six times those for white men and twice that for Hispanic ...

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