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Review of Antiretroviral Therapy in Adults. HAIVN Harvard Medical School AIDS Initiative in Vietnam. Learning Objectives. By the end of this session, participants should be able to: Explain the criteria for starting ART Identify the first line ARV regimens
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Review of Antiretroviral Therapy in Adults HAIVN Harvard Medical School AIDS Initiative in Vietnam
Learning Objectives By the end of this session, participants should be able to: • Explain the criteria for starting ART • Identify the first line ARV regimens • Describe the common side effects caused by NRTIs and NNRTIs • Describe the protocol for performing routine follow-up with ARV patients
Drug Classes of Antiretrovirals (ARV) • Nucleoside Reverse Transcriptase Inhibitors (NRTI) • Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) • Protease Inhibitors (PI) • Fusion/Entry Inhibitors • Integrase Inhibitors
Goals of ARV Therapy • Inhibit HIV replication • As low as possible (undetectable) • For as long as possible • Allow recovery of the immune system • Prevent opportunistic infection • Improve survival, health and quality of life
When to Start ART? • ARV therapy is never an emergency • Patients with high CD4 are not at risk for OIs and can delay ARV treatment • Decide when to start ARV based on:
When to Start ARV in Vietnam Patients with: • CD4 ≤ 350 cells/mm³ irrespective of clinical stage • Clinical stage 3 or 4 irrespective of CD4 cell count Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011
First Line ARV Regimens in Vietnam (1) 2 NRTI + 1 NNRTI Lamivudine (3TC) Tenofovir (TDF) Zidovudine (AZT) Efavirenz (EFV) Nevirapine (NVP) Stavudine (D4T) is no longer recommended as a first line ARV Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011
First Line ARV Regimens in Vietnam (2) TDF or AZT EFV or NVP + + 3TC Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011
First Line ARV Regimens in Vietnam (3) Priority Regimens Alternative Regimens TDF/3TC/EFV TDF/3TC/NVP AZT/3TC/EFV AZT/3TC/NVP Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011
Monitoring: How Often? • If the clinical situation is stable:
What to Monitor? (1) Adherence Monitoring • Assess missed doses • Provide counseling about adherence, prevention, and healthy living Clinical Monitoring • Weight, temperature • WHO Clinical Stage • ARV side effects or toxicity • Signs of IRIS
What to Monitor? (2) Laboratory Monitoring:
Key Points • Patients with clinical stage 3 or 4 or CD4 ≤ 350 should start ART • Two priority first ARV regimens in Vietnam: • TDF + 3TC + EFV • TDF + 3TC + NVP • All ART patients need routine clinical and laboratory monitoring
Thank You! Questions?