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Introduction to ARV therapy

Introduction to ARV therapy. HAIVN Havard Medical School AIDS Initiative in Vietnam. Learning objectives. By the end of this session, participants should be able to: Present the goals of ARV therapy Outline ARV drugs used in Viet Nam Instruct patients on medication adherence

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Introduction to ARV therapy

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  1. Introduction to ARV therapy HAIVN Havard Medical School AIDS Initiative in Vietnam

  2. Learning objectives By the end of this session, participants should be able to: • Present the goals of ARV therapy • Outline ARV drugs used in Viet Nam • Instruct patients on medication adherence • Recognize common and/ or significant side effects of ARV drugs

  3. What are the goals of ARV therapy? Why do we use ARV drugs knowing they don’t eliminate HIV?

  4. Goals of ARV therapy • Ultimately: Improve patient’s quality of life • Reduce HIV replication in patient: • Reduce viral load • Lessen attack of the virus on the immune system • Create opportunities for the immune system to recover: • Help increase the number of CD4 cells

  5. Relationship between CD4 count and viral load HIV RNA (viral load) = Speed of train Slow: <5,000 Fast: 50,000+ CD4 count = Distance to crash

  6. Results of decrease in viral load and increase in CD4 count • Prevent the progression from HIV to AIDS • Prevent opportunistic infections • Increase survival rate • Decrease HIV transmission

  7. HIV uses CD4 cell as a “factory” to produce HIV ARV goes into the “factory” and reduces its ability to “produce” HIV When patient takes ARV, virus production can be minimized Effect of ARV CD4

  8. Why do we have to combine drugs in treatment? • Each patient is infected with different strains of HIV • Each strain of HIV is sensitive to some but not all ARV drugs • To achieve the best and the longest effect, patient has to take at least 3 different ARV drugs

  9. Progression to AIDS according to ARV therapy % Month Non therapy Mono therapy 15 Triple therapy Dual therapy

  10. ARV drugs currently available in Viet Nam

  11. First line ARV regimens in Viet Nam + Lamivudine (3TC) Tenofovir (TDF) Zidovudine (AZT) Efavirenz (EFV) Nevirapine (NVP) Stavudine (D4T) is no longer recommended as a first line ARV drug Modified and Supplemented from Guidelines for Diagnosis and Treatment of HIV/AIDS,11/2011

  12. Side effects of ARV

  13. Side effects of ARV (1) • Side effects can happen when taking ARVs • Usually in the first weeks of therapy • improve over time or with symptomatic management • Side effects can be mild or severe • Some side effects relate to dosage and/or drug interactions

  14. Side effects of ARV (2) • Common side effects: • Peripheral neuropathy • Diarrhea • Rash • Nightmare • Uncommon but severe side effects : • Pancreatitis • Bone marrow suppression • Severe rash • hypersensitivity Nurse should instruct patients to recognize side effects of ARV

  15. Some examples of side effects of ARV

  16. Allergy to Nevirapine (1) rash

  17. Allergy to Nevirapine (2) Stevens-Johnson syndrome

  18. Allergy to Nevirapine (3) Stevens-Johnson syndrome

  19. Allergy due to Efavirenz Hộichứng Stevens-Johnson

  20. Allergy to Cotrimoxazole (1) • Allergy to cotrimoxazole may cause erythematous rash, flat or slightly elevated lesions on the trunk and extremities

  21. Allergy to Cotrimoxazole (2) Rash

  22. Adherence

  23. Adherence • Adherence means taking the correct medications, in proper doses and on time • To achieve the best effect with ARV therapy, adherence rate is required to be above 95%. • Example: If medications are prescribed 2 times a day, don’t forget more than 2 doses a month.

  24. Non adherence to ARV therapy is common • Assessments of rates of non adherence to treatment range from 20% to 80%, with the average rate of 50%. • Adherence rate in IDUs (40% - 80%) and non-IDUs (30% - 70%) are similar.

  25. Common levels of adherence Three types of patient’s adherence Very good adherence Reduced adherence 100% Non adherence Adherence Howard AIDS 2002; Ickovics Antiviral Ther 2002; Moss CID 2004 0% 0 12 24 Treatment time (month)

  26. Common reasons for non adherence to ARV

  27. Factors influencing non adherence to HIV treatment • Medications interfere with daily life • Drinking alcohol or using drugs • Sad mood, stress • Pessimistic about HIV • Treatment is less effective than desired

  28. Goals of adherence to ARV drugs • Maximizes inhibition of viral load • Reduces drug resistance • Increases time of exposure to effective medication • Above all, helps: • Delay progression to AIDS • Prolong survival • Improve quality of life

  29. Components of adherence • Take medicine on time • Maintain regular check up • Maintain “healthy lifestyle with HIV” • Eat healthy food • Exercise regularly • Do not smoke tobacco or drink alcohol

  30. Nurse should pay attention to

  31. Learn about the patient (1) Find out attitudes, knowledge and beliefs of the patient by asking questions : • About medication generally: • For example: Did you take medication before? Tell me about that. • About HIV/AIDS: • For example: Can HIV be cured?

  32. Learn about the patient(2) • About ARV drugs: • Do you know someone who is on ARV therapy? • How is his/ her health after taking ARVs? • What would happen if you take ARV drugs? • Patient’s desires: • benefit and cost of treatment • changes in appearance (or not) • side effects

  33. Learn about the life circumstances of the patient (1) • Has patient ha disclosed his / her HIV status to anyone? • Who is the main support person for the patient? • Does s/he know that the patient has HIV? • What does s/he know about ARV drugs?

  34. Learn about the life circumstances of the patient (2) • Life circumstance • Have a house? • Is anyone in the family aware of the patient's diagnosis? • Are there any children at home? • Daily living • work? • child care?

  35. The role of nurses in ARV therapy groups (1) • Instruct patients on ARV therapy purposes • Understand how ARV impacts patients’ lives • Collaborate with physicians and pharmacists in ARV therapy group to give patients the best care

  36. The role of nurses in ARV therapy groups (2) • Ensure that patients: • understand how to take medicine before leaving the clinic • have plans to remember to take medicine • Instruct patients on: • possible side effects • what to do if side effects occur • Give patients and their families a message of: HOPE

  37. Key points • The goal of ARV treatment is to reduce viral load and increase CD4 count and ultimately to increase quality of life • A 3-drug combination is most effective • The role of nurses is to help patients adhere to treatment to obtain the best results from ARVs

  38. Thank you Question?

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