Maryland Massage Therapy Ebook Continuing Education

● Protease inhibitors (PIs) : Block the HIV enzyme protease. By blocking this enzyme, PIs prevent new, immature HIV from becoming a mature virus that can infect and harm CD4+ cells. The following are drugs in this class.

Healthcare Consideration : Patients might mistakenly believe that once their viral load becomes undetectable, they can discontinue their antiretroviral therapy (ART) treatment (Jones, 2020). Therefore, it is crucial to provide comprehensive education regarding the treatment regimen and the significance of viral load management. Currently, there are over 30 medications authorized for the treatment of HIV infections. They are typically categorized into six groups based on their mechanisms of action. Clinical guidance advocates for the use of a combination of at least two medications from different classes. It’s worth noting that some of these medications are conveniently available in a single combination pill. Antiretroviral drugs are utilized in various combinations and are referred to as highly active retroviral therapy. These include nucleoside/nucleotide reverse transcriptase inhibitors (NRTs), NRTI fixed-dose combinations, integrase inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTis), protease inhibitors, integrase inhibitors, and CCR5 inhibitors. Regardless of the CD4 count, individuals should be started on lifelong HAART therapy (Angel et al., 2023). ● Nucleoside/nucleotide reverse transcriptase inhibitors (NNRTIs) : HIV depends on reverse transcriptase to convert its RNA into DNA. NNRTIs block reverse transcriptase and reverse transcription, thus preventing HIV from replicating. This class is often referred to as the backbone of a first-line HIV treatment combination. The following are medications in this category. ○ Abacavir ○ Emtricitabine ○ Lamivudine ○ Tenofovir ○ Zidovudine ● NRTI fixed dose combinations : ○ Abacavir/lamivudine ○ Abacavir/lamivudine/zidovudine ○ Emtricitabine/tenofovir disoproxil ○ Lamivudine/zidovudine ● Non-nucleoside reverse transcriptase inhibitors (NRTIs) : This classification also works by blocking reverse transcriptase and reverse transcription, which prevents HIV from replicating. The following are medications in this class. ● Integrase inhibitors : Block the HIV enzyme integrase, which the virus needs to integrate its viral DNA into the DNA of the host CD4+ cell. Blocking integrase stops HIV from replicating. Medications in this class include the following. ○ Dolutegravir ○ Raltegravir Complications Opportunistic infections (OIs) are a category of infections that occur more frequently and with greater severity in individuals with weakened immune systems. The CDC has compiled a list of the most common opportunistic infections observed among people living in the U.S. When individuals with HIV contract any of these infections, they receive an AIDS diagnosis, regardless of their CD4+ T-cell count, signifying the advanced stage of the disease. ○ Etravirine ○ Rilpivirine

○ Atazanavir ○ Darunavir ○ Lopinavir

In addition to following the WHO guidelines for preferred ART, selection of a regimen should be individualized based on virologic efficacy, potential adverse effects, pill burden, dosing frequency, drug–drug interaction potential, the patient's resistance test results, comorbid conditions, and cost (World Health Organization, 2023) Patients and their families require a lot of education regarding ART. Adherence to ART is critically important, and healthcare workers should therefore spend a good amount of time educating patients and their families on this. Medication adherence means taking HIV medications every day and exactly as prescribed. Benefits of adherence include sustained viral suppression, reduced risk of drug resistance, better overall health, improved quality of life, and decreased risk of HIV transmission (CDC, 2020i; HIV.gov & NIH.gov, 2020a). Key Treatment Updates • In 2018, the U.S. Department of Health and Human Services (HHS) updated its HIV treatment guidelines to recommend starting antiretroviral therapy (ART) as soon as possible after HIV diagnosis. The previous guidelines recommended starting ART when the CD4 count dropped below 500 cells/mm3, but the 2018 update recommends immediate treatment after diagnosis regardless of CD4 count. • In 2019, the World Health Organization (WHO) updated its HIV guidelines to recommend dolutegravir-based ART regimens as the preferred first-line treatment in all populations. Dolutegravir regimens are more effective and have fewer side effects compared to older regimens. • In 2021, the U.S. Preventive Services Task Force gave a grade A recommendation for PrEP for HIV prevention, meaning PrEP is highly recommended for those at risk of HIV acquisition. • Also in 2021, the WHO recommended long-acting injectable cabotegravir and rilpivirine as an alternative HIV treatment option to daily oral ART. • In 2022, the HHS guidelines were updated again to recommend offering a rapid start of ART on the same day as HIV diagnosis. Rapid start improves linkage to care and HIV outcomes. Fortunately, the landscape of opportunistic infections has changed due to the effectiveness of HIV treatment. The introduction and widespread availability of antiretroviral therapy (ART) have significantly reduced the occurrence of OIs. ART strengthens the immune system and helps maintain higher CD4+ T-cell counts, thus lowering the risk of opportunistic infections in individuals with HIV. This progress highlights the importance of effective HIV management in improving the health outcomes of those living with the virus (CDC, 2020b).

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