HIV & ADHERENCEMr. A. Ndlovukazi

(ART Nurse – Good Shepherd Mission Hospital)

21/11/11

ObjectivesTo be able to:

Differentiate between ARVs and HAARTList primary goals HAARTExplain how HAART worksIdentify and manage minor side effects at

homeExplain the importance of adherence

Let us recap on life cycle of HIV...

HAARTAntiretroviral drugs are medications for the

treatment of infection by retroviruses, primarily HIV.

When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Anti-Retroviral Therapy (HAART).

GOALSThe primary goal of HAART is to Decrease HIV-related morbidity and mortalityand thereby;a) the patient should experience fewer HIV-related

illnesses with an improvement in quality of life.b) restore the patient’s immune function as

indicated by a rise in CD4+ countc) reduce viral load to undetectable levels (<400

copies/ml) and remain undetectable on HAART for as long as possible – only available for selected patients in Swaziland

How do ARVs work?ARV drugs are of different classes and they

work in different stages of the HIV life cycle, thus preventing the virus from replicating itself and maturing which then leads to decrease in the amount of the virus in the body – viral load.

The body will continue making up its own antibodies including the CD4, thus the immunity is strengthened, i.e. CD4 count will increase and the body will be able to fight infections.

MOST IMPORTANT!!!ARVs:do not make antibodies (CD4)do not cure the HI Virusdo not treat other opportunistic infections.do not prevent HIV transmission from one

person to another

HAART is a lifelong treatment or until cure is discovered.

How are they taken?Combination of at least 3 drugs (TRIPLE

THERAPY) must be given. (mono-therapy or dual-therapy are not acceptable).

Mostly taken twice a day, same time everyday (e.g. 7am, 7pm)

Some may be taken once a day.

Requirement for starting HAART.• Documented HIV positive test result• Medical eligibility (i.e. clinical staging) and/or

immunological eligibility (CD4) – to be determined by a trained nurse or medical officer.

• Any opportunistic infection has been treated or stabilized, particularly TB

• Patient is ready for ARV Therapy• Supportive clinical team prepared for chronic

care

Readiness for ART…Acceptance of HIV status.Knowledge of how HIV affects the body and

the understanding the role of ARVs.Demonstrate good adherence and compliance

prior to ART initiation e.g. keeping appointment dates, co-trimoxazole prophylaxis, etc

Prepared to take treatment for life.Social support structures and disclosure may

also be considered.

ART ELIGIBILITY CRITERIACD4+ count <350cells/ml irrespective of WHO

clinical stage i.e. whether sick or not. ORWHO clinical stage III and IV disease

irrespective of Cd4+ count. ORCo-infection: HIV/TB and HIV/HBV

ANDPatient expresses willingness and readiness to

take ART adherently.

Side Effects

Definition:

Usually bad unintended results of medicine in the body. It may be minor to life threatening.

They can be managed at home if minor or at clinic/hospital if worse

Symptom Strategies to ManageHeadache Decrease activity; rest in a quiet, dark room with

eyes closed Place cold moist cloth over eyes Stay out of the sun: decrease exposure to light Stay hydrated: drink boiled water; avoid caffeine

(coffee, tea, carbonated soft drinks) and alcohol Avoid foods and other stimuli that trigger

headaches

Nausea/Vomiting/Anorexia

Stay hydrated: drink boiled water; peppermint or ginger tea

Eat small, bland snacks throughout the day (bananas, white rice, toast, applesauce, porridge, potatoes)

Avoid foods and smells that trigger nausea/vomiting or decrease appetite: spicy, greasy, acidic foods (e.g., oranges, tomatoes)

For nausea/vomiting: drape a comfortably warm moist towel around the neck until the nausea/vomiting subsides

Diarrhoea Stay hydrated: drink boiled water, weak tea

Don’t stop eating, but avoid foods and fluids that can increase diarrhoea (fruits, vegetables, milk products, high fat foods, very sweet foods)

Eat bland foods: white rice, porridge Maintain good hygiene: wash hands after

going to the bathroom, before and after eating, before and after handling any food

Gently clean skin around rectal area after each episode of loose stool

Mild tingling, burning, or pain in hands or feet

Wear loose-fitting shoes or sandals Walk around to help blood circulation to

the feet, but not too much Soak hands/feet in coldest water

tolerated Gently massage hands/feet Keep hands and feet uncovered in bed

Insomnia Reduce noise and light: sleep in a quiet, dark room Avoid exercise and other energetic activity several

hours before bedtime Avoid eating a large meal 3-4 hours before bedtime Avoid drinking fluids with caffeine at least four

hours before going to bed (coffee, tea, carbonated soft drinks)

Avoid drinking alcohol Consciously relax muscles, especially in shoulders,

arms and legs Perform quiet activities that usually make you

sleepy (for example, listening to soft music)

Dizziness Change positions very slowly (for example, from lying down to sitting)

Use nearby furniture and walls for support if dizziness occurs when walking

Ask family members and friends for support if intense dizziness occurs when walking

Stay hydrated: drink boiled water and fluids without caffeine

Avoid alcohol

Bad dreams Talk about your dreams with a family member or friend

Recognize that dreams are imagination and not real

Confusion/difficulty concentrating

Talk about your feelings of confusion or difficulty concentrating with a family member or friend

Ask a family member or friend to clarify what confuses you

Focus on one activity or thought at a time

Mild rash Bathe with unscented mild soap (e.g. oatmeal, aqueous cream)

Avoid bathing in extra hot water Protect the skin from sun exposure Don’t scratch your skin

Adherence Definition:the act of continuing to obey a rule, law,

agreement etc.- acceptance of an active role in one’s own health care

Why Adherence?Cornerstone for successful HIV therapy It is also a major contributor of treatment

failure

Important aspects of AdherenceTime

Choose your time well Have reliable reminders (e.g. Alarm clock, cell phone)

Treatment supporter Encouraging, reminding

Early treatment of illnessesSafe sex

Prevents infecting partner/re-infecting self

Of importance...Family planning – to prevent unplanned pregnanciesRegular exercise and enough rest – to stay healthyBalanced diet – for strong immunityBe relaxed & cheerfulAvoid alcohol & drugsAvoid traditional medicines and over-the-counter

drugsAlways carry your medication wherever you goWhen sick, notify your Doctor/Nurse of your status

and the treatment you are taking

Questions?

Thank you!Ngiyabonga!