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!
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