Management of the Client with HIV
Clients with AIDS are treated with several categories of drugs. Highly active antiretroviral therapy (HAART), formerly known as the AIDS “cocktail,” consists of treatment with multiple drugs. Examples of drugs used in this type of therapy include the following:
- Nucleoside analog reverse transcriptase inhibitors: Inhibit reverse transcriptase. Examples include nevirapine (Viramune), delavirdine (Rescriptor), efavirenz (Sustiva), zidovudine (AZT), and lamivudine (3TC). AZT is used during pregnancy to decrease maternal-fetal transmission. After delivery, the infant will probably be given AZT for approximately the first six weeks of life.
- Protease inhibitors: Block the HIV protease enzyme and prevent viral replication and the release of viral particles. Examples include indinavir (Crixivan), ritonariv (Norvir), saquinavir (Invirase), nelfinavir (Viracept), amprenavir (Agenerase), lopinavir (ABT- 378r, Kaletra), and TMC-114 darunavir (Prezista).
- Ribonucleotide reductase inhibitors: As a new use for cytotoxic therapies, they interfere with DNA synthesis and stop viral replication. Examples include hydroxyurea (Hydrea).
- Entry inhibitors: This group of drugs is newly released and has been shown to reduce the viral load significantly. Fusion drugs inhibit the HIV from entering target cells by binding protein in the virus. When the virus is bound to the drug, the virus cannot adhere to the cell membrane. Examples include Enfuvirtide (Fuzeon).
- IbIntragrase strand transfers: This new group of medications includes a drug named Tivicay (dolutegravir).
Opportunistic diseases are also treated specifically dependent on the pathogen responsible for the infection. Some examples of these opportunistic illnesses and their treatment include the following:
- Pneumocystis carinii pneumonia: TMP/SMX (Bactrim).
- Toxoplasmosis encephalitis: Pyrimethamine and sulfadiazine.
- Cryptosporidiosis: Metronidazole (Flagyl), antidiarrheal (Lomotil).
- Candidiasis: Fluconazole (Diflucan), ketoconazole (Nizoral).
- Cryptococcosis: Fluconazole (Diflucan).
- Histoplasmosis: Ketoconazole (Nizoral).
- Unresolved vaginal yeast infections for a year or more might indicate presence of HIV.
- Mycobacterium avium: Intracellular complex (MAC), ciprofloxacin (Cipro), clofazimine (Lamprine).
- Tuberculosis: Pyrazinamide (Tebrazid), isoniazid (Lanzid).
- Cytomegalovirus (CMV): Ganciclovir (Cytovene).
- Herpes simplex virus (HSV): Acyclovir (Zovirax).
- Varicella: zoster virus (VZV): Acyclovir (Zovirax).
The client should be cautioned regarding the use of herbals such as echinacea because they decrease the effectiveness of antiviral medications.
Comfort measures include pain management and nonsteroidal anti-inflammatory medications for myalgia and inflammation. Antidepressants such as amitriptyline (Elavil) are used to treat depression associated with the disease and the prognosis. Anticonvulsants such as phenytoin (Dilantin) might be ordered to treat seizure disorders associated with neuropathies.
Diet therapy should include education regarding the need to increase calories, protein, vitamins, and minerals. The client should be educated in the risk of eating contaminated foods. The client should be instructed to wash and/or cook food to destroy bacteria. Eating from a salad bar, eating foods grown in or on the ground, and eating cultured foods such as yogurt and cottage cheese should be discouraged. The client should avoid drinking standing water or liquids because bacteria begins to grow in standing water after 20 minutes. The cap should be kept on the bottle, and liquids should be stored in the refrigerator or cooler to minimize bacterial growth. Vitamin supplementation and total parenteral nutrition (TPN) might be ordered for clients with severe nutritional deficits.
Other treatment for the client with AIDS includes mouth care, skin care, oxygen therapy, emotional support, chemotherapy for cancers associated with AIDS, and seizure precautions. The prognosis depends on the progression of the illness. Since the discovery of the HIV virus, the development of a vaccine to prevent HIV infection has been the focus of research. Vaccines that stimulate the immune system are also being developed, but at present none are available.