Chapter 32: HIV & AIDS Antiretroviral Drug Therapy

The text details the pathophysiology of HIV as an RNA retrovirus that destroys CD4+ T cells, leading to immune deficiency, and outlines the primary goals of therapy: reducing HIV-associated morbidity, restoring immunologic function, preventing transmission, and suppressing plasma viral load to undetectable levels, specifically (lesser than) 200 copies/mL. A comprehensive classification of antiretroviral drugs is presented, including Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) like zidovudine and tenofovir, which inhibit viral DNA polymerase; Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) such as efavirenz that bind directly to reverse transcriptase; and Protease Inhibitors (PIs) like atazanavir, which block the enzyme responsible for viral assembly and often require pharmacokinetic boosting with ritonavir or cobicistat. The chapter also explores advanced drug classes such as Integrase Strand Transfer Inhibitors (INSTIs) like dolutegravir, Fusion Inhibitors like enfuvirtide, and CCR5 Antagonists like maraviroc, which are utilized based on treatment history and resistance profiles. Significant emphasis is placed on the nurse's role in promoting strict medication adherence (100 percent) to prevent drug resistance and treatment failure, as well as managing complex side effects like mitochondrial toxicity, lipodystrophy, and Immune Reconstitution Inflammatory Syndrome (IRIS). Furthermore, the text covers the prevention and treatment of opportunistic infections (OIs) including Pneumocystis jiroveci pneumonia (PJP), Kaposi sarcoma, and cytomegalovirus (CMV), and provides specific protocols for preventing mother-to-child transmission (MTCT) during pregnancy and managing occupational exposure via Postexposure Prophylaxis (PEP).