7.3 Introduction to HIV, AIDS, and Antiretrovirals
4 min read•june 18, 2024
is a complex that targets the , leading to if left untreated. Understanding its pathophysiology, transmission, and diagnosis is crucial for effective management and prevention of this chronic condition.
Antiretroviral therapy has revolutionized HIV treatment, transforming it from a fatal disease to a manageable chronic condition. Various drug classes target different stages of the viral life cycle, with combination therapy being the cornerstone of effective treatment.
HIV Pathophysiology and Progression
Mechanisms of HIV infection
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- HIV primarily targets and infects , a critical component of the immune system
- Virus attaches to CD4 receptor and or co-receptors on cell surface facilitating entry
- Viral RNA undergoes into DNA and integrates into host cell genome
- Infected cells produce new virus particles leading to cell death and spread of infection to other cells
- Progressive decline in CD4+ T cell count gradually weakens the immune system over time
- () and cancers () emerge as the immune system deteriorates
Symptoms of HIV/AIDS
- occurs 2-4 weeks after exposure
- Flu-like symptoms manifest: fever, fatigue, sore throat, rash, headache, lymphadenopathy
- (asymptomatic phase)
- Persistent generalized lymphadenopathy
- Gradual onset of fatigue, weight loss, low-grade fever
- AIDS (advanced stage)
- Opportunistic infections: ,
- Cancers: , cervical cancer
- Wasting syndrome, dementia, other neurological complications
HIV Transmission and Diagnosis
Risk factors for HIV transmission
- Unprotected sexual contact with an HIV-positive person
- Anal intercourse carries the highest risk followed by vaginal intercourse
- Sharing of needles, syringes, other injection drug equipment
- Mother-to-child transmission during pregnancy, childbirth, breastfeeding
- Occupational exposure to infected blood or body fluids (needlestick injuries)
Diagnostic tests for HIV
- Antibody tests (, rapid tests)
- Detect antibodies produced by the immune system in response to HIV infection
- Window period of up to 12 weeks after exposure for antibodies to develop
- Antigen/antibody combination tests (4th generation)
- Detect both HIV antibodies and , a viral protein
- Shorter window period (2-6 weeks) compared to antibody tests alone
- HIV RNA tests ()
- Measure the amount of HIV RNA in the blood
- Used to confirm infection, monitor treatment response, detect early infection
- CD4+ T cell count
- Assesses the status of the immune system, guides treatment decisions
Antiretroviral Therapy
Classes of antiretroviral drugs
- ###nucleoside/nucleotide_reverse_transcriptase_inhibitors_()_0###
- Block reverse transcription of viral RNA into DNA (, )
- ###non-nucleoside_reverse_transcriptase_inhibitors_()_0###
- Bind to and inhibit reverse transcriptase enzyme (, )
- ()
- Prevent cleavage of viral polyproteins inhibiting maturation of new virions (, )
- ()
- Block integration of viral DNA into host cell genome (, )
- Entry inhibitors
- CCR5 antagonists () and fusion inhibitors ()
Side effects of antiretrovirals
- NRTIs: , , bone marrow suppression, renal toxicity
- NNRTIs: Rash, hepatotoxicity, neuropsychiatric symptoms, lipid abnormalities
- PIs: Gastrointestinal intolerance, , metabolic abnormalities, drug interactions ( inhibition)
- INSTIs: Generally well-tolerated, potential for weight gain and neural tube defects (dolutegravir)
- Drug interactions
- PIs and NNRTIs are prone to drug interactions due to CYP450 metabolism
- Dose adjustments or alternative regimens may be necessary when co-administered with interacting medications
HIV and Antiretroviral Therapy Concepts
HIV as a retrovirus
- HIV is classified as a retrovirus due to its unique replication cycle
- Reverse transcriptase enzyme allows viral RNA to be converted into DNA
- involves integration of viral DNA into host cell genome
- targets various stages of the viral life cycle
- Combination therapy (highly active antiretroviral therapy or HAART) uses multiple drug classes
- HAART suppresses viral replication more effectively than single-drug regimens
- can occur during viral replication
- Resistance testing guides selection of effective antiretroviral regimens
Nursing Considerations and Patient Education
Nursing considerations for HIV medications
- Assess for drug allergies, contraindications, potential drug interactions
- Monitor for adverse effects and toxicities (liver function tests, renal function, CBC)
- Ensure proper dose, route, timing of medication administration
- Encourage to antiretroviral therapy
- Educate patients on the importance of taking medications as prescribed
- Assist in developing strategies to maintain adherence (pill boxes, reminders)
- Maintain patient confidentiality, provide emotional support
Patient education for antiretroviral therapy
- Emphasize the importance of strict adherence to prevent treatment failure and
- Educate on proper storage and handling of medications
- Discuss common side effects and management strategies
- Encourage regular follow-up with healthcare providers for monitoring
- Advise on preventive measures to reduce the risk of transmission to others
- Safe sexual practices (consistent condom use)
- Avoiding sharing of needles or injection equipment
- Consultation with healthcare providers regarding pregnancy and breastfeeding
- Provide resources for support services including mental health and substance abuse treatment if needed
Key Terms to Review (71)
Acquired immunodeficiency syndrome (AIDS): Acquired Immunodeficiency Syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the Human Immunodeficiency Virus (HIV). It severely weakens the immune system, making the body susceptible to opportunistic infections and certain cancers.
Acute HIV Infection: Acute HIV infection is the initial stage of HIV (Human Immunodeficiency Virus) infection, characterized by a rapid and intense viral replication shortly after the virus enters the body. This stage is marked by the presence of high levels of HIV in the bloodstream and a variety of flu-like symptoms as the immune system responds to the infection.
Adaptive immune system: The adaptive immune system is a specialized part of the immune system that targets specific pathogens with high precision. It has memory capabilities, allowing it to respond more effectively upon subsequent exposures to the same pathogen.
Adherence: Adherence refers to the extent to which a person's behavior, such as taking medication, following a diet, or executing lifestyle changes, corresponds with the recommendations or instructions provided by their healthcare provider. It is a critical factor in the successful management of various health conditions, including HIV/AIDS and cardiovascular diseases like those treated with statins and PCSK9 inhibitors.
AIDS: AIDS, or Acquired Immunodeficiency Syndrome, is a chronic and potentially life-threatening condition caused by the Human Immunodeficiency Virus (HIV). It represents the most advanced stage of HIV infection, characterized by the body's inability to fight off opportunistic infections and certain cancers due to a severely compromised immune system.
AIDS-Defining Illness: An AIDS-defining illness is a specific condition or infection that, in the context of HIV infection, indicates the progression of the disease to the advanced stage known as Acquired Immunodeficiency Syndrome (AIDS). These illnesses are defined by the Centers for Disease Control and Prevention (CDC) and serve as markers for the severe immunodeficiency associated with the late stages of HIV infection.
Antibiotic drug resistance: Antibiotic drug resistance occurs when bacteria develop the ability to defeat the drugs designed to kill them. This makes infections harder to treat and increases the risk of disease spread, severe illness, and death.
Antiretroviral Drugs: Antiretroviral drugs are medications used to treat infections caused by retroviruses, primarily HIV. They work by inhibiting the virus's ability to replicate within the human body.
Antiretroviral therapy (ART): Antiretroviral therapy (ART) is the use of a combination of antiretroviral drugs to treat HIV infection. It aims to reduce the viral load, improve immune function, and prevent HIV transmission.
Antiretroviral Therapy (ART): Antiretroviral therapy (ART) is the use of a combination of HIV medications, known as antiretrovirals, to treat HIV infection. ART works by suppressing the virus, reducing the amount of HIV in the body, and preventing the progression of the disease to AIDS.
Antiretrovirals: Antiretrovirals are a class of medications used to treat and manage human immunodeficiency virus (HIV) infection, the virus that causes acquired immunodeficiency syndrome (AIDS). These drugs work by inhibiting various stages of the HIV replication cycle, helping to suppress viral load and slow the progression of the disease.
Atazanavir: Atazanavir is an antiretroviral medication used in the treatment of HIV/AIDS. It belongs to a class of drugs called protease inhibitors, which work by blocking the action of an enzyme essential for the replication of the HIV virus. Atazanavir is also known to interact with certain medications used to treat acid reflux and heartburn, making it an important consideration in the management of HIV patients.
Bictegravir: Bictegravir is an integrase strand transfer inhibitor (INSTI) used in the treatment of HIV infection. It works by blocking the activity of the HIV integrase enzyme, which is essential for the virus to replicate and infect new cells, thereby preventing the progression of the disease.
CCR5: CCR5 is a chemokine receptor that serves as a co-receptor for the entry of the human immunodeficiency virus (HIV) into host cells. It is a critical component in the pathogenesis of HIV infection and the development of acquired immunodeficiency syndrome (AIDS).
CD4+ T cells: CD4+ T cells, also known as helper T cells, are a type of lymphocyte that plays a crucial role in the adaptive immune response. They are essential for coordinating and regulating the body's immune defenses against various pathogens, including the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS).
Chemokine Coreceptor (CCR5) Antagonists: Chemokine Coreceptor (CCR5) Antagonists are antiretroviral drugs that block the CCR5 receptor on the surface of T-cells, preventing HIV from entering and infecting these cells. They are specifically used in the treatment of HIV-1 infection.
Chronic HIV Infection: Chronic HIV infection refers to the persistent and long-term nature of the human immunodeficiency virus (HIV) in the body, where the virus continues to replicate and gradually impairs the immune system over an extended period. This ongoing infection is a central aspect of the progression from initial HIV exposure to the development of acquired immunodeficiency syndrome (AIDS).
Cobicistat: Cobicistat is a pharmacokinetic enhancer used in combination with other antiretroviral drugs to boost their effectiveness by inhibiting the liver enzyme CYP3A4. It has no direct antiviral activity but helps maintain higher levels of the active drugs in the bloodstream.
Cryptococcal Meningitis: Cryptococcal meningitis is a serious fungal infection of the membranes surrounding the brain and spinal cord, commonly seen in individuals with weakened immune systems, such as those living with HIV/AIDS. It is caused by the encapsulated yeast-like fungus Cryptococcus neoformans and can lead to life-threatening complications if left untreated.
CXCR4: CXCR4 is a chemokine receptor that plays a crucial role in the entry of the human immunodeficiency virus (HIV) into host cells, making it a key target in the treatment and understanding of HIV/AIDS. This receptor is expressed on the surface of various cell types, including T cells, and serves as a co-receptor for HIV-1 entry, alongside the primary CD4 receptor.
CYP450: CYP450 refers to a superfamily of enzymes, primarily located in the liver, that are responsible for the metabolism and breakdown of various drugs and other xenobiotics. These enzymes play a crucial role in the pharmacokinetics of many medications, influencing their absorption, distribution, metabolism, and elimination.
Cytochrome P-450 Inhibitors: Cytochrome P-450 Inhibitors are substances that decrease the metabolic activity of cytochrome P-450 enzymes, leading to reduced metabolism of certain drugs. This can result in increased drug levels and potential toxicity.
Darunavir: Darunavir is a protease inhibitor medication used in the treatment of human immunodeficiency virus (HIV) infection. It is an essential component of antiretroviral therapy, which aims to suppress the replication of HIV and prevent the progression to acquired immunodeficiency syndrome (AIDS).
Dolutegravir: Dolutegravir is an antiretroviral medication used in the treatment of human immunodeficiency virus (HIV) infection. It belongs to a class of drugs called integrase strand transfer inhibitors (INSTIs) that work by preventing the HIV virus from integrating its genetic material into the host cell's DNA, thereby interrupting the viral replication process.
Dolutegravir/rilpivirine: Dolutegravir/rilpivirine is a combination antiretroviral medication used to treat HIV-1 infection. It combines two drugs that inhibit viral replication by targeting different stages of the HIV life cycle.
Drug Resistance: Drug resistance refers to the ability of a pathogen, such as a virus, bacteria, parasite, or cancer cell, to withstand the effects of a drug or medication that is designed to kill or inhibit its growth. This phenomenon can significantly impact the effectiveness of various treatments, including those for HIV/AIDS, sexually transmitted infections, parasitic infections, and cancer.
Drug Resistance Mutations: Drug resistance mutations are genetic changes in a pathogen, such as a virus or bacteria, that allow it to survive and replicate in the presence of a drug that would normally inhibit or kill it. These mutations reduce the effectiveness of antimicrobial drugs, making infections more difficult to treat.
Efavirenz: Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) medication used in the treatment of HIV infection. It works by inhibiting the reverse transcriptase enzyme, which is essential for the replication of HIV within host cells, thereby reducing the viral load and slowing the progression of the disease.
ELISA: ELISA, or Enzyme-Linked Immunosorbent Assay, is a widely used analytical technique that employs antibodies and color changes to detect and quantify specific substances, such as proteins, hormones, or antibodies, in a sample. It is a fundamental tool in various fields, including immunology, virology, and microbiology, and plays a crucial role in the diagnosis and monitoring of infectious diseases, including bacterial, viral, and fungal infections, as well as HIV and AIDS.
Emtricitabine: Emtricitabine is a nucleoside reverse transcriptase inhibitor (NRTI) used in the treatment of HIV infection. It works by inhibiting the reverse transcriptase enzyme, which is essential for the replication of the HIV virus, thereby preventing the virus from multiplying and spreading in the body.
Enfuvirtide: Enfuvirtide is a synthetic peptide drug used in the treatment of HIV infection. It works by inhibiting the fusion of the HIV virus with the host cell, preventing the virus from entering and infecting the cell. Enfuvirtide is an important antiretroviral medication in the context of managing HIV/AIDS and the progression of the disease.
Etravirine: Etravirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used in combination with other medications to treat HIV-1 infection. It works by inhibiting the reverse transcriptase enzyme, which is essential for viral replication.
Fusion Pump Inhibitors: Fusion Pump Inhibitors are a class of antiretroviral drugs that prevent HIV from entering human cells by inhibiting the fusion of the virus with the host cell membrane. These inhibitors are crucial in managing and treating HIV/AIDS.
Hepatic Steatosis: Hepatic steatosis, also known as fatty liver disease, is a condition characterized by the abnormal accumulation of fat within the liver cells. This buildup of fat can lead to inflammation and potential liver damage if left untreated, making it an important consideration in the context of HIV, AIDS, and antiretroviral therapy.
Highly Active Antiretroviral Therapy (HAART): Highly Active Antiretroviral Therapy (HAART) is a combination of multiple antiretroviral medications used to treat HIV infection. HAART is the standard of care for managing HIV/AIDS, as it aims to suppress the virus, prevent disease progression, and improve the quality of life for those living with the condition.
HIV: HIV, or Human Immunodeficiency Virus, is a virus that attacks the body's immune system, specifically the CD4+ T cells, which are crucial for fighting off infections. If left untreated, HIV can progress to the advanced stage of the disease, known as Acquired Immunodeficiency Syndrome (AIDS), which can be life-threatening.
HIV transmission: HIV transmission is the spread of the Human Immunodeficiency Virus (HIV) from one person to another. It occurs through specific activities that allow contact with infected bodily fluids such as blood, semen, vaginal fluids, and breast milk.
Human immunodeficiency virus: Human Immunodeficiency Virus (HIV) is a virus that attacks the body's immune system, specifically the CD4 cells (T cells). If left untreated, it can lead to Acquired Immunodeficiency Syndrome (AIDS).
Immune System: The immune system is a complex network of cells, tissues, and organs that work together to defend the body against infections, diseases, and foreign invaders. It plays a crucial role in maintaining health and well-being by recognizing and eliminating threats, while also regulating the body's response to various stimuli.
INSTIs: INSTIs, or Integrase Strand Transfer Inhibitors, are a class of antiretroviral drugs used in the treatment of HIV/AIDS. They work by inhibiting the activity of the HIV integrase enzyme, which is responsible for inserting the viral genetic material into the host cell's DNA, thereby preventing the virus from replicating and spreading within the body.
Integrase strand transfer inhibitors: Integrase strand transfer inhibitors (INSTIs) are a class of antiretroviral drugs that block the action of the HIV integrase enzyme. This prevents the viral DNA from integrating into the host cell genome, essential for HIV replication.
Intelence: Intelence, also known as etravirine, is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used in the treatment of HIV-1 infection. It is typically prescribed for patients who have shown resistance to other antiretroviral drugs.
Isentress: Isentress is a brand name for raltegravir, an antiretroviral drug used to treat HIV-1 infection. It belongs to the class of integrase inhibitors, which block the integration of viral DNA into the host cell genome.
JULUCA: Juluca is a combination antiretroviral medication that contains dolutegravir and rilpivirine. It is used for the maintenance treatment of HIV-1 infection in adults who are virologically suppressed.
Kaposi's Sarcoma: Kaposi's sarcoma is a type of cancer that causes abnormal cells to grow in the skin, mucous membranes, and other organs. It is commonly associated with HIV/AIDS and is considered an AIDS-defining illness.
Lactic Acidosis: Lactic acidosis is a metabolic condition characterized by the accumulation of lactic acid in the body, leading to a disruption in the body's pH balance and the development of acidic conditions. This term is particularly relevant in the context of HIV/AIDS treatment and the management of diabetes.
Lipodystrophy: Lipodystrophy is a medical condition characterized by abnormal or uneven distribution of body fat, often associated with certain medications or medical conditions. It can manifest in different ways, including the loss of fat tissue (lipoatrophy) or the accumulation of excess fat tissue (lipohypertrophy), and can have significant impacts on various aspects of health and well-being.
Maraviroc: Maraviroc is a type of antiretroviral medication used in the treatment of human immunodeficiency virus (HIV) infection. It works by blocking the CCR5 co-receptor on the surface of CD4+ T cells, preventing the virus from entering and infecting these cells, thereby reducing the viral load and slowing the progression of the disease.
NNRTIs: NNRTIs, or Non-Nucleoside Reverse Transcriptase Inhibitors, are a class of antiretroviral drugs used to treat HIV infection. They work by binding to and inhibiting the HIV reverse transcriptase enzyme, which is essential for the virus to replicate and infect new cells.
Non-Hodgkin's lymphoma: Non-Hodgkin's lymphoma is a type of cancer that originates in the lymphatic system, which is part of the body's immune system. It is characterized by the uncontrolled growth and proliferation of abnormal lymphocytes, a type of white blood cell, that can spread to other parts of the body.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a class of antiretroviral drugs used to treat HIV. They work by binding to and inhibiting the reverse transcriptase enzyme, preventing the virus from replicating.
NRTIs: NRTIs, or Nucleoside Reverse Transcriptase Inhibitors, are a class of antiretroviral medications used in the treatment of HIV/AIDS. They work by inhibiting the reverse transcriptase enzyme, which is essential for the replication of the HIV virus within host cells.
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) are a class of antiretroviral drugs used to treat HIV. They work by inhibiting the reverse transcriptase enzyme, preventing the virus from replicating.
Opportunistic Infections: Opportunistic infections are infections caused by pathogens that take advantage of a weakened or compromised immune system, often seen in individuals with conditions like HIV/AIDS. These infections can be life-threatening if left untreated and are a major concern for those with impaired immunity.
P24 Antigen: The p24 antigen is a key structural protein found in the core of the human immunodeficiency virus (HIV). It is a crucial component of the virus and plays a vital role in the context of HIV infection, AIDS, and antiretroviral therapy.
PIs: PIs, or Protease Inhibitors, are a class of antiretroviral medications used in the treatment of HIV/AIDS. These drugs work by blocking the activity of the HIV protease enzyme, which is essential for the virus to replicate and infect new cells, effectively slowing the progression of the disease.
Pneumocystis Pneumonia: Pneumocystis pneumonia (PCP) is a serious form of pneumonia caused by the fungus Pneumocystis jirovecii. It is a common opportunistic infection that primarily affects individuals with weakened immune systems, such as those living with HIV/AIDS. PCP is a key topic in the context of HIV, AIDS, and antiretroviral therapies.
Protease inhibitors: Protease inhibitors are a class of antiviral drugs that prevent viral replication by inhibiting the activity of protease, an enzyme used by viruses like HIV to produce infectious particles. They are crucial in the treatment of HIV/AIDS as part of antiretroviral therapy (ART).
Raltegravir: Raltegravir is an antiretroviral drug used to treat HIV infection by inhibiting the integration of viral DNA into the host cell genome. It belongs to a class of drugs known as integrase strand transfer inhibitors (INSTIs).
Retrovirus: A retrovirus is a type of virus that uses ribonucleic acid (RNA) as its genetic material, rather than the more common deoxyribonucleic acid (DNA). Retroviruses have the unique ability to convert their RNA into DNA and integrate it into the host cell's genome, allowing them to hijack the cell's machinery to replicate and spread throughout the body.
Reverse Transcription: Reverse transcription is a process in which a single-stranded RNA molecule is used as a template to synthesize a complementary DNA (cDNA) strand. This process is a crucial step in the life cycle of retroviruses, such as the Human Immunodeficiency Virus (HIV), which causes Acquired Immunodeficiency Syndrome (AIDS).
Reyataz: Reyataz, also known by its generic name atazanavir, is an antiretroviral medication used to treat and manage HIV infection. It belongs to the class of drugs known as protease inhibitors which help prevent the virus from multiplying in the body.
Rilpivirine: Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used in the treatment of human immunodeficiency virus (HIV) infection. It works by interfering with the reverse transcriptase enzyme, which is essential for the replication of HIV within the host cells, thereby preventing the virus from multiplying and spreading throughout the body.
Tenofovir: Tenofovir is a nucleotide reverse transcriptase inhibitor (NtRTI) used in the treatment of HIV and hepatitis B infections. It works by interfering with the reverse transcriptase enzyme, which is essential for the replication of the HIV and hepatitis B viruses, effectively preventing the virus from multiplying within the host's cells.
Toxoplasmosis: Toxoplasmosis is a parasitic infection caused by the protozoan Toxoplasma gondii. It is a common disease that can have serious implications, especially for individuals with weakened immune systems, such as those living with HIV/AIDS. This term is particularly relevant in the context of understanding HIV, AIDS, and antiretroviral treatments.
Tybost: Tybost is a pharmacokinetic enhancer used in combination with certain antiretroviral drugs to treat HIV-1 infection. It works by inhibiting enzymes that metabolize these drugs, thereby increasing their effectiveness.
Vertical Transmission: Vertical transmission refers to the transmission of a pathogen, such as a virus or bacteria, from a mother to her child during pregnancy, childbirth, or breastfeeding. This mode of transmission is particularly important in the context of infectious diseases that can be passed from an infected mother to her offspring.
Viral load: Viral load is the measurement of the amount of HIV virus present in a patient's blood. It is a critical indicator of how effectively antiretroviral therapy (ART) is controlling the infection.
Viral Load: Viral load refers to the amount of a virus, such as the human immunodeficiency virus (HIV), present in an individual's blood or other bodily fluids. It is a crucial measure in the management and monitoring of HIV/AIDS, as it provides insight into the progression of the disease and the effectiveness of antiretroviral therapy.
Viral Replication: Viral replication is the process by which a virus reproduces inside the host cell, hijacking the cell's machinery to create new viral particles. This process is crucial for the spread and propagation of viruses, including the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS).
Viread: Viread is a brand name for tenofovir disoproxil fumarate, an antiviral medication used to treat HIV and chronic hepatitis B. It works by inhibiting viral replication in infected cells.