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Chemotherapeutic agents
infected with HIV are urged not to breastfeed. Teno
fovir, zidovudine and emtricitabine should be used with
caution in the presence of hepatic dysfunction or severe
renal impairment. Zidovudine should also be used with
caution with any bone marrow suppression.
Adverse effects
Serious-to-fatal hypersensitivity reactions have occurred
with abacavir, and it must be stopped immediately at
any sign of a hypersensitivity reaction (fever, chills, rash,
fatigue, GI upset, flu-like symptoms).
Serious pancreatitis, hepatomegaly and neurological
problems have been reported with didanosine, which
is why its use is limited to the treatment of advanced
infections.
Emtricitabine has been associated with severe and
even fatal hepatomegaly with steatosis.
Severe hepatomegaly with steatosis has been
reported with tenofovir, so it must be used with extreme
caution in any individual with hepatic impairment or
lactic acidosis. People also need to be alerted that the
drug may cause changes in body fat distribution, with
loss of fat from arms, legs and face and deposition of fat
on the trunk, neck and breasts.
Severe bone marrow suppression has occurred with
zidovudine.
Clinically significant drug–drug interactions
Tenofovir can cause large increases in the serum level of
didanosine. If both of these drugs are given, tenofovir
should be given 2 hours before or 1 hour after didano-
sine. Severe toxicity can occur if abacavir is combined
with alcohol; this combination should be avoided.
Didanosine can cause decreased effects of several anti-
biotics and antifungals; any antibiotic or antifungal
started with didanosine should be evaluated carefully.
There is an increased risk of potentially fatal pancreatitis
if stavudine is combined with didanosine and increased
risk of severe hepatomegaly if it is combined with other
Public education about AIDS
When AIDS was first diagnosed in the early 1980s, it was
found in a certain population in NewYork City.The people
in this group tended to be homosexuals, intravenous
drug users, and debilitated persons with poor hygiene
and nutrition habits. Originally, a number of healthcare
practitioners thought that the disease was a syndrome
of opportunistic infections that occurred in a population
with repeated exposures to infections that naturally
deplete the immune system. It was not until several
years later that the human immunodeficiency virus
(HIV) was identified. Since then, it has been discovered
that HIV infection is rampant in many African countries.
The infection has also spread throughout Australia and
New Zealand in populations that are not homosexual or
intravenous drug users and who have good nutrition and
hygiene habits. As healthcare practitioners have learned,
HIV is not particular about the body it invades. Once
introduced into a body, it infectsT cells and causes HIV
infection.
The evidence shows that when a person is diagnosed
with HIV infection, the health professional faces a
tremendous challenge in providing education and
support.The person and any significant others should be
counselled about the risks of transmission and reassured
about ways in which the virus is not transmitted.They will
need to learn about drug protocols,T-cell levels, adverse
drug effects and anticipated progress of the disease.They
also will need consistent support. Many communities have
AIDS support groups and other resources that can be very
helpful; the health professional can direct the person to
these resources as appropriate.
The combinations of drugs that are being used today
and the constant development of more drugs make the
disease less of a death sentence than it was in the past.
The result, however, is that many people must take a
large number of pills each day, at tremendous cost and
inconvenience. Many people today do live for long periods
with HIV infection. An AIDS vaccine is currently being
studied and offers hope for preventing this disease in the
future.
Public education is key for promoting the acceptance
and care of people with HIV infection or AIDS, who need a
great deal of support and assistance. Health professionals
can be role models for dealing with people with HIV and
can provide informal public education whenever the
opportunity presents.
The evidence
BOX 10.3
Prototype summary: Zidovudine
Indications:
Management of adults with
symptomatic HIV infection in combination with
other antiretrovirals; prevention of maternal–fetal
HIV transmission.
Actions:
A thymidine analogue that is activated to a
triphosphate form, which inhibits the replication of
various retroviruses, including HIV.
Pharmacokinetics:
Route
Onset
Peak
Oral
Varies
30–90 minutes
IV
Rapid
End of infusion
T
1/2
:
30 to 60 minutes; metabolised in the liver and
excreted in the urine.
Adverse effects:
Headache, insomnia, dizziness,
nausea, diarrhoea, fever, rash, bone marrow
suppression.
