C H A P T E R 1 0
Antiviral agents
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CRITICAL THINKING SCENARIO
Antiviral agents for HIV and AIDS
THE SITUATION
H.P. is a 34-year-old attorney who was diagnosed with
AIDS, having had a positive HIV test 3 years ago. Although
his T cell count had been stabilised with treatment with
zidovudine and efavirenz, it recently dropped remarkably.
He presents with numerous opportunistic infections
and Kaposi sarcoma. H.P. admits that he has been under
tremendous stress at work and at home in the last few
weeks. He begins a combination regimen of lamivudine,
zidovudine and ritonavir.
CRITICAL THINKING
What are the important care implications in this case?
What role would stress play in the progress of this disease?
What specific issues should be discussed?
What other clinical implications should be considered?
DISCUSSION
Combination therapy with antivirals has been found
to be effective in decreasing some of the morbidity
and mortality associated with HIV and AIDS. However,
this treatment does not cure the disease. H.P. needs to
understand that opportunistic infections can still occur
and that regular medical help should be sought. He also
needs to understand that these drugs do not decrease
the risk of transmitting HIV by sexual contact or through
blood contamination and he should be encouraged to take
appropriate precautions.
It is important to make a dosing schedule for H.P., or
even to prepare a weekly medication dispenser, to ensure
that all medications are taken as indicated. H.P. should also
receive interventions to help him decrease his stress because
activation of the sympathetic nervous system during periods
of stress depresses the immune system. Further depression
of his immune system could accelerate the development of
opportunistic infections and decrease the effectiveness of
his antiviral drugs. Measures that could be used to decrease
stress should be discussed and tried with H.P.
Discussing the adverse effects that H.P. may experience
is important because GI upset and discomfort may occur
while he is taking all of these anti-HIV/AIDS medications.
Small, frequent meals may help alleviate the discomfort.
It is important that every effort be made to maintain H.P.’s
nutritional state, and a nutritional consultation may be
necessary if GI effects are severe. H.P. also may experience
dizziness, fatigue and confusion, which could cause more
problems for him at work and may necessitate changes in
his workload. Because some of the prescribed drugs must
be taken around the clock, provisions may be needed to
allow H.P. to take his drugs on time throughout the day.
For example, he may need to wear an alarm wristwatch,
establish planned breaks in his schedule at dosing times,
or devise other ways to follow his drug regimen without
interfering with his work schedule. The adverse effects
and inconvenience of taking this many drugs may add to
his stress. It is important that a healthcare provider work
consistently with him to help him to manage his disease
and treatment as effectively as possible.
CARE GUIDE FOR H.P.: ANTIVIRAL AGENTS FOR
HIV AND AIDS
Assessment: History and examination
Allergies to any of these drugs
Bone marrow depression
Renal or liver dysfunction
Skin: colour, lesions, texture
CNS: affect, reflexes, orientation
GI: abdominal and liver evaluation
Haematological: FBC and differential; viral load; T-cell levels;
renal and hepatic function tests
Implementation
Monitor FBC and differential before and every 2 weeks
during therapy.
Provide comfort and implement safety measures: assistance,
temperature control, lighting control, mouth care, back
rubs.
Provide small, frequent meals and monitor nutritional status.
Monitor for opportunistic infections and arrange treatment
as indicated.
Provide support and reassurance for dealing with drug
effects and discomfort.
Provide teaching regarding drug name, dosage, adverse
effects, warnings, precautions, use of OTC or herbal
remedies, and signs to report.
Evaluation
Evaluate drug effects: relief of signs and symptoms of AIDS
and AIDS-related complex (ARC) stabilisation of T-cell
levels.
Monitor for adverse effects: GI alterations, dizziness,
confusion, headache, fever.
Monitor for drug–drug interactions as indicated for each
drug.
Evaluate effectiveness of teaching plan.
Evaluate effectiveness of comfort and safety measures.
Teaching for H.P.
A combination of antiviral drugs has been prescribed to
treat your HIV infection. These drugs work in combination
