Pharmacological intervention is at the core of HIV management. This is due to the fact that antiretrovirals are the medications which slow the progression of the disease as a single measure to minimize the detrimental impacts of the virus on the human body and systems. The primary task of the nurse in context essay revise service relates to risk-to-benefit balancing with regard to drugs in the scope of the anti-viral therapy in light of prescriptions relevant to the patient condition and potential complications. Nursing professionals should possess the necessary knowledge and skills to provide the well-planned and administered pharmacological treatment to HIV patients. The complexity of nurse’s task is concerned with the goal of the therapy that may focus on disease progression or transmission, complications for other body systems, improvement of the quality of life, or minimizing the drug-related side effects among other factors. Hence, antiretroviral medications are of critical significance for patient’s HIV management while nurses have the crucial role of evaluating the patient readiness for medication intake, monitoring the therapeutic effect, and preventing the side effects of the drugs.
Life-Long Treatment of HIV
The main healthcare regulations in the US generally recommend starting HIV medical treatment as soon as possible. For instance, HHS emphasizes that once diagnosed, a patient should adhere to the HIV treatment as a way to ensure their quality life with HIV and protect others from infection. In case the patient starts the HIV treatment late or adherence to the medical treatment plan is low, a high likelihood exists in terms of obtaining the opportunistic infections as a complication of HIV. The antiretroviral therapy is life-long, with adjustments to be made in the treatment plan according to the individual drug rejection or intolerance, possible adverse side effects or complications which can occur in the process of treatment administration. Overall, the HIV medications comprise of different drugs linked to specific steps of the HIV cycle, and they are commonly classified per five groups.
Reverse Transcription Inhibitors
This class of HIV medications aims at ensuring transcription of viral RNA into the proviral DNA. The commonly prescribed drugs involve abacavir, lamivudine, emtricitabine, tenofovir disoproxil fumalate, and tenofovir alafemide fumarate. With these drugs, the HIV-infected cells are blocked so that they are unable to build more viral cells in the body impacting the progress of the disease. Possible side effects can be drug-specific, while some common ones refer to hepatic steatosis, lactic acidosis and lipodystrophy.
Integrase Strand Transfer Inhibitors (INSTIs)
According to the HHS recommendations, combining one INSTI with two NRTIs is the most commonly applied pharmacological treatment strategy for the initial HIV treatment. The medications which are commonly prescribed in this context are raltegravir, elvitegravir, cobicistat, and dolutegravir. They are used to block the infected cells from replicating. Being mostly well-tolerated for routine clinical use, sometimes this group of drugs can lead to gastrointestinal and general adverse drug reactions, such as malaise and fatigue, especially for patients treated with elvitegravir.
Protease Inhibitors (PIs) and Pharmacoenhancers
Some of PIs involve darunavir, amprenavir, and atazanavir which aim at blocking the protein necessary for the building of the new particles of the HIV virus. The drugs in the scope of this group are often associated with kidney-related complications and metabolic abnormalities requiring interacting agents and cautious intake for hemophilic patients. As for commonly prescribed pharmacoenhancers, cobicistat and ritonavir, or norvir, are used to enhance the effectiveness of the drugs when a few HIV medications are used together. They can lead to gastrointestinal and general ADRs, especially in case of high dosage, while may also have significant interactions with other drugs.
Nursing Implications
The complex objective of a nurse administering the HIV antiretroviral therapy involves assessing the patient readiness for medication intake, monitoring the effect of the therapy, and avoiding or minimizing the drug-related side effects. Understanding patient readiness for the therapy is critical at any stage of HIV progression. This factor defines the patient adherence to the treatment plan in terms of medication intake, awareness of infection symptoms and adversity, transmission as well as identification and timely response to complications or side effects. Drug-to-drug interaction and possible intolerance of the prescribed medications are another area of concern a nurse should monitor to ensure a timely adjustment of the treatment, if needed. To evaluate the therapeutic impact of medications, the nurse should monitor the viral load (reduction means a positive outcome) and CD4 cell count (increase is a positive implication). Moreover, the empirical evidence showed that patient worries, negative perceptions and HIV-related stigma can cause or worsen the side effects of the drugs and duration of the disease overal. Hence, the nurse should possess extensive knowledge in the HIV care, including in-depth awareness of pharmacokinetics of the drugs and patient history, to provide the proper disease management combined with comprehensive patient education and support.
Conclusion
To summarize, antiretroviral therapy is vital for thorough and holistic HIV treatment and nurses have a pivotal role in treatment administration and organization of the disease management, including evaluation of the patient readiness for adhering to the treatment plan, monitoring the therapeutic effect, and mitigating the side effects. Divided per five groups, HIV drugs are prescribed according to the disease cycle and patient condition. They can be used to slower the progress of the disease, improve the patient life quality, or prevent further transmission of the virus. The combination of the medications in the scope of the HIV therapy as well as the complexity of the patient health condition requires the high-level nurse’s competence in both pharmacology and various aspects of patient care, such as psychological state among others.
