HIV: Antiretroviral Treatment (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 So what is this miracle treatment? Well antiretroviral treatment.

    00:05 We also call it ART, right? Antiretroviral therapy, ART.

    00:09 There the drugs that are used to treat HIV that virus.

    00:13 Okay so that's easy to remember antiretroviral HIV is a virus and we call it ART for short.

    00:21 So many people living with HIV.

    00:23 I promise this is such an amazing time compared to when the disease was first discovered.

    00:29 People were terrified, they were afraid, we didn't understand how it worked.

    00:32 We didn't think we had any options for treatment.

    00:35 Now, we really do have some pretty exciting options.

    00:38 So it's not a cure.

    00:40 I understand that but it can keep HIV effectively under control so we can't cure it yet, but we can control it with adequate treatment.

    00:51 So let's talk about how this amazing therapy or treatment works.

    00:55 ART works by keeping the level of HIV in your body very low.

    00:59 So the Lower the number of viruses in your blood that's a positive thing the number of viruses in your blood is called viral load.

    01:09 So those are key terms you want to make sure that you recognize those.

    01:12 So viral load is the number of HIV viruses in your blood the goal to have as few as possible because the lower the viral loads allow my own immune system to recover and stay strong.

    01:26 Well that makes sense because the less virus I have is hijacking my own immune system my own immune syste is going to be able to stay strong and fight off infections.

    01:36 So also keeping it low.

    01:38 Remember we want to remind you that it stops HIV from being passed on which is clearly and obviously critically important, but the challenge is consistency in ART.

    01:50 The patient has to take the drug every day relatively the same time if they can do that it will significantly extend the life expectancy of someone with HIV.

    02:01 But there's the biggest challenge is consistently taking the medication on a daily basis at the same time.

    02:09 See that's the part where we can help support the patient educate the patient and help them problem solve with the challenges each individual faces with doing something every day.

    02:21 So here's the goal, undetectable viral load.

    02:26 This is a huge win for somebody who's hiv-positive.

    02:30 So if we can keep that treatment consistently going they follow it as it was prescribed, people living with HIV are really achieving that undetectable viral load.

    02:39 That means that virus is in such a small quantity in their bloodstream that it doesn't affect their health and it limits the risk of them transmitting the virus to others.

    02:49 Now the patient still has HIV technically but we're keeping it under control.

    02:55 So undetectable viral load doesn't mean whoo! I've been cured.

    02:59 It just means I still have this.

    03:01 I'm still living with this.

    03:03 However, it's under tight control.

    03:06 There should be low risk for passing that on to anyone else and this individuals life and immune system are both going to be stronger.

    03:14 Now if the patient stops taking the medication regimen for any reason, they're not consistent with it again, the viral load will go back up.

    03:24 I know we've said that multiple different ways.

    03:25 That's always one of our strategies with you is to use repetition to make sure that things are making sense.

    03:31 But this is the most important point that you can help your patient understand.

    03:37 Here's our goal undetectable viral load.

    03:40 You'll be less impacted your family and people that you care about will be less impacted by the risk of transmission.

    03:46 However, if for some reason you're finding barriers to taking the medication, please contact us quickly because you have to take it consistently to get to this goal of an undetectable viral load.

    04:00 Now, what are the ways we use these medications, Now there are several different types of antiretroviral or ARV drugs and they work in different ways.

    04:09 Just like if someone had an infection, we can give a couple of different antibiotics that have different mechanisms of action.

    04:15 If someone has hypertension, we give sometimes more than one two, three, four, five medications for really severe hypertension because they work in different mechanisms of action.

    04:27 Same thing with treating HIV.

    04:29 In fact, the World Health Organization recommends a combination of antiretroviral drugs for people starting HIV treatment.

    04:36 So the often recommend you be on more than one drug for treating HIV.

    04:42 So usually it's about three or more of the drugs are taken together.

    04:46 Sometimes some of these drugs are even combined into one pill, which is really helpful for patients, because you know, it's hard to remember to do something every day.

    04:55 It just is bright, sharp, intelligent people.

    04:59 We sometimes forget.

    05:00 I know I plotted my driveway and as I'm driving up and thinking like did that garage door closed did I turn the iron off all those kinds of things that go through your mind? So you have to help your patients develop a system of reminders, so they'll know yes they did or no, they didn't and remind them to do it because they're going to have to have some type of system in order to take this medication as it's prescribed.

    05:25 So every day roughly the same time.

    05:29 So usually you're going to need to help work with the patient actually have the discussion for them what works best for you.

    05:36 Are you a paper calendar person? Are you a digital person, do use your phone.

    05:41 Do you not use your phone? So work with them within the systems that they're already using to help them be successful in taking these medications as it's prescribed everyday.

    05:52 It's going to take nurse-patient collaboration to work for a plan.

    05:57 Just don't throw this out there for patient and expect them to pull it all together.

    06:01 This is a lot to deal with this is a lot of overwhelming information for someone who's not used to this.

    06:08 Wait a minute, even if it was a healthcare professional this would be a lot of information for someone to take.

    06:14 So be patient, collaborate, work with them.

    06:17 Listen to their life.

    06:19 Listen to what they think might be challenges, help them problem solve.

    06:23 They need to plan ahead.

    06:24 What if they're going on vacation? That's awesome.

    06:27 But that means they could be away for extended period of time.

    06:31 How are they going to stay on schedule? Are they going to be in a different time zone? Do they have enough medication through their insurance plan or not? However, they get their medications that they'll have enough in case they covers over different prescription times.

    06:45 So these are all things that sometimes people don't think about if you've been a health care provider you these are concerns.

    06:52 That's why it's our role to bring them up and have the discussion with the patient.

    06:57 Now sometimes people experience side effects with this treatment all medications usually have some type of side effect, but like other medications the side effects usually go away if they can hang in there.

    07:10 So if they stick around we can maybe look at switching the ARV treatment with the health care provider to a different combination of drugs.

    07:18 So that would involve you having open therapeutic communication with your patient and being a liaison for your patient and advocating with the healthcare provider.

    07:27 Who will be very open to coming up with a new plan.

    07:31 Physicians and Healthcare professionals that are used to prescribing these medications understand that this is a common thing since we all want compliance for the patient everyone works together to help them find a combination treatment plan that's effective and with tolerable side effects.

    07:50 Now, let's talk about some of those side effects.

    07:52 Now EFV, you can see why we shorten that one it often causes us some weird, I mean really weird dreams in the first few weeks of taking it.

    08:03 So that's going to be kind of unsettling for the patient who's taking it make them aware of it before they start taking the medication know that some people have reported when they first start taking this medication.

    08:15 They have some strange dreams.

    08:17 It usually should go away after the first few weeks, but we wanted you to be aware of it.

    08:22 That way when they do start having the dreams they know that this It'd be an example of side effect of the medication.

    08:29 They know they're not going crazy or anything like that.

    08:33 Now there's some other side effects TDF.

    08:35 This can cause problems with kidneys.

    08:37 So if this is one of the medications the patient is prescribed, then the healthcare team will need to monitor their renal function.

    About the Lecture

    The lecture HIV: Antiretroviral Treatment (Nursing) by Rhonda Lawes, PhD, RN is from the course Antiviral Medications (Nursing).

    Included Quiz Questions

    1. ...keep HIV under control.
    2. ...cure HIV.
    3. ...temporarily eliminate HIV.
    4. ...antagonize HIV symptoms.
    1. ...using a combination of antiretroviral drugs for people with HIV.
    2. ...taking no more than two antiretroviral drugs at a time for people with HIV.
    3. ...maintaining one antiretroviral treatment for people with HIV.
    4. ...avoiding antiretroviral treatments for people with early HIV.
    1. Patients need to maintain a strict calendar
    2. The drugs inhibit a patient's consciousness
    3. The drugs inhibit a patient's mobility
    4. Patients cannot take the medicines on their own
    1. Strange dreams
    2. Loss of consciousness
    3. Hypertension
    4. Increased appetite

    Author of lecture HIV: Antiretroviral Treatment (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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