HIV: Assessing Antiretroviral Treatment (Nursing)

00:00 Now I want to talk about ART, antiretroviral therapy and CD4 T-cells.

00:06 These patients will have regular blood tests because we want to measure the levels of virus in their body.

00:10 That's the viral load and we also want to look at the strength of their immune system.

00:15 So we'll look at the CD4 T-cell count that's going to tell us how well the treatment is working.

00:22 So, how do we evaluate treatment for HIV? We're going to look at what two things.

00:28 Good! The viral loads these are both going to require the test of viral load and a CD4 T cell count which can be done on your basic CBC.

00:39 If we've got a differential so if the CD4 T-cell count is too low.

00:44 Remember the bottom number for normal is 500.

00:47 If it's too low then we know that hey something's going on.

00:51 Let's ask some more questions.

00:52 Let's do some more assessments.

00:54 Let's figure out is the patient able to be compliant with the medication.

00:58 With out judgment.

01:01 The minute you make the patient feel guilty or bad or why aren't you doing this? They'll shut down and stop talking to you.

01:08 That's not what we want, it doesn't help anybody.

01:11 We want open communication.

01:12 So if you notice a lot of work is changing there might be an issue.

01:16 The patient is challenged in staying compliant with taking it every day.

01:20 So make sure you assess that maybe the medications aren't working, but they may not be working because it's a compliance issue.

01:27 See, that's our job as Healthcare Providers is to figure out why to monitor to assess and then to have adult and open communication with the client to help them resolve it.

01:39 So when were assessing the treatment we look at the CD4 T-cell count.

01:42 So this will let us know how strong the immune system is.

01:45 Why? Right, because CD4 T cells.

01:50 These are like the helper cells in my body.

01:52 They helped my immune system be all that it can be fight off infection.

01:56 So when these are healthy my immune system is healthy so ART should cause the CD4 T-cell count to go up.

02:04 So if I see, I have a patient I have their CD4 T-cell count before treatment if treatment is effective the impact I should see is their CD4 T-cell count going up.

02:16 Now we're assessing treatment from the perspective of a viral load this gives an indication of the level the numbers of HIV virus in the body ART should lower the viral load, CD4 T-cell count should go up that tells me immune system is stronger viral load should go down and then we want to keep it as low as possible.

02:39 So as a nurse when you're checking the value awaiting the effectiveness of therapy, these are the 2 go to test for someone on ART.

02:48 Now, how often do we test will WHO the World Health Organization recommends a viral load test every six months.

02:55 So you see on the calendar we've got there for you, 6 right at we want to at least 6 months after you start taking treatment.

03:03 So first test at six months and then once a year, so you're thinking about frequency of testing for viral load six months after treatment got to give the medication in the body time to work together and then once a year.

03:18 So help the patient pick a date that means something to them.

03:22 Because effective treatment means lower viral load and it means a normal CD4 T-cell count or at least moving up there but for effective treatment, we want a normal CD4 T-cell count.

03:35 So that means it's going to be 500 or more.

03:40 So sometimes art does stuff working for many people in treatment, they start taking will continue to work as long as they take it.

03:49 Okay, so there's the key point, for most people the treatment will continue to be effective if they continue to take it.

03:58 So as long as they take it correctly, then they should have effective treatment if something gets in their way and stops them from doing that.

04:06 Remember the viral load is going to go back up.

04:09 So if notice ART is stopping working.

04:12 It's not working as much.

04:14 First of all, how do we know that? Right. We look at those two tests.

04:18 We look the CD4 T-cell count and we looked at viral load.

04:21 So now we see that the CD4 T count is too low and the viral load is getting higher so we know, this is not working.

04:30 So now we might thinking we're going to think through the possibilities.

04:34 I'm going to first find out if they're able to be compliant with timing and taking it every day and having the drug available.

04:41 We're also going to look at the other medications they're taking because another drug might be having some type of interaction with their medication that could be the cause of the ART to stop working.

04:51 So we might also deal with patients experiencing drug resistance.

04:55 Well, how does drug resistance happen? Think about how it happens with antibiotics, right? Patients don't finish a complete prescription.

05:03 They take some, then they don't, they take the wrong medication.

05:06 Well the same thing happens with ART, if they stop and start, stop and start, and stop and start therapy too much for their body.

05:14 They might be becoming resistant to a drug.

05:17 So the healthcare provider can help identify a different drug that is likely to be effective.

05:22 That's the good news.

05:24 So what's our role? Well, when we receive the results that say that ART is not working.

05:30 It's communication with the patient.

05:31 Assess, talk to them have a conversation know in the back of your mind, Hey, these are the reasons I know that art stops working.

05:39 Most often most common.

05:41 These are the reasons it stops working have a non-judgmental conversation with the patient, gather data about other medications that they're on so when you speak with the healthcare provider you have complete information for them to make the next best decision.