Learning The Names Of Hiv Drugs Is Horribly Difficult Heres Why
Happens every time. We start teaching about HIV, and at first, everything is going great.
Epidemiology, pathogenesis, diagnosis, clinical presentation. The students are right there with us.
However, then we start covering treatment and things immediately get tricky.
Because no matter how engaged and brilliant they are, and no matter how scintillating we are, when the long list of antiretroviral agents appears, their eyes glaze over with fatigue.
Instant somnolence. Like someone turned up the temperature in the room, dimmed the lights, and passed out soft blankets and pillows.
And its no wonder! There are lots of drugs, with a dizzying array of names, abbreviations, combination tablets, and mechanisms of action.
We havent helped matters by following these RULES OF HIV MEDICINE, all of which were designed by evil creatures to make learning HIV medications terrifying. Here are these baleful rules:
So whats a poor clinician to do? Some great responses here, I especially liked this one:
Ive had folks threaten to get an interpreter when we were discussing HIV meds in our hospital formulary meeting.
Does Art Cause Side Effects
Like most medicines, antiretroviral therapy can cause side effects. However, not everyone experiences side effects from ART. The HIV medications used today have fewer side effects, fewer people experience them, and they are less severe than in the past. Side effects can differ for each type of ART medicine and from person to person. Some side effects can occur once you start a medicine and may only last a few days or weeks. Other side effects can start later and last longer.
If you experience side effects that are severe or make you want to stop taking your HIV medication, talk to your health care provider or pharmacist before you miss any doses or stop taking the medication. Skipping doses or starting and stopping medication can lead to drug resistance, which can harm your health and limit your future treatment options.
Some side effects of ART that are most commonly reported include:
- Nausea and vomiting,
What Happens If I Delay Starting Hiv Treatment
In the past people could delay treatment if they werent ready to start. However, this isnt recommended now. If you have HIV, the sooner you start treatment, the better it is for your health.
The START trial found that there was a 53% reduction in the risk of death or serious illness if treatment was started when the CD4 count was still above 500.
Its common for people to feel apprehensive about taking treatment but all you need to remember is that:
- It will enable you to live a normal lifespan.
- When you’re on effective treatment you won’t be able to pass on HIV.
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Never Assume Hiv Risk
Stewart stressed that physicians should never make assumptions about which patients are most likely to contract HIV. For example, a patient might be monogamous in their relationship, but their partner might not be. A patient could also be in a relationship with a person who uses IV drugs.
It is not just for men right now. It’s for womenespecially African American women, said Stewart, adding that they care for an 87-year-old female patient who was recently found to be HIV positive.
According to Collins-Ogle, many physicians do not consider women in their 30s for 40s as being at risk for HIV. Therefore, they’re not having these important conversations about sex with them.
I’ve had many women who have been denied PrEP because the clinician does not perceive that person as being at risk, said Collins-Ogle. The primary care clinician is in a great place a great point of entry to receiving prevention services and appropriate sexual health counseling.
Stewart added that counseling sexually active adolescents about whether PrEP could be right for them is also crucial. Stewart asks the patient’s parents or caregivers to step out of the room, which gives them the opportunity to ask teenagers questions about their sexuality privately.
Questions To Ask About Each Drug
One of the most important things you can do to make sure you take your medicine correctly is to talk with your medical provider about your lifestyle, such as your sleeping and eating schedule. If your provider prescribes a drug, be sure and ask the following questions :
- What dose of the drug should be taken? How many pills does this mean?
- How often should the drug be taken?
- Does it matter if it is taken with food, or on an empty stomach?
- Does the drug have to be kept in a refrigerator?
- What are the possible side effects of the drug?
- What should be done to deal with the side effects?
- How severe do side effects have to be before a provider is called?
During every medical visit you should talk about whether you are having trouble staying on your treatment plan. Studies show that people who take their medicine in the right way get the best results: their viral loads stay down, their CD4 counts stay up, and they feel healthier.
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Funding Hiv Prevention For People Who Inject Drugs
Funding low-cost harm reduction initiatives such as NSPs and OST is a much more cost-effective way of tackling HIV among people who inject drugs than having to pay for antiretroviral treatment for the rest of a person’s life.44
Despite this, a deepening funding crisis is facing harm reduction services globally. The majority of countries that have a large HIV prevalence among their drug user population are middle-income countries. However, international HIV funding for these countries is shrinking as large donors such as the Global Fund shift their focus to low-income countries under the assumption that the funding gap for services will be filled by domestic resources. While there has been an increase in domestic investment in HIV programmes in some countries, very few are prioritising HIV prevention for key populations including harm reduction for people who inject drugs.45
Under-investment in HIV prevention for people who inject drugs is often not a question of lack of resources but of allocation. For example, an estimated US$100 billion is spent annually on global drug control. Reallocating as little as 2.5% of this money from drug enforcement to harm reduction programmes could reduce new HIV infections among people who inject drugs by 78%, alongside a 65% drop in HIV-related deaths. A shift of 7.5% of drug control funding would reduce new infections and HIV-related deaths by around 94%.46
– Harm Reduction International47
Antiretroviral Treatment For Children Living With Hiv
- Antiretroviral treatment can keep your child healthy and help them lead a normal life with HIV.
- Your healthcare professional can help you find the right type of treatment for your child.
- In some cases, your child may not be able to take a certain medicine but their treatment can always be changed.
- If youre living with HIV and have recently given birth, continuing to take HIV treatment while breastfeeding will help protect your baby.
If you are the parent or carer of a child with HIV, its likely you will have lots of questions. The most important thing to remember is that with the right treatment, your child can live a normal, healthy life. It’s recommended that children living with HIV start treatment straight away.1
You can talk to your childs healthcare professional about any questions you have. Here is some information that may help you to think about what to ask.
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How Do You Deal With Side Effects
Some side effects can be hard to deal with. One way to cope with them is to know what to watch out for and have a plan to deal with problems that come up.
That’s why you need to talk to your provider about the risk of side effects from different drugs, before you start therapy.
At the beginning of any treatment, you go through a period of adjustment–a time when your body has to get used to the new drugs you’re taking. Sometimes you’ll have headaches, an upset stomach, fatigue, or aches and pains. These side effects may go away after a few days or a few weeks.
If you notice any unusual or severe reactions after starting or changing a drug, report the side effects to your provider immediately.
More information is available in the .
How Does Drug Use Affect Symptoms And Outcomes Of A Viral Infection
Drug use can worsen the progression of HIV and its symptoms, especially in the brain. Studies show that drugs can make it easier for HIV to enter the brain and cause greater nerve cell injury and problems with thinking, learning, and memory. Drug and alcohol use can also directly damage the liver, increasing risk for chronic liver disease and cancer among those infected with HBV or HCV.
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When Is It Time To Start Taking Hiv Medicines
People with HIV should start taking HIV medicines as soon as possible after an HIV diagnosis. It is especially important for people with AIDS-defining conditions or early HIV infection to start HIV medicines right away.
Women with HIV who become pregnant and are not already taking HIV medicines should also start taking HIV medicines as soon as possible.
Simplify Your Studying With The Hiv Cheat Sheet
Its hard to even call this a cheat sheet, as this sucker weighs in at 16 pages. But you could call these 16 pages Basically everything you need to know about HIV pharmacotherapy. Its got renal/hepatic dosing adjustments, adverse effects and clinical pearls, brand/generic/abbreviation for every drug and combination product, preferred regimens for healthy adults, pediatrics, and pregnancy, opportunistic infection prophylaxis and treatment, adult and pediatric dosing tables, drug-drug interactions, drug-food interactions, and a lot more.
This cheat sheet will save you a ton of time and frustration as you prep for the NAPLEX or any time you come across HIV in your practice.
Its yours for only $19.
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My Child Has Hiv What Treatment Do They Need
Taking HIV treatment wont cure your child but it can keep HIV under control. Without treatment, HIV will damage your childs immune system putting them at risk of getting ill. Untreated HIV is particularly serious for babies and young children.
Once your child has started treatment, its important that they take it every day. Your healthcare professional will explain how much of the drug you need give your child. This will change as your child grows and gets heavier.
The drugs your child can take may vary according to national guidelines. Some types of HIV medication for babies and young children are available as liquids or syrups. However, not all drugs are available in this form and some may not be available where you live.
Pack Your Pills First
It is one thing if you forget your socks, or your toothbrush, or even your cell phone. You can replace these items when you reach your destination, or you can get along without them. You cannot get along without your HIV drugs, not even for a day, so pack them first and pack them carefully.
Count out your pills for how long you will be away and transfer them to appropriate containers. It is wise to take a two-day backup supply of your HIV drugs with you in case of any travel delays. At home you may use a subdivided multi-day plastic pillbox to hold all your drugs, but for travel it is often more convenient to carry your pills in something smaller, such as sturdy plastic bags that can be resealed, or a pocket-sized plastic tackle box. However, if you are traveling internationally or anywhere by plane, you should carry your medications in their original bottles clearly marked with the prescribing information so that security or customs will not give you too much trouble.
Pack your pills in a carry-on bag and nowhere else. There is no guarantee that your flight will depart on time or arrive on time, or that checked baggage will be waiting for you at your destination.
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Patients Cured Of Hiv Infection
The so-called “Berlin patient” has been potentially cured of HIV infection and has been off of treatment since 2006 with no detectable virus. This was achieved through two bone marrow transplants that replaced his immune system with a donor’s that did not have the CCR5 cell surface receptor, which is needed for some variants of HIV to enter a cell. Bone marrow transplants carry their own significant risks including potential death and was only attempted because it was necessary to treat a blood cancer he had. Attempts to replicate this have not been successful and given the risks, expense and rarity of CCR5 negative donors, bone marrow transplant is not seen as a mainstream option. It has inspired research into other methods to try to block CCR5 expression through gene therapy. A procedure zinc-finger nuclease-based gene knockout has been used in a Phase I trial of 12 humans and led to an increase in CD4 count and decrease in their viral load while off antiretroviral treatment. Attempt to reproduce this failed in 2016. Analysis of the failure showed that gene therapy only successfully treats 11-28% of cells, leaving the majority of CD4+ cells capable of being infected. The analysis found that only patients where less than 40% of cells were infected had reduced viral load. The Gene therapy was not effective if the native CD4+ cells remained. This is the main limitation which must be overcome for this treatment to become effective.
Should You Ever Take A ‘holiday’ From The Drugs
Taking a “drug holiday” from your HIV treatments for reasons other than a severe reaction to medications may be harmful to your health. Having said that, your provider may suggest that you temporarily stop your antiretroviral drugs for certain specific reasons. Be sure to talk with your provider about this issue if you have questions about it. How you stop taking your HIV drugs safely can be a complicated process.
Remember, just skipping doses without your provider’s instruction is dangerous you should never change your treatment plan without talking with your provider.
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What Are Drug Interactions
Your HIV medications can be affected by other medicines, including other prescription drugs you are taking and drugs you buy over the counter at a pharmacy. Even herbal therapies, nutritional supplements, and some things found in common foods can affect your HIV medicines.
When one drug affects how another drug behaves, this is called a drug-drug interaction. For example, some drugs become less effective or cause side effects when they are taken with certain other drugs.
When something in food affects how a drug behaves, it is called a drug-food interaction. For example, grapefruit juice, taken at the same time as certain drugs, can boost the amount of these drugs in your bloodstream to an undesirable level. Everyone taking HIV drugs needs to be very careful about these interactions. Luckily, many of these interactions are well known to your provider and can be managed.
Your provider can give you a list of drugs and foods to avoid, depending on what treatment you are taking. Ask for this information for each drug that you are taking.
Also, be sure that you tell your provider about every single medication, drug, supplement, and herb you are taking–whether you got them by prescription or not.
How Have Hiv Meds Improved Over The Years
In addition to fewer and less serious side effects, we really have come a long way with the science of ART. Heres how HIV treatment has changed in the U.S. over time in some very important ways:
- 1980s: Almost no treatment was available. The first HIV medication, AZT , was approved in 1987. It had to be taken several times a day and had many side effects.
- 1990-1995: Four new drugs were developed that fight HIV in the same part of its life cycle as AZT does. They also had to be taken frequently, had many food or water restrictions, and carried a lot of side effects.
- 1996-2005: Drug development accelerated, and 17 new medications were released, providing many new options. Most importantly, most of these drugs worked in a different way than the older ones, and the concept of a “triple-drug cocktail” emerged: taking three medications together to slow down HIV at different points in its life cycle. This made treatment success much more likely.
- 2006: The first pill was released that combined an entire regimen of HIV medications into a single tablet. Called Atripla, it had three drugs inside it that each fought HIV in a different way.
- 2007-today: Weve seen steady improvements in HIV treatment options, with over a dozen new single-tablet regimens and a handful of unique new drugs giving people more choice than ever, while keeping HIV at bay better and causing fewer side effects.
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Hiv Meds Used To Be Very Toxic
Theres a lot of misinformation floating on the internet and social media about the toxicity of current HIV medications. Truth is, its the older HIV medslike AZT , d4T and others that were commonly used in the 1990s and early 2000sthat had many side effects. Nausea, headaches, a metallic taste in the mouth, diarrhea, low blood counts, and nerve damage were just some of the common complications we used to see from those medications.
In fact, many people living with HIV back then used to comment that taking HIV meds felt like they were substituting one disease for another: While ART slowed down the virus and helped people them live longer, they now had to deal with all the toxicity from those early medications.