The management of HIV/AIDS involves a multidisciplinary approach with pharmacological, social, and physical wellbeing as the focus. The main goal is to ensure that the CD4 count levels are below above 200 cell/mm3 at any given time to prevent immunosuppression. The therapy also targets AIDS induced syndromes. This paper outlines the primary therapies used in HIV AIDS, long-term management, education, and referrals done to ensure patient safety.
Therapy
Pharmacological therapy is the preferred method of treatment as per the CDC guidelines for active management. The first-line therapy used is Tenofovir 300 mg daily, lamivudine 300 mg daily, and efavirenz 600mg daily or nevirapine 200mg, if no hypersensitivity is present (Aberg et al., 2014). Tenofovir and lamivudine are nucleoside reverse transcriptase inhibitors, and efavirenz is a non-nucleoside reverse transcriptase inhibitor. In case of resistance, or when the viral copies are greater than 1000/ml, the second line recommended is zidovudine and lamivudine and indinavir/lopinavir (Aberg et al., 2014). Nevirapine is used to prevent mother to child transmission in cases of pregnancy.
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Lab tests
The initial lab tests done are to ensure that the viral loads are kept below 20 in an ml of blood. They are also used to evaluate the treatment therapy being used. Liver function tests and kidney function tests should also be assessed every six months or upon the development of complications by the patients. Drugs such as zidovudine cause pancytopenia, hepatotoxicity, and nephrotoxicity (Mendes et al., 2018). Lipid profiles due to hyperlipidemia in HIV should be done, to prevent the buildup of coronary artery diseases. Full blood counts should also be regularly done to reduce any developments of anemia (Harding et al., 2019).
In HIV aids, examination and history taking should always be taken to rule out any infection such as TB and pneumonia, which are common. Antigen testing for Cytomegalovirus and Hepatitis B and C should be done. Toxoplasmosis is also of particular interest in HIV monitoring. Tumor markers for cervical cancer should be regularly carried out ladies above 35 years.
Education
Patient education in HIV involves healthy dieting, lifestyle modification, counseling, and support groups.
Diet modification through eating a balanced diet, helps boost immunity. Vitamin C and A help in boosting antibodies such as IgA, which prevent surface pathogens in UTI and pneumonia. It also reduces the metabolic syndromes associated with mitochondrial toxicity (Fitch, 2019). Regular Exercises also prevent lipodystrophy and obesity, since drugs like stavudine cause hyperlipidemia.
Lifestyle modification should be done to reduce instances of drug abuse, such as alcohol, to reduce any hepatotoxicity by the drugs. Sexual counseling should also be done to ensure them barrier methods and ARV drugs to prevent transmission to the community or acquiring a different strain of HIV (Suthar et al., 2013). Depression, suicide, and associated mental disorders are also prevalent In HIV aids, hence the need to undergo counseling sessions and support groups in the meantime.
Referrals in HIV and AIDS should be done in accordance with the associated comorbidities. A counselor is the most appropriate person to provide a strong support system. A physician should also be regularly consulted in order to monitor adverse effects or any drug resistance. Respiratory specialists can be involved in cases of multidrug resistance TB or complicated pneumonia, and oncologists in aids associated tumors such as anal and cervical cancers.
References
Aberg, J. A., Gallant, J. E., Ghanem, K. G., Emmanuel, P., Zingman, B. S., & Horberg, M. A. (2014). Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases , 58 (1), e1-e34.
Fitch, K. V. (2019). Contemporary Lifestyle Modification Interventions to Improve Metabolic Comorbidities in HIV. Current HIV/AIDS Reports , 16 (6), 482-491.
Harding, B. N., Whitney, B. M., Nance, R. M., Crane, H. M., Burkholder, G., Moore, R. D., ... & Rodriguez, B. (2019). Class of antiretroviral drugs and anemia risk in the current treatment era. bioRxiv , 674549.
Mendes, J. C., de Fátima Bonolo, P., Ceccato, M. D. G. B., de Oliveira Costa, J., Reis, A. M. M., dos Santos, H., & Silveira, M. R. (2018). Adverse reactions associated with first-line regimens in patient initiating antiretroviral therapy. European journal of clinical pharmacology , 74 (8), 1077-1088.
Suthar, A. B., Ford, N., Bachanas, P. J., Wong, V. J., Rajan, J. S., Saltzman, A. K., ... & Baggaley, R. C. (2013). Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS medicine , 10 (8).
