Name: KITZ IRISH D.

BELLO

Section: BSN 2-1

HIV-AIDS RELATED DRUGS

1. In the Phils, what ART (Antiretroviral Therapy) or ARV is available in various treatment hubs and
being given to Filipino clients with HIV?
The Philippines uses antiretroviral treatment (ART) to treat people with HIV/AIDS. This
treatment involves using different kinds of drugs such as zidovudine, lamivudine,
and nevirapine. Another method that is being used is lab examination, which will help monitor
the patient’s ART or antiretroviral drug level. Since treatment for HIV/AIDS is based on a case to
case level, this will determine how the patient will be treated. The antiretroviral drug does not
kill the virus that causes the disease. It’s simply a way to help fight infection. This way, the
patient prolongs his/her life even with the disease. With this being said, patients have to go
undergo lab examinations depending on their respective cases and receive this treatment
throughout their existence. It is a form of therapy that they would have to undergo. The
government will handle most of the costs in association with the disease. The initial treatment
will costs the government P7,920 a year. As of April 20th, 2015, the Department of Health (DOH)
mentioned that they plan to buy P180 million worth of ARV or antiretroviral drugs to be used in
ART. Treatment is also partially covered by PhilHealth (Philippine Health Insurance Corporation),
the country's national social health insurance program through the OHAT package.

2. What is the difference between CD4 count and viral load monitoring? In what way an HIV
patient can become resistant to ART/ARV?
CD4 COUNT

The CD4 test is one of the more familiar testing assays known to people with HIV. The test measures the
level of CD4 helper T-cells in the blood—cells that are not only vital to immune function but are the
primary target of HIV infection. As HIV gradually depletes these cells, the body becomes less able to
defend itself against a widening range of opportunistic infections.
The test is performed by taking a blood sample, the results of which measure the number of CD4 cells in
a microliter (µL) of blood. The baseline count establishes the status of your immune system, while
follow-up testing largely informs us about:
 The stage of infection and rate of disease progression
 The likelihood that certain infections will develop as CD4 cells are depleted
 How well you are responding to treatment either by maintaining or reconstituting your immune
function
Normal CD4 counts are anywhere between 500-1,500 cells/ µL. Conversely, a CD4 count of 200 cells/ µL
or less is technically classified as AIDS.
Previous treatment guidelines recommended that antiretroviral therapy (ART) be initiated in patients
with a CD4 count under 500 cells/µL or in the presence of an AIDS-defining illness.

VIRAL LOAD MONITORING

While the CD4 count is an indicator of immune status and treatment efficacy, the  viral load is arguably
the more important measure when antiretroviral therapy begins.
The viral load measures the concentration of virus in the blood, also known as your "viral burden." Labs
will use a genetic testing technology—typically, the polymerase chain reaction (PCR) or a bDNA
(branched DNA)—to quantify the number of viral particles in a milliliter (mL) of blood. HIV viral loads can
range from undetectable (below the detection levels of current testing assays) to the tens of millions.
An undetectable result does not mean there is no virus in your blood or you have been "cleared" of
infection. Undetectable simply means that the virus population has fallen below testing detection levels
in blood but may be detectable elsewhere, such as in the semen.

The aim of antiretroviral therapy is to fully suppress viral activity to undetectable levels, which, in turn, is
associated with:
 Greater treatment durability
 A lower risk for the development of drug-resistant virus
 Better clinical outcomes correlating to increased life expectancy
 The reduction of HIV transmission risk to an uninfected sexual partner (a strategy popularly
referred to as treatment as prevention (TasP)
On the other hand, an increase in the viral load can often be an indication of treatment failure, poor
drug adherence, or both.

HIV drug resistance occurs when the virus starts to make changes (mutations) to its genetic
 make-up (RNA) that are resistant to certain HIV drugs, or classes of HIV drugs. This can happen
either as a result of a prolonged period of time on treatment, or more commonly, as a result of
suboptimal treatment adherence. These new mutations make copies of themselves, gradually
increasing the level of the virus (viral load) in the person living with HIV – meaning treatment
may no longer be effective.

When HIV first enters the body, it will actively go about replicating. But retroviruses such as HIV have a
high mutation rate, so every now and then, the virus will reproduce a copy with errors.

‘Wild type’ viruses – the naturally-occurring, non-mutated forms of the virus – are most susceptible to
ART, but mutated forms of the virus may be less so. When antiretroviral treatment is given in
inadequate levels, we are allowing for these drug resistant mutations to be selected out and multiplied
to the point that drug resistant virus becomes the primary population in the viral pool.

Depending on the specific mutation, it is possible for people to become resistant to a drug they have
never taken – this is called ‘cross-resistance’. This is because some mutations affect the efficacy of
different drugs within the same drug class. Even when taking ART optimally, small populations of virus
still replicate. Over time, due to mutations, the population of viruses in an individual may contain fewer
viral strains susceptible to HIV treatment, and more strains that are drug resistant. This is when viral
load may become higher and detectable – and the prescribing healthcare provider would consider
switching out a different drug or drug class.

3. Choose atleast 1 HIV-related opportunistic infection experienced by HIV patient, and describe its
clinical manifestation and enumerate the corresponding nursing management and intervention
for the chosen opportunistic infx.

Candidiasis is a common opportunistic infection in HIV-infected patients. The spectrum of Candida

infection is diverse, starting from asymptomatic colonization to pathogenicforms. The low absolute
CD4+ T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of
Oropharyngeal Candidiasis and current guidelines suggest increased risk once CD4+ T lymphocyte counts
fall below 200 cells/µL. Gradual emergence of non-albicans. Candida species as a cause of refractory
mucosal and invasive Candidiasis, particularly in patients with advanced immunosuppression and
problem of resistance to azoles and other antifungal agents in the Candida species is a point of concern.
The infection is caused by Candida albicans, a dimorphic fungal organism that is typically present in the
oral cavity in a nonpathogenic state in about one-half of healthy individuals but under favorable
conditions, has the ability to transform into a pathogenic (disease causing) hyphal form.

It is important to take a high vaginal swab for culture from women with recurrent infections of what
appear to be thrush in order to confirm that the infection is, indeed, thrush. A full history should also be
taken, and consideration given to the possibility of an underlying condition, such as diabetes. As nursing
intervention, the nurse should inform the patient to have genital care. Provide good ventilation to the
genital area so as to reduce humidity and preclude the creation of favourable conditions for the Candida
to thrive. Maintain normal vaginal flora so that the Candida are not given the opportunity to multiply.
Avoid irritants or trauma to the vagina, as damaged tissue is more susceptible to infection. Care should
always be taken to ensure any underlying precipitating factors have not been missed. Women suffering
from vaginal thrush should be dealt with empathetically. Many feel embarrassed about their condition
and nurses are ideally placed to offer relevant health education that will improve patient ’s
understanding of their condition, to reassure them and to offer advice that will help them reduce its
recurrence.