HIV Antiretroviral Therapy: Nursing Study Guide

This note reviews the essentials of antiretroviral therapy (ART) for HIV — the major drug classes, how they work, current first-line regimens, side effects, monitoring labs, and key nursing and NCLEX points. ART is lifelong, and understanding adherence and monitoring is central to safe nursing care.

Antiretroviral Drug Classes

• NRTIs (Nucleoside Reverse Transcriptase Inhibitors) — e.g., Zidovudine, Tenofovir. Inhibit reverse transcriptase.
• NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors) — e.g., Efavirenz. Non-nucleoside RT inhibition.
• Protease Inhibitors — e.g., Ritonavir, Lopinavir. Prevent viral maturation.
• Integrase Inhibitors (INSTIs) — e.g., Dolutegravir. Block integration of viral DNA into the host genome.
• Entry Inhibitors — e.g., Maraviroc. Block viral entry into host cells.

Mechanism of Action

• Antiretroviral drugs block different stages of the HIV life cycle.
• They prevent viral replication and reduce viral load in the bloodstream.
• Combination therapy improves effectiveness and reduces the risk of drug resistance.

Current Treatment Guidelines

• All individuals diagnosed with HIV should begin ART immediately after diagnosis, regardless of CD4 count.
• Early treatment:
  • Reduces viral load
  • Preserves immune function
  • Prevents disease progression
  • Reduces HIV transmission
• Standard first-line therapy is combination ART, typically:
  • Two NRTIs + one integrase strand transfer inhibitor (INSTI)
• A commonly recommended first-line regimen: Tenofovir + Lamivudine (or Emtricitabine) + Dolutegravir.
  • High effectiveness, low resistance rates, good tolerability.
• Treatment is lifelong to maintain viral suppression.

Goals of Therapy

• Achieve an undetectable viral load
• Increase CD4 cell count
• Prevent opportunistic infections

Indications

• Treat HIV infection
• Prevent progression to AIDS
• Reduce HIV transmission
• Prevent mother-to-child (vertical) transmission
• Begin as soon as possible after diagnosis

Side Effects

Side effects vary by drug class. High-yield adverse effects include:

• Hepatotoxicity
• Hyperlipidemia
• Bone marrow suppression — especially with zidovudine
• Nephrotoxicity — especially with tenofovir
• Insulin resistance and metabolic syndrome
• GI symptoms such as nausea and diarrhea

Labs to Monitor

Patients on ART require regular monitoring:

• HIV viral load — measures treatment effectiveness
• CD4 cell count — reflects immune system strength
• Liver function tests (LFTs)
• Renal function tests

A decreasing viral load indicates effective treatment.

Contraindications and Cautions

• Use cautiously in patients with:
  • Severe liver disease
  • Renal impairment
  • Significant drug interactions
• Many antiretrovirals interact with drugs metabolized by cytochrome P450 enzymes.

Pregnancy Safety

• Guidelines recommend continuing ART during pregnancy.
• Treatment significantly reduces the risk of vertical transmission.
• A common regimen used in pregnancy: Tenofovir + Lamivudine + Dolutegravir.
• Early treatment is critical for protecting both mother and infant.

Nursing Safety & High-Yield NCLEX Notes

• ART must be taken consistently and exactly as prescribed.
• Poor adherence leads to viral resistance and treatment failure.
• Patient education:
  • HIV treatment is lifelong
  • Missing doses can cause drug resistance
  • Do not stop medications without medical advice
• NCLEX high-yield points:
  • Undetectable viral load significantly reduces transmission risk (U=U).
  • Combination therapy is always required.
  • ART should start immediately after diagnosis.
  • CD4 count reflects immune system strength.
  • Viral load measures treatment effectiveness.

Key Takeaways

• HIV is treated with combination ART, started immediately after diagnosis regardless of CD4 count.
• Standard first-line therapy = 2 NRTIs + 1 INSTI (e.g., Tenofovir + Lamivudine + Dolutegravir).
• Monitor viral load, CD4 count, LFTs, and renal function regularly.
• Know class-specific toxicities: zidovudine → bone marrow suppression, tenofovir → nephrotoxicity.
• Adherence is critical — missed doses lead to drug resistance and treatment failure.
• ART should be continued in pregnancy to prevent vertical transmission.