Acyclovir (Zovirax)

Antiviral

Drug of choice for most infections caused by HSV or VZV

Suppresses synthesis of viral DNA

Activated by thymidine kinase

Does not eliminate virus or prevent transmission to sexual partners

Dosages must be reduced in pts w/ renal impairment

IV: can injure kidneys. Infuse slowly and ensure adequate hydration

S/E: Generally well tol. Oral: N/V/D, HA, vertigo IV: Phlebitis/inflammation at inj. site

Zidovudine (Retrovir)

Nucleoside/Nucleotide Reverse Transcriptase Inhibitor (NRTI)

Antiretroviral

Used for HIV infection

Suppress HIV replication by: 1. Incorporate into growing strand of viral DNA and prevent further growth 2. Competitively inhibit the nucleoside triphosphate enzyme

Dec viral load, inc CD4 T-cell counts, delay onset of disease symptoms, and reduce symptom severity

Serious S/E: severe anemia and neutropenia from bone marrow suppression

Should always be combined with other antiretrovirals to avoid resistance

Efavirenz (Sustiva)

Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)

Antiretroviral

Only NNRTI recommended for first-line therapy for HIV infection

Binds directly to HIV reverse transcriptase and suppresses enzyme activity

NOT to be used during pregnancy

Long half life; can be administered 1x/day

CNS symptoms occur in 50% of pts (dizziness, insomnia, drowsiness, nightmares)

Generally resolve w/in 2-4 wks

Rash may also develop, mild to severe

If combined w/ indinavir, indinavir should be inc

Lopinavir/Ritonavir (Kaletra)

Protease Inhibitor (PI)

Antiretroviral

Bind to active site of HIV protease, causing structural proteins and enzymes of HIV to not function

Virus remains immature and noninfectious

1/2 life: 5-6 hrs

Antiretroviral effects due to Lopinavir

S/E: diarrhea, nausea, HA, weakness

R/f hyperglycemia, new-onset DM, hyperlipidemia

Enfuvirtide (Fuzeon)

HIV fusion inhibitor

Antiretroviral

Binds with gp41 on the viral envelope, therby blocking entry of HIV into CD4 T cells

Used for HIV infection that is resistant to other drugs

Major S/E: injection site rxs, which occurs in nearly all pts

Inc r/f pneumonia

Should always be combined w/ other antiretrovirals

Reducing Perinatal HIV Transmission

Give mother antiretroviral drugs during gestation and labor

Give antiretrovirals to the infant for several wks postpartum

If viral load is > 1000 copies/mL, a C-section is recommended

Zidovudine is the preferred drug for preventing perinatal HIV transmission

Adherence to Therapy

Use multiple sessions to educate the pt about importance of adherence and therapy goals

Ensure pt is motivated to take meds before prescription is written

Negotiate a treatment plan the pt understands and will commit to

Devise a dosing schedule that fits the pts daily routine

Educate pt about s/e; anticipate them and treat them

Recruit fam/friends to support the treatment plan

HAART

Highly Active Antiretroviral Therapy

Regiment containing three or four drugs

Preferred regimens: 1. an NNRTI with two NRTI's 2. a PI with two NRTI's

By using two different classes of drugs, we attack HIV in two different ways (ex: inhibition of reverse transcriptase and protease)

Dec risk of resistance

Plasma HIV RNA should be monitored to assess the impact of treatment

Should show a ten-fold dec by 8 wks

Interferon alpha 2a/2b

Immunostimulant

Immunomodulator

Active against Hep B/C

Anticancer effects by: 1. enhancement of host immune responses 2. direct antiproliferative effects on cancer cells

Many S/E: flu-like syndrome (fever, fatigue, myalgia, HA), anorexia, wt loss, diarrhea, abd pain, cough

Tend to diminish w/ continued therapy

High dose therapy can cause bone marrow suppression, thyroid dysfunction, alopecia, cardiotoxicity and neurotoxicity

Cyclosporine

Immunosuppressant

Immunomodulator

Used to prevent organ rejection in recipients of an allogenic transplant (kidney, liver, heart)

Major S/E: nephrotoxicity and inc risk of infection

A glucocorticoid (prednisone) is usually given concurrently

Oral or IV (IV for pts who cannot tolerate oral)

Excreted via bile