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Pharmacology · chapter 7 · Anti-infective Drugs

Introduction to HIV, AIDS, and Antiretrovirals

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. HIV is lifelong

    However, HIV infection is a lifelong condition with no known curative treatment. After the individual’s initial exposure to HIV, the virus targets the CD4 T lymphocytes (helper T cells).

  2. Latent period gives false security

    After several weeks, the virus enters a latent period, and the person becomes asymptomatic. This provides a false sense of security because the virus is continually replicating, and immune cell destruction is occurring steadily.

  3. Body fluids that carry HIV

    Many bodily fluids from an infected individual, including blood, breast milk, semen, and vaginal fluids, contain the virus.

  4. Viral load and transmission

    The higher the viral load in the blood, the more likely the infected individual’s fluids will contain copies of the virus capable of infecting another individual.

  5. Antibody tests can miss early infection

    The first two tests look for the presence of antibodies against the virus that the body has produced; therefore, the test may be negative if the client was recently infected and has not had time to develop antibodies.

  6. Nucleic acid test detects sooner

    The nucleic acid test looks for copies of the viral RNA and can detect the presence of HIV sooner than antibody-based tests can.

  7. CD4 count shows immune damage

    The second is the CD4 cell count, which shows the degree of immune system degradation that has occurred and the degree of risk for developing opportunistic infections.

  8. Adherence prevents resistance

    The client’s adherence is critical to achieve viral suppression and preserve their immune function. Nonadherence will often lead to viral resistance against ART drugs.

  9. Fewer pills, better adherence

    Choosing combination products that reduce the number of pills a client takes in a day can help decrease regimen complexity and increase adherence.

  10. Enfuvirtide is injected twice daily

    Enfuvirtide is usually reserved for clients with treatment-resistant HIV because the drug must be injected subcutaneously twice daily and is quite costly.

  11. Boosters cause drug interactions

    These inhibitors can also be the source of many drug interactions, including medications used for tuberculosis, high cholesterol, and bacterial infections. Nurses should always inspect a client’s medication history to determine whether any changes to their current medications are necessary to avoid drug toxicity.

  12. NRTIs never used alone

    The NRTIs are ineffective as a monotherapy due to rapid resistance. First-line antiretroviral regimens include two NRTIs and one other drug from a different class, such as NNRTIs or protease inhibitors.

  13. Protease inhibitors: glucose and lipids

    Protease inhibitor use, however, can increase the risk for metabolic complications in these clients, including raising serum glucose and lipid levels.

  14. Check HLA-B*5701 before abacavir

    Evaluate for the presence of the HLA-B*5701 genetic mutation before beginning abacavir because its presence increases the risk for anaphylaxis.

Terms to know

acquired immunodeficiency syndrome (AIDS)
This state of immunodeficiency is known as acquired immunodeficiency syndrome (AIDS).
viral load
One factor that may influence the risk for viral transmission is the infected individual’s viral load, or the number of copies of the viral RNA that are measured in the blood.
non-nucleoside reverse transcriptase inhibitors (NNRTIs)
This class of drugs is known as the non-nucleoside reverse transcriptase inhibitors (NNRTIs) and includes the drugs delavirdine, efavirenz, etravirine, and rilpivirine.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client who had a high-risk exposure to HIV one week ago has a negative antibody test. The client asks if this means they are not infected. What is the nurse's best response?

    1. The test may be negative because your body has not had time to make antibodies yet.
    2. Antibody tests detect the virus sooner than any other test.
    3. You only need testing again if you develop symptoms.
    4. Yes, a negative antibody test rules out HIV.

    Answer: The test may be negative because your body has not had time to make antibodies yet.

    Antibody-based tests may be negative if the client was recently infected and has not yet developed antibodies. The nucleic acid test detects HIV sooner. Many infected people have few or no symptoms early, so waiting for symptoms is unsafe.

  2. A client with HIV says, "I feel fine now, so I skip my pills on weekends." What is the most important concern for the nurse?

    1. Weekend breaks are acceptable once the viral load is undetectable.
    2. Feeling fine means the virus has stopped replicating.
    3. Skipping doses often leads to viral resistance against ART drugs.
    4. Skipping doses will cause immediate liver injury.

    Answer: Skipping doses often leads to viral resistance against ART drugs.

    Adherence is critical for viral suppression, and nonadherence often leads to resistance against ART drugs. Feeling well is a false sense of security because the virus keeps replicating, and there is no support for planned breaks.

  3. A provider plans to start abacavir for a client with HIV. Which assessment should the nurse make sure is done first?

    1. Tuberculin skin test
    2. CCR5 tropism test
    3. Serum lipid panel
    4. HLA-B*5701 genetic testing

    Answer: HLA-B*5701 genetic testing

    Clients should be evaluated for HLA-B*5701 before starting abacavir because its presence increases the risk for anaphylaxis. Lipid monitoring relates to protease inhibitors, and CCR5 testing relates to maraviroc.

  4. A client with HIV has been taking a protease inhibitor for many years. Which assessments should the nurse include? Select all that apply.

    1. Serum lipid levels
    2. Liver function
    3. Tendon pain
    4. Serum glucose
    5. Hearing tests

    Answer: Serum lipid levels, Liver function, Serum glucose

    Protease inhibitors are associated with liver injury and metabolic disorders such as dyslipidemia and glucose intolerance, so glucose, lipids and liver function are monitored. Hearing and tendon problems are not listed adverse effects of this class.

  5. A client's HIV regimen includes ritonavir as a booster. The client has been started on another medication for high cholesterol. What should the nurse do?

    1. Give the two drugs at least 12 hours apart to prevent interaction.
    2. Nothing, because ritonavir does not affect other drugs.
    3. Tell the client to stop the ritonavir.
    4. Review the medication history for CYP3A4 interactions that could cause toxicity.

    Answer: Review the medication history for CYP3A4 interactions that could cause toxicity.

    Ritonavir inhibits CYP3A4, which boosts antiretroviral levels but also causes many interactions, including with cholesterol medications. The nurse inspects the medication history to prevent toxicity. Stopping the booster or spacing doses is not the action described.

  6. A nurse is teaching a client who has started antiretroviral therapy. Which statements are appropriate? Select all that apply.

    1. Stop the medication once your viral load is undetectable.
    2. Take a double dose if you miss one.
    3. Use condoms and avoid sharing needles.
    4. Take every dose in your regimen.
    5. Tell your provider about any barriers to taking the medication correctly.

    Answer: Use condoms and avoid sharing needles., Take every dose in your regimen., Tell your provider about any barriers to taking the medication correctly.

    Teaching includes taking every dose to prevent resistance, practicing safer sex and not sharing needles, and reporting barriers to adherence. Missed doses should not be doubled, and HIV is lifelong with no cure, so therapy is not stopped.

Where every quote comes from

Section 7.3 Introduction to HIV, AIDS, and Antiretrovirals of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.