Sample Answer for NURS 6521 Week 8: Infections Included After Question
While HIV/AIDS is still currently incurable, the prognosis for patients with this infectious disease has improved due to advancements in drug treatments. Consider the case of Kristy Aney. Kristy was diagnosed with HIV in 1992 and was told she would survive, at most, 10 more years. Despite unfavorable odds, Kristy is still alive 20 years later. Since her diagnosis, she has witnessed tremendous improvements in HIV/AIDS treatments which have helped patients live longer with fewer side effects. While she acknowledges that these drug treatments have kept her alive, she fears that improvements in drug therapy have led to more people becoming complacent about the disease (Idaho Statesmen, 2012). In fact, the number of people living with HIV/AIDS in the United States is higher than it has ever been (CDC, 2012). This poses the question: Is there a relationship between drug advancements, societal complacency, and infection?
To prepare:
- Review Chapter 49 of the Arcangelo and Peterson text, as well as the Montaner et al (2014) articles in the Learning Resources.
- Reflect on whether or not the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options for HIV/AIDS.
- Consider how health care professionals can help to change perceptions and make people more aware of the realities of the disease.
- Think about strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.
With these thoughts in mind:
By Day 3
Post an explanation of whether or not you think the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options.Then, explain how health care professionals can help to change perceptions and increase awareness of the realities of the disease. Finally, describe strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.
By Day 6
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who provided a different rationale than you did, in one or more of the following ways:
- Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Prior to the H1N1 influenza pandemic in 2009, it had been more than 40 years since an infectious virus had resulted in such substantial illness, hospitalizations, and deaths on a global scale (CDC, 2010). This can be attributed to improved prevention such as proper hygiene, as well as vaccinations and other drug therapies. However, as the H1N1 pandemic illustrates, infections are sometimes unavoidable even when appropriate prevention methods are implemented. In clinical settings, patients present with various infections including common disorders such as flus and colds, as well as disorders that require more extensive treatment and care such as the human immunodeficiency virus (HIV) or tuberculosis (TB). As an advanced practice nurse, you must evaluate patients presenting with symptoms of infections and recommend appropriate drug treatments.
This week you begin to explore infections by considering issues surrounding the prevalence, management, and education about HIV/AIDS. You also examine viral and bacterial infections, as well as the appropriate use of antimicrobial agents.
Learning Objectives
By the end of this week, students will:
- Analyze reasons for the prevalence of HIV/AIDS
- Analyze ways health care professionals can change society’s perceptions of HIV/AIDS
- Analyze strategies to educate HIV positive patients on treatment and management
- Analyze categories of antimicrobial agents
- Differentiate between viral and bacterial infections
- Analyze the relationship between infections and antimicrobial agents
- Understand and apply key terms, concepts, and principles related to prescribing drugs to treat infections and infestations
Photo Credit: E.M. Pasieka/ Science Photo Library/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
- Chapter 8, “Principles of Antimicrobial Therapy” (pp. 111-134)
This chapter covers factors that impact the selection of an antimicrobial treatment regimen. It also examines the clinical uses, adverse events, and drug interactions of various antimicrobial agents such as penicillin.
- Chapter 12, “Fungal Infections of the Skin” (pp. 163-196)
This chapter explores the pathophysiology of several fungal infections of the skin as well as related drug treatments and examines the importance of patient education when managing these infections.
- Chapter 14, “Bacterial Infections of the Skin” (pp. 181-196)
This chapter begins by examining causes of bacterial infections. It then explores the importance of selecting an appropriate agent for treating bacterial infections.
- Chapter 32, “Urinary Tract Infection” (pp. 519-526)
This chapter covers drugs used to treat urinary tract infections and identifies special considerations when treating geriatric patients, pediatric patients, and women.
- Chapter 35, “Sexually Transmitted Infections” (pp. 512-535)
This chapter outlines the causes, pathophysiology, and drug treatment of six sexually transmitted infections, including gonorrhea, syphilis, and human papilloma virus infection (HPV). It also examines the importance of selecting the proper agent and monitoring patient response to treatment.
- Chapter 49, “Human Immunodeficiency Virus” (pp. 843-860)
This chapter presents the causes, pathophysiology, diagnostic criteria, and prevention methods for HIV. It also covers various methods of drug treatment and patient factors to consider when selecting, administering, and managing drug treatments.
Krummenacher, I., Cavassini, M., Bugnon, O., & Schneider, M. (2011). An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Note: Retrieved from the Walden Library databases.
This article analyzes medication adherence in HIV patients and examines factors that increase adherence as well as factors that contribute to termination or discontinuation of treatment.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Antimicrobials. Baltimore, MD: Author.
This media presentation outlines principles of antimicrobial therapy
Note: The approximate length of this media piece is 7 minutes.
A Sample Answer For the Assignment: NURS 6521 Week 8: Infections
Title: NURS 6521 Week 8: Infections
The amount of people living with AIDS globally reaches almost thirty-eight million with 5000 new infections daily in 2017; more than one million of them living in the United States (HIV.gov, n.d.). Just over half have achieved viral suppression using highly active antiretroviral therapy (HAART) (HIV.gov, n.d.). The following presents the pharmacology of the six classes of drugs used in HIV/AIDS treatment, and treatment as prevention (TasP).
Because each drug class used to treat HIV interrupts a different part of the viral replication cycle, the key to understanding how these medications work is by understanding the steps of the replication and invasion process. Arcangelo, Peterson, Wilbur, and Reinhold (2017) break this down into nine steps starting with the interaction of the viral envelope of HIV RNA with the CD4 receptor on the T lymphocyte to the last phase which consists of the formation of a capsid which shields viral RNA. Treatment choices must be individualized, and initial treatment consists of two nucleoside/nucleotide reverse transcriptase inhibitors plus a protease inhibitor or an integrase strand transfer inhibitor (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). A short description of each class and an example of each follows.
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
NRTIs interfere with the transcription of viral RNA to DNA after the HIV RNA enters the cell (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). These nucleoside and nucleotides analogs enter cells and are incorporated into the DNA chain by reverse (RI) and terminating any further replication of viral RNA (Whalen, Finkel, & Panavelil, 2015) the chain is incomplete, and no further transcription is possible (Animated HIV Science, n.d.). Tenofovir and emtricitabine, also active against the hepatitis B virus, is one of the NRTI combinations used for beginning treatment (Arcangelo et al., 2017)
The bioavailability of tenofovir increases when taken with a high-fat meal, and is minimally bound to protein (DrugBank, n.d.b). Rises in serum creatinine may indicate the need for a dose reduction, and gastrointestinal symptoms are a common adverse effect (Arcangelo et al., 2017). Emtricitabine is well absorbed orally (Whalen et al., 2015). Both drugs are excreted by the kidneys primary unchanged and have long half-lives which allow for once-daily administration (Whalen et al., 2015), and discontinuation of either drug may result in rebound of symptoms in those coinfected with hepatitis B (Arcangelo et al., 2017).
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs also block the transcription of viral DNA but this is accomplished by interacting directly with reverse transcriptase (RT) enzyme before the transcription process begins (Mechanisms in Medicine, n.d.). Efavirenz is a preferred over other NNRTI, and is well absorbed orally taken on an empty stomach (Whalen et al., 2015). Efavirenz, along with the other medications in this drug class, is metabolized by the cytochrome P-450 enzyme and is a consideration when concomitantly with other drugs that are metabolized by this pathway (Arcangelo et al., 2017). It is administered once daily and should be taken on an empty stomach; common adverse side effects include dizziness, confusion, hallucinations, rash, nausea, and fatigue (RxList, n.d. b). Efavirenz can lengthen the QT interval, use is associated with elevated liver function tests (LFTs), false positives on drug screening tests, and should not be used during pregnancy (Arcangelo et al., 2017).
Protease Inhibitors (PIs)
PIs interfere with the protease-mediated cleavage of polyprotein chains and decreases HIV RNA duplication (Arcangelo et al., 2017). All PIs are CYP3A4 substrates and CYP450 enzyme inhibitors, so drug interactions are common (Whalen et al., 2015). Drugs metabolized by CYP450 enzymes, or CYP450 isoenzyme inducers can all cause a change in serum levels of the PI or concurrent drug (Whalen et al., 2015). Common adverse effects in include nausea, vomiting, and diarrhea; patients taking PIs can experience elevated liver enzymes, hyperlipidemia, hyperglycemia, and lipodystrophy (Arcangelo et al., 2017) The recommended PI combination for treatment naïve patients is darunavir/ritonavir (Arcangelo et al., 2017). The sulfa component of darunavir may cause a rash in some patients (Arcangelo et al., 2017).
Integrase Inhibitors
Integrase strand inhibitors (INSTIs) prevent entry of viral DNA into a host’s cells genome by binding to the active site of the integrase enzyme (Whalen et al., 2015). Elvitegravir, available by itself or in a combination tablet with other medications, belongs to this drug class (Arcangelo et al., 2017). It is highly protein bound, metabolized in the liver, and excreted primarily in the stool (Gilead Sciences, 2014). Elvitegravir must be taken with food and is metabolized by cytochrome CYP3A (Gilead Sciences, 2014). Common side effects are nausea and vomiting; more serious and less frequent side effects include depression, suicidal ideation or attempt (Gilead Sciences, 2014).
Entry Inhibitors (CCR5 Antagonist)
Entry inhibitors block the CCR5 coreceptor which prevents HIV from entering a healthy cell (Arcangelo et al., 2017). Maraviroc is the only drug in this class and prevents the HIV virus from attaching to the T lymphocyte (Whalen et al., 2015). It is not indicated for use as first treatment for HIV, and a tropism assay must be completed before use to ensure that the patient’s strain uses the CCR5 receptor for attachment. Just over one-fifth to one-third of maraviroc is bioavailable, is significantly protein bound in the serum, and metabolized via the CYP3A pathway (DrugBank, n.d. a). Marked drug interactions can occur with use of maraviroc and severe systemic reaction followed by hepatotoxicity have resulted in a black box warning for this medication (Arcangelo et al., 2017).
Fusion Inhibitors
After HIV has attached to CD4 T cell, fusion inhibitors prevent fusion of the virus to the cell (Arcangelo et al., 2017). Enfuvirtide is the only dug in this class, is available only in injectable form, and is indicated for use in patients who have highly resistant forms of the HIV (Arcangelo et al., 2017). Localized site injections are the most common side effect, occurring in over ninety percent of patients and absorption is similar whether injected into the abdomen, thigh, or arm (RxList, n.d.a). It is highly protein bound, does not appear to cross into cerebrospinal fluid, and route of excretion has not been determined in humans (RxList, n.d. a).
Treatment as Prevention (TasP)
Achieving viral suppression also reduces the amount of HIV in genital secretions and results in decreased transmission rates (Arcangelo et al., 2017). Though fifty percent of HIV infected individuals have achieved viral suppression, TasP is the most effective when all HIV patients receive testing, labs, and HAART are available to all infected (Montaner et al., 2014).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice a practical
approach (4th ed.) Philadelphia, PA: Wolters Kluwer
DrugBank. (n.d. a). Miraviroc. Retrieved January 18, 2019, from https://www.drugbank.ca/drugs/DB04835
DrugBank. (n.d. b). Tenofovir disoproxil. Retrieved January 16, 2019, from https://www.drugbank.ca/drugs/DB00300
Gilead Sciences. (2014). Vitekta (elvitegravir) [Highlights of prescribing information]. Retrieved from
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/203093s000lbl.pdf
HIV.gov. (n.d.). U.S. Statistics. Retrieved January 16,2019, from https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
Mechanisms in Medicine. (n.d. a). Animation: Mechanisms of action of non-nucleoside reverse transcriptase inhibitors (NNRTIs) [Video file].
Retrieved from http://www.animatedhivscience.com/site/antiviral-animations-mechanisms-of-action-of-non-nucleoside-reverse-
transcriptase-inhibitors-nnrtis.html
Mechanisms in Medicine. (n.d. b). Mechanisms of Action of Nucleoside Reverse Transcriptase Inhibitors (NRTIs). [Video file]. Retrieved
from http://www.animatedhivscience.com/site/animation.aspx?file=animations/antiviral
Montaner, J. S., Lima, V. D., Harrigan, P. R., Lourenco, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is
associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV treatment as prevention”
experience in a Canadian setting []. PLos ONE, 9(2). https://doi.org/10.1372/journal.pone.0087872
RxList. (n.d. a). Fuzeon. Retrieved January 17, 2019, from https://www.rxlist.com/fuzeon-drug.htm#description
RxList. (n.d. b). Sustiva. Retrieved January 16, 2019, from https://www.rxlist.com/sustiva-drug.htm#indications
Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincott illustrated reviews: Pharmacology (6th ed.). Philadelphia, PA: Wolters Kluwer.
A Sample Answer For the Assignment: NURS 6521 Week 8: Infections
Title: NURS 6521 Week 8: Infections
HIV Prevalence
As we all know HIV affects a devastating amount of people across the United States. According to the HIV Surveillance Reports 1.1 million people are infected with HIV and 1 in 7 people are unaware that they have HIV (CDC, 2018). In my opinion, I do not think the prevalence of HIV is due to increased complacency because of advanced drug options. I would fault the increased opioid epidemic and casual sexual encounters as the reason for prevalence other f HIV in the United States. Yes, I do agree that individuals may not view HIV as a death sentence anymore because we are now aware that individuals can live long normal lives with the disease.
The medications used to try and decrease the risk of transmission antiretroviral (ART) regimens. HIV is a disease cannot be cured, so the next best attempt is to decrease the spread. The goal of treatment is to suppress the viral replication to levels that are undetectable (Arcangelo, Peterson, Wilbur & Reinhold, 2019, p.846). There should be education to reintroduce the seriousness of the disease. Patient’s do need to understand that even though HIV can be managed and individuals can live long lives the medication is not a cure and complications are still possible.
Healthcare professionals can help change the perception and the reality of the disease through education and prevention. According to Arcangelo et al. 2017, tenofovir/emtricitabine in sexually active adults who at increased risk of becoming infected with HIV has helped to decrease the transmission of the disease (p. 856). Safe sex education and needle exchange programs are one way to combat complacency. Talking about the issues keeps the issues relevant in the mind of individuals so that they do not forget that HIV remains a serious health threat.
To educate patients who are HIV positive in adherence to their treatment regimen and reducing the risk of infecting others should take place in multiple settings. Education should happen with their primary care provider, in schools, public health fairs, and anywhere else that a person could be educated. Patients who are infected should understand their diseases fully and how it is transmitted and the benefits of healthy living and medication compliance. As a provider, we should be offering screenings and testing routinely — populations who at higher risk should be targeted with more information and screenings.
Reference:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach(4th ed.). Ambler, PA: Lippincott Williams & Wilkins
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the
United States, 2010–2015.HIV Surveillance Supplemental Report 2018;23(No. 1). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published March 2018. Accessed [January 16,2019].
Singh, S., Song, R., Johnson, A. S., McCray, E., & Hall, H. I. (2018). HIV Incidence,
Prevalence, and Undiagnosed Infections in U.S. Men Who Have Sex With Men. Annals Of Internal Medicine, 168(10), 685–694. https://doi-org.ezp.waldenulibrary.org/10.7326/M17-2082
A Sample Answer For the Assignment: NURS 6521 Week 8: Infections
Title: NURS 6521 Week 8: Infections
HIV and AIDS
Acquired Immunodeficiency Syndrome (AIDS) is a secondary immunodeficiency syndrome as a result of a viral infection with Human Immunodeficiency Virus (HIV) (Huether & McCance, 2017). CD4 positive Th cells, which play an integral role in development of plasma and cytoxic T cells, are infected and destroyed by HIV causing a suppression of immune responses, increasing the acquiring of opportunistic infections, resulting in the development of AIDS (Huether & McCance, 2017). In this post, treatment of HIV/AIDS will be described, increased incidence in relation to increased patient complacency will be discussed, the impact of the healthcare provider on the perception and awareness will be explored, and strategies for education on medication adherence and prevention of transmission will be identified.
Treatment
HIV/AIDS treatment options all revolve around inhibiting the DNA and RNA actions within the cell. The goals of treatment are to maintain a suppression of the viral replication at a level that is undetectable, restore and preserve the immune system function, enhance the duration and quality of life, reduction of morbidity and mortality, and preventing transmission of the virus (Arcangelo, Peterson, & Reinhold, 2017). There are six different drug classes that can be utilized as treatment options, Nucleoside Reverse Transcriptase Inhibitors (NRTI), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI), Protease Inhibitors (PI), Fusion Inhibitors (FI), Ingrase Inhibitors (II), and CCR5 Antagonists . Treatment regime is contingent on the history of treatment with the specific patient, is the patient treatment naïve or treatment experienced, the side-effects of the medications, drug to drug interactions, the response to prior treatment options attempted, and the presence of specific receptors on cell membranes (Arcangelo, Peterson, & Reinhold, 2017).
NRTIs interrupts the transcription of the ribonucleic acid (RNA) to deoxyribonucleic acid (DNA) by either inserting itself into the chain, resulting in chain termination or competitive inhibition (Arcangelo, Peterson, & Reinhold, 2017). NTRIs are activated in the target cell through phosphorylation prior to the key activity causing the interruption of the transcription (Arcangelo, Peterson, & Reinhold, 2017). Dosing adjustments are made in individuals with renal impairments because it is eliminated by the kidneys and hypersensitivity usually occurs within the first six weeks (fever, rash, gastrointestinal (GI) disturbances, lethargy, and malaise) (Arcangelo, Peterson, & Reinhold, 2017). Lactic acidosis with steatosis can occur as an adverse reaction, which is rare; however, can increase the risk of death from the adverse reaction. The incidences of an adverse reaction is increased in females, pregnancy, obesity, regime components, and prolonged utilization (Arcangelo, Peterson, & Reinhold, 2017).
There are five types of NNRTIs (Delavirdine, Efavirenz. Etravirine, Nevirapine, and Rilpivirine), which inhibits the conversion of RNA to DNA through binding with reverse transcriptase (Arcangelo, Peterson, & Reinhold, 2017). Adverse effects include GI disturbances, elevation in hepatic transamines, and rash (Arcangelo, Peterson, & Reinhold, 2017). Efavirenz is usually utilized after treatment failure due to the increased incidences of central nervous system (CNS) symptoms (dizziness, impaired concentration, and abnormal dreams), it has been shown to cause birth defects, and side effects usually resolve within 2-4 weeks (Arcangelo, Peterson, & Reinhold, 2017). Nevirapine has the possibility of causing hepatotoxicity (Arcangelo, Peterson, & Reinhold, 2017). NNTRIs have drug-drug interaction with drugs whose metabolism is dependent on the CYP450 SA 4 (Arcangelo, Peterson, & Reinhold, 2017).
The cleavage of polyproteins, responsible for creating new HIV RNA, is hindered by PIs as the mechanism of action (Arcangelo, Peterson, & Reinhold, 2017). There are 9 PIs available, with ritonavir or cobicistat being utilized in combination with other PIs to boost the impact on the virus (Arcangelo, Peterson, & Reinhold, 2017). Numerous drug to drug interactions exist, the pharmacokinetics vary in each drug in this class, and adverse reactions can include GI disturbances, nausea, vomiting, and diarrhea (Arcangelo, Peterson, & Reinhold, 2017). A coinfection with Hepatitis B or Hepatitis C, alcohol abuse, underlying liver disease, and utilization of hepatotoxic agents simultaneously can increase the incidence of hepatotoxicity (Arcangelo, Peterson, & Reinhold, 2017). Other side effects include fat redistribution, hyperlipidemia, and hyperglycemia (Arcangelo, Peterson, & Reinhold, 2017). Drug-drug interactions occur in medications metabolized by in the CY450 (Arcangelo, Peterson, & Reinhold, 2017).
Enfuvirtide is the only drug available in the FI class, which prevents the HIV from moving into the cell through inhibition of the fusion of the virus to the cell membrane of the CD4 T Cell (Arcangelo, Peterson, & Reinhold, 2017). FI should only be utilized in treatment experienced patients, is a subcutaneous injection administered twice a day and almost 100% of the patients have injection site reactions as an adverse reaction (Arcangelo, Peterson, & Reinhold, 2017). Adverse effects also include an increase in the rate of bacterial pneumonia and hypersensitivity reactions (Arcangelo, Peterson, & Reinhold, 2017).
Ingrase Inhibitors (II) protects the host cell DNA through inhibition of the integration of the viral cell’s DNA into the host cell’s DNA (Arcangelo, Peterson, & Reinhold, 2017). There are three available (dolutegravir, elvitegravir, and rattegravir), which are recommended for use with with NTRIs as a backbone for initial therapy in treatment naïve patients (Arcangelo, Peterson, & Reinhold, 2017). There is minimal drug-drug interaction, an increased risk for rhabdomyolysis, adverse reactions can include nausea, headaches, and diarrhea, as well as insomnia and headache in extreme cases (Arcangelo, Peterson, & Reinhold, 2017). Dosing can occur as a once a day dose, for treatment naïve patients, or a twice a day dose for treatment experiences patients (Arcangelo, Peterson, & Reinhold, 2017). Since the absorption is impacted by calcium and irons supplements, and antacids, IIs should be taken 2 hours before or 6 hours after these supplements (Arcangelo, Peterson, & Reinhold, 2017).
Maraviroc is the only CCR5 antagonist available which acts through prevention of the HIV entry by inhibiting the CCR5 receptor on the membrane of the CD4+ T cells (Arcangelo, Peterson, & Reinhold, 2017). Laboratory testing, Coreceptor tropism assay, is required to determine if the virus in the patient contains CCR5 receptors since not all HIV viruses have CCR5 receptors (Arcangelo, Peterson, & Reinhold, 2017). Adverse reactions include a systemic allergic reaction, which can be followed by hepatotoxicity, cough, orthostatic hypotension, rash, and fever (Arcangelo, Peterson, & Reinhold, 2017). There is an increased incidence of drug-drug interaction and this should not be the first line of treatment (Arcangelo, Peterson, & Reinhold, 2017).
Increased Incidence and Increase in Complacency
Approximately 50,000 people are newly diagnosed with HIV every year in the United States (Huether & McCance, 2017). An increase in complacency does play a role in the incidence of HIV; however, the role is viewed by the writer as very small, contingent on the discussed population, compared to the “fear of knowing” the individual has the disease, causing individuals not to be tested (Thapa, et al., 2018). Complacency, as it pertains to HIV treatment would be significant in the middle- to upper- class citizen who can afford treatment for HIV; however, the stigma of having the virus could cancel out the effects the potential “complacency” would cause if the individual decides to act in integrity and disclose the presence of the virus. Complacency becomes an issue when there is no disclosure and the patient is aware of the decreased potential to transmit, and/or, both are aware of the presence of the virus and the decreased incidence of transmission with a low viral load. In summary, the complacency secondary to treatment options is contingent on the presenting scenario.
Healthcare Provider Impact on Perception and Awareness
In the area of perception and awareness, the main role of the healthcare provider is to provide patient centered education, which can be created through candid conversations about the sexual activity of the patient and current knowledge of the viral infection. This would provide the possibility of the provider to supplement existing knowledge about the viral infection and provide methods, unknown to the patient, for the prevention of transmission. The provider should always develop, just like a plan of care, an individualized education plan in order for it to be effective. The implementation of Highly Active Antiretroviral Therapy (HAART) could impact the incidence of transmission; however, it does not eliminate the compete possibility to transmit the disease (Montaner, et al., 2014), which is important to relay to the patient.
Education on Medication Adherence and Prevention of Transmission
A method to increase the medication adherence would be to attempt to develop a plan of care based on the results of an interdisciplinary assessment of the patient (Krummenacher, Cavassini, & Bugnon, 2011). The intervention should not be limited to the drug therapy; however, it should include reminders, calls to review any challenges the patient could be facing, constant re-evaluation of the financial burden of taking the medication, and inclusion of social workers to help mitigate some of the challenges the patient may have with the current medication regime. A multidisciplinary approach will allow a holistic approach of treatment and can be utilized for risk reduction in the high-risk for infection population.
Conclusion
In conclusion, the incidences of HIV continues to be a challenge to decrease. Six classes of medications are present to treat the disease; however, complacency can impact the efficacy based on the patient’s social status and whether they decide to disclose the presence of the infection. Providers have a responsibility to ensure they educate patients through correcting and supplementing the knowledge of the patient. An interdisciplinary approach for treatment and risk reduction would be the most effective method of treatment and prevention.
Reference
Arcangelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins.
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology. S. Louis, Missouri: Elsivier.
Krummenacher, I., Cavassini, M., & Bugnon, O. (2011). An interdisciplinary HIV-adherence program combining moticational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 550-561.
Montaner, J. S., Lima, V. D., Harrigan, P. R., Lourenco, L., Yip, B., Nosyk, B., . . . Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS Morbidity, MOrtality, and HIV Transmission:The “HIV Treatment as Prevention” Experience in a Canadian Setting. PLOS ONE, 9.
Thapa, S., Hannes, K., Cargo, M., Buve, A., Peters, S., Dauphin, S., & Mathei, C. (2018). Stigma reduction in relation to HIV test uptake in low- and middle- income countries: A realist review. BMC Public Health, 1-21.
A Sample Answer For the Assignment: NURS 6521 Week 8: Infections
Title: NURS 6521 Week 8: Infections
Drug Treatments for HIV/AIDS
Although strategies and information about HIV/AIDS are flourishing across the world, there is no doubt that the incidences of infections are still at a higher level. HIV is one of the most dreaded pathogens of the 21st century. The virus is spreading not only in Africa where more than twenty-five million people are infected but also across the United States and Canada. According to the Center for Disease Control and Prevention (CDC), an estimated number of about 1.2 million US citizens have been infected in the US, and nearly an eighth of the victims are not aware (Laborers Health and Safety Fund. (2017). Therefore, undiagnosed HIV infections form a significant impediment in eradication AIDS. Every year, more than 50000 people are infected with HIV in the US causing the death of about 13000 people annually. Observance to HAART supports to retain the viral load under control and extend the time of progression to AIDS, consequential in near normal life expectancy.
The classes of anti-HIV/AIDS drugs include
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as efavirenz, nevirapine etravirine help turn off a protein needed by HIV to make copies of itself. Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) Abacavir Descovy, lamivudine-zidovudine are defective types of the structure blocks that HIV wishes to duplicate of itself (Center for Disease Control and Prevention (CDC). Protease inhibitors (PIs) atazanavir, darunavir, fosamprenavir are incapacitate HIV protease, additional protein that HIV needs to duplicate of itself. Integrase inhibitors such as raltegravir, and dolutegravir work by deactivating a protein named integrase, which HIV uses to insert its genetic material into CD4 T cells (Center for Disease Control and Prevention (CDC). The pharmacology management differences between viral and bacterial infections. Bacterial infections are instigated by bacteria, and viral infections are instigated by viruses. Conceivably the most significant distinction among bacteria and viruses is that antibiotic drugs typically kill bacteria, nonetheless they aren’t effective against viruses.
Prevalence of HIV/AIDS and its Relationship to Advanced HAART
I support the thinking that prevalence of HIV/AIDS emanates from increased complacency due to the several advanced options of drug treatment. The United States encounters complacency about the needs for preventing HIV hence becoming a barrier for communities to achieve prevention standards. Although there is a significant success in the use of highly active antiretroviral therapies (HAART) witnessed by a reduction in newly reported AIDS cases and deaths, the epidemic control is still challenging(Arcangelo, Peterson, Wilbur, & Reinhold, 2017). There are a continuing number of infected individuals who must face years of multiple daily medications, possibly severe and unpleasant side effects and great expenditure for medicines that suppress the disease and prevent opportunistic infections.
The HAART mostly helps the affected persons to live longer and lead better lives. However, the availability of drug treatment may lull people into believing that there is no importance of instituting preventive measures for HIV/AIDS. Therefore, it is this complacency about the need for prevention that makes it complicated for both individuals and program planners on the infection risk. Nowadays, infected people can lower the amount of the virus in their bodies and also lead a long, healthy and productive life. In some cases, some individuals may forget to take the doses of skip the medications while others may take ‘drug holidays.’ Failing to follow treatment schedules makes the drugs less effective. This diversion from treatment increase drug resistance hence limiting treatment options for infected people in the future.
Health Practitioners’ Perception on the Realities of HIV/AIDS Prevalence
Healthcare professionals can help increase awareness about the brutality of the disease. I believe that, it is an obligation as a health practitioner to assistance individuals comprehend that HIV is not a disease of the past and there are still probabilities of contracting this disease. Individuals essential to be conscious of their own HIV status and understand that, they are putting others at great risk by spreading the disease. The NP should be willing to convey prevention messages, skills and support people with HIV risk behaviors. It involves encouraging them to reduce sexual and drug-related risks. In the US, every individual who abuses drugs should be counseling and treatment services that help them stop substance abuse and prevent further infections (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). At the same, the issue with sexual risks among the drug users should be incorporated in the prevention programs.
The new generation of young people require a comprehensive and continuous health information and appropriate interventions that may help them to develop life-long skills, which empower them to avoid activities that can result in HIV infection. Such programs should involve parents and educators, and they should begin at early age where they advise the adoption of healthy behaviors such as healthy diet and avoidance of substance abuse. Also, healthcare professionals should also improve means of treating sexually transmitted diseases thus reducing the risk of acquiring and transmitting HIV (Arcangelo, Peterson, Wilbur & Reinhold, 2017).
Strategies to Educate HIV Positive Patients on Medication Adherence
Education is key in creating HIV/AIDS awareness and changing people’s perception on the disease and treatment options available to them (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Furthermore, observance interventions contain an individual support factor that includes personalized or group education about HAART. The HAART adherence, the progress of basic medication management skills, and problem-solving with respect to adherence barriers. The victims of the disease should be trained in how to prevent behaviors of re-infection and also avoid drug abuse that could minimize new people being infected. Also, frequent sex education helps the youths in preventing the frequency of intercourse, reduce the number of partners and increase the use of condoms and other contraceptives (Laborers Health and Safety Fund. (2017).
It is important for health providers to be traditionally and culturally knowledgeable and use a multidisciplinary approach to serve and improve by providing teaching to those affected to guarantee a better result. Providing resources, such as places and where these patients can go and get support. Pregnant mothers that are infected with HIV are assisted through perinatal prevention programs. The program has realized significant success in reducing HIV transmission to the unborn babies. Patients with HIV/AIDS positive status should be introduced to a HIV/AIDS adherence program where the patient must meet with his/her health practitioner/specialist and the pharmacist to discuss the challenges and knowledge of AIDS, and medication compliance (Krummenacher et al (2018).
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (2019). CDC FACT SHEET: Today’s HIV/AIDS
Epidemic. Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/
Krummenacher, I., et al (2018). An interdisciplinary
HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Laborers Health and Safety Fund. (2017). New HIV Risk: Complacency. Retrieved
January 14, 2019, from laborers health and safety fund: https://www.lhsfna.org/index.cfm/lifelines/september-2015/new-hiv-risk-complacency/
A Sample Answer For the Assignment: NURS 6521 Week 8: Infections
Title: NURS 6521 Week 8: Infections
Human Immunodeficiency Virus and Categories of Medications
Human immunodeficiency virus (HIV) tends to attack the immune system of the individual that is infected by it, making the immune system incapable of defending itself. The HIV attacks the T- cells causing it to replicate itself while at the same time making more of the virus (Center for Disease Control, 2017). Therefore, it is imperative that correct antivirals are used to treat the HIV, and strict adherence to treatment is followed. There are several categories of antivirals that are used to treat HIV, they are; “nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 antagonists, post-attachment inhibitors, and integrase strand transfer inhibitors (INSTIs)” (U.S. Department of Health and Human Services, 2019).
Nucleoside reverse transcriptase inhibitors(NRTI’s)– prevent the replication of ribonucleic acid (RNA) from converting into deoxyribonucleic acid (DNA) in doing this these categories of medication which in include Abacavir, Emtricitabine, Lamivudine among others prevent the HIV from infecting more healthy cells. These medications can be taken anywhere from once a day to even four times depending on which one is chosen from the category. NRTIs are highly bioavailability ranging from 40- 92%, serum half-life ranges from 1.5 hours to 14 hours, with intracellular serum ranging from 7-22 hours, metabolized in the liver and excreted by the urinary system and feces (Smith, 2018). Medication adjustment should be made for patients who have renal and hepatic issues (Smith, 2018). According to Smith (2018), some potential side effects are lactic acidosis which can be fatal, confusion, rash and dizziness among others.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) consist of five medications that are currently approved by the Food and Drug Administration. These medications are; nevirapine, delavirdine, efavirenz, etravirine, and rilpivirine, (Usach, Melis and Peris, 2013). NNRTIs mechanism of action consisting of holding on to and preventing HIV enzyme from making more copies of themselves (Smith, 2018). NNRTIs medications are mainly metabolized in the liver and are mainly taken once per day, they are taken with food and have oral bioavailability of between 42- 92 percentage, half-life serum anywhere between 25- 50 hours, route of elimination is through urine and feces (Usach et al., 2013). Some possible side effects are rash, elevated liver enzymes, headaches, insomnia, and depression, among others (Smith, 2018).
Protease inhibitors (PIs)- It was reported by U.S. Department of Health and Human Services, 2019) that these class of medications stops the enzyme that is needed to convert immature viral proteins into a mature virus that will attack other healthy helper cells or CD4 cells. Some examples of these categories of medications are; Atazanavir, Darunavir, and Fosamprenavir, among others. These medications are absorbed by the gastrointestinal system and food increase the absorption and bioavailability rate, they are metabolized in the liver, eliminated through urine and feces (Smith, 2018). Once more dose adjustments are required for those with hepatic and renal insufficiency (Smith, 2018). The side effect is nausea, vomiting, weight loss and taste bud alteration (Smith, 2018).
Entry inhibitors and Integrase strand transfer inhibitors (INSTIs)- These two classes of medication consist of Enfuvirtide, Maraviroc, Dolutegravir among others, these medications work by preventing the HIV from inserting the virus into the DNA of the host, by preventing this, the infected cells are unable to replicate themselves, therefore destroying their abilities to attack CD4 cells (Smith, 2018). Some of these medications can be taken without or with food. The serum half-life ranges from 4 to 14 hours, they are metabolized the liver, some potential side effects are coughing, trouble with breathing, fever, and chills, among others (Smith, 2018).
Cysteine – Cysteine Chemokine Receptor 5 (CCR5 antagonists)- Prevent the coreceptor on the immune cells from letting the HIV inside the cells (Smith, 2018). An example of this class of medication is Maraviroc, it is metabolized in the gastrointestinal system and eliminated from the body through the liver into the renal system, the half-life of 14- 18 hours and have possible side effects of a cough, rash, respiratory infection (upper) among other (Smith, 2018).
HIV Medication Compliance and Adherence
Although there has been a great stride in the development and advancement in medication regime in antiviral treatment therapy compliance and adherence continue to be an issue. Most antivirals medication are now only required to be taken once a day, therefore limiting potential side effects and to increase adherence to treatment. There are still issues with patients who are not following their medication regimen guidelines. According to Fagbami, Oluwasanijo, Fitzpatrick, Fairchild, Shin and Donato (2015) this may be attributed to due to lack of support both from family members and healthcare providers. Patients who experience side effects such as diarrhea, nausea, depression among others tend to do better whenever they have the support of family members who can assist on days when side effects are at their highest (Fagbami, et al., 2015). According to (Fagbami et al., (2015) in their study that was conducted that participants with support from their communities, children, family members and open communication and trust in their healthcare providers yield higher compliance and adherence to antiviral treatment regime medication therapy. Poor patient and provider interaction were found to be a huge contributing factor to adherence, especially whenever there is a perception that there was lack of sympathy and empathy for the patients by healthcare providers (Fagbami, et al., 2015).
Changing Perceptions about HIV and Patient Education
Many of the stigmas that still occurs with HIV is that it still is seen as a disease that is causing my immoral behaviors. Cultural beliefs and norms also play a role in some of the stigma that is associated with HIV. To combat some of these stigmas continuous education about the disease is needed, there needs to be open and honest communication, none judgmental attitudes.
Healthcare providers should educate patients on the importance of adhering to their medication regimen, and how the lack of adherence can have an impact on the longevity of the lives and cause rapid progression of the virus. Seeing that skipping doses of medication can lead to mutation of the virus that causes medication resistance. Healthcare providers can inform their patients about the importance of using protective methods whenever they are intimate with their partner, take medication daily seeing that doing this can lower the viral load, therefore decreasing the chances of infecting someone, for substance abusers’ users, don’t share needles, use only clean needles (U. S Department of Health Services, 2019).
There are many factors such as side effects, interaction with other medications that patient is taking, working schedule, depression, lack of coverage and substance use disorders that can greatly impact medication compliance and adherence, therefore, it is important that treatment plans are individualized and based on the preference of the patient.
References
Center for Disease Control (2017). Hiv in the southern united states. Retrieved from
https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf
Fagbami, O., Oluwasanjo, A., Fitzpatrick, C., Fairchild, R., Shin, A., & Donato, A. (2015).
Factors supporting and inhibiting adherence to hiv medication regimen in women: a qualitative analysis of patient interviews. The open AIDS journal, 9, 45-50. doi:10.2174/1874613601509010045
Smith, C.L. (2018). Hiv/infection disease. Retrieved from
file:///C:/Users/coldi/Downloads/ACCP%20Updates%20in%20Therapeutics%C2%AE%202018-%20Pharmacotherapy%20Preparatory%20Review%20and%20Recertification%20Course.pdf
Usach, I., Melis, V., & Peris, J. E. (2013). Non-nucleoside reverse transcriptase inhibitors: a
review on pharmacokinetics, pharmacodynamics, safety, and tolerability. Journal of the International AIDS Society, 16(1), 1-14. doi:10.7448/IAS.16.1.18567
U.S. Department of Health and Human Services. (2019). Understanding hiv. Retrieved from
https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/1561/drug-class/
- S. Department of Health and Human Services (2019). Understanding hiv-aids fact-sheets.
Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/48/the-basics-of-hiv-prevention