Adult Antiretroviral Guidelines

US DHHS Guidelines with Australian Commentary

Guidelines

References

World Health Organization. Health promotion [Internet]. World Health Organization online; 2024 [Cited 2024 Feb 6]. Available from:  https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference. World Health Organization. Ottawa Charter for Health Promotion [Internet]. 1987. World Health Organization; 2012 [Cited 2024 Feb 6]. Available from: https://www.who.int/publications/i/item/WH-1987. Green J, Cross R, Woodall J, Tones K. Health and health promotion. In Green J, Cross …

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Adherence support

Danielle Collins: HIV nurse practitioner, Victorian HIV Service, Infectious Diseases Department, Alfred Hospital  Acknowledgments  Elizabeth Crock: Bolton Clarke HIV Program, Melbourne, was co-author on previous editions Oscar Morata Ramirez: Royal District Nursing Service HIV Program, Melbourne was co-author on the first edition.  Summary  In this section, the author discusses the important issue of adherence to antiretroviral …

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Factors affecting adherence and nursing interventions used to promote adherence

Factors influencing antiretroviral adherence are multifactorial. They can be internal – pertaining to the person, and external – pertaining to those providing the care and to the medicines themselves. (14)  External factors affecting an individual’s adherence can also be structural and systemic.   The advent of the COVID-19 pandemic in 2020 brought with it a multitude of …

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Conclusion and future directions

The ability of people with HIV to adhere to treatment can be a complex matter, influenced by a wide range of individual, system-related, psychosocial, and socio-political factors potentially compounded by the life-long nature of antiretroviral therapy for HIV treatment.  Nursing strategies to encourage, improve and maintain adherence include discussing potential antiretroviral therapy regimens with consideration …

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Additional resources

Initiation of Antiretroviral Therapy – ARV Guidelines (ASHM)  Australian Commission on Safety and Quality in Health Care. National Medication Management Plan – User Guide. 2021.  Find a Prescriber – ASHM Health 

References

Osterberg L and Blaschke T.  Adherence to Medication. N Engl J Med 2005; 353:487, August 4.   García de Ollala P, Knobel H, Carmona A, Guelar A, López-Colomés JL, and Caylà JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes 1999; 30(1): 105-110.   Mille W, …

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Background

Denise Cummins: Sydney District Nursing, Sydney Local Health District  Summary   This section explores key issues for nurses in relation to cognitive impairment and people living with HIV (PLHIV):  Background  Examples of dementia  HIV associated neurocognitive disorder (HAND)  Screening, diagnosis, and predictors of HAND  Signs and symptoms of HAND   Treatment of HAND  Strategies for support of cognitive …

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Screening and diagnosis for HAND 

It is recommended that PLHIV be questioned and screened annually about any changes to cognition or memory decline (23). If any symptoms are identified, HIV neurology review should be considered. In the short-term strategies should be discussed with the person to treat symptoms. If the person is then diagnosed with cognitive impairment the person should …

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Predictors of HAND

Studies suggest predictors of HAND include history of AIDS-defining central nervous system (CNS) disease (14), other CNS disease (14), low T cell nadir (30), longer duration of HIV infection (31), drug and alcohol use (31), and hepatitis C infection (32). Additionally, the risk of HAND increases as CD4+ counts decline below 350cells/uL and with higher plasma viral load …

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General (non-HAND) cognitive impairment risk factors

Comorbidities often appear earlier and progress faster in PLHIV.  Vascular risk factors such as smoking, hypertension, diabetes, hypercholesterolaemia and hyperlipidaemia should be considered, as they would in the non-HIV population. Other considerations include impaired renal function, cytomegalovirus, frailty, chronic pulmonary disease; the gut biome may also be involved (4,35).  

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