Lecture 10 - Antiretroviral Therapy

HOLISTIC CARE FOR PEOPLE WITH HIV
Definitions
Holistic: Relating to or concerned with complete systems:
 Comprehensive Integrated Aggregate

 All-encompassing Exhaustive Extensive
 Wide-ranging
Holistic care is based on the philosophy that the parts of something (in this case human being)
are intimately interconnected and explicable only by reference to the whole
Holistic approach
To provide support that looks at the whole person’s wellbeing including:
Physical Emotional Mental Social Spiritual
The eight components of holistic care of a PLHIV are:
1. Antiretroviral Therapy (ART)

2. Positive Health, Dignity, and Prevention, GBV/IPV & Health Education and Counselling
3. Screening for and Prevention of Specific Opportunistic Infections
4. Reproductive Health Services
5. Screening for and Management of Non-Communicable Diseases
6. Mental Health Screening and Management
UCC 101 LECTURE NOTES – Page 1

7. Nutrition Services
8. Prevention of Other Infections
LECTURE 10: ANTIRETROVIRAL THERAPY (ART)

10.1 Antiretroviral Therapy
Therapy = Treatment
 Antiretroviral Therapy refers to treatment with drugs (medicines) called antiretroviral drugs
(ARVs) which work against (anti) the HIV by interrupting one or more of the seven stages of
the HIV life cycle thereby preventing the virus from replicating thereby keeping the viral
load (VL) low.
 ART is a combination of 3 or more different medicines.
 Lowering the viral load enables the body to make CD4 cells and hence the antibodies that
sustain the body’s immunity to protect against opportunistic diseases (IOs).
10.2 Eligibility (who qualifies for ART)
 All PLHIV irrespective of CD4 cell count, WHO clinical stage, age, pregnancy status, or
comorbidities
 ART should be initiated as soon as possible to stop the replication (multiplication) of the
HIV virus.
10.3 Benefits of ART

a) Patients regain of appetite and weight after a few weeks of taking ART
b) Increased energy levels and general sense of well being
c) PLHIV are able to carry on with normal chores and duties i.e. work, education, domestic
chores etc.
d) PLHIV can live a long and health life if ART is taken properly
10.4 Timing of Commencement (starting) of ART
• As soon as possible after laboratory test confirmation and when the patient is ready[after
receiving professional post-test counselling.
• Preferably within two weeks of testing HIV positive because the longer the delay, the
more the virus multiplies and the more the damage which increases the chances of
getting sick and even dying[of opportunistic infections].
• Even when the CD4 cell count of a PLHIV is high, the virus replicating and doing
damage hence should be controlled
• Sometimes ART is started a few weeks later than two weeks if the patient is not ready or
has certain infections such as cryptococcal meningitisand tuberculosis (TB) meningitis.
10.5 Role /Effect of ART

a) ART DOES NOT CURE!(does not eliminate) HIV
b) ART reduces the replication of HIV thereby lowering the viral load to enable the body to
protect itself from opportunistic infections.
c) When a patient is on ART and the viral load is very low, it is unlikely that the patient can
transmit HIV.
d) However, since the virus is not completely eliminated by ART, there is still a
possibility/chance of transmission hence the need for:
a. Disclosing HIV status to sexual partners
b. Consistent use of protected sex e.g. use of a condom to prevent transmission, re-
infection by other HIV strains and infection by other sexually transmitted
infections (STIs)
10.6 How ART Should be Taken
 Correct dose as prescribed by a clinician (Not less and not more)
 Taking less than the prescribed dosage makes the treatment ineffective and causes HIV
drug resistance hence treatment failure.
 ART prescription is specific to a patient hence should never be shared with someone
else
 Because children are growing, their dosage keeps changing to match their age, body
weight etc.
10.7 Duration of ART

 ART is administered to a HIV patient for a lifetime because the ART does not
cure/eliminate the virus
 ARVs are taken daily for a life time; pausing or skipping a dose or stoppage of the
medicines will give an opportunity for the virus to replicate/multiply and increase the
viral load
 A PLHIV MUST TAKE ART AS PRESCRIBED AND NEVER TO MISS A DOSEto
avoid the HIV developing drug resistance thereby becoming ineffective against the virus.
10.8 ART Side Effects
Side effect:
 Unintended/undesirable/adverse secondary effect which occurs in addition to the

intended/desirable therapeutic effect of a drug or medication
 Side effects can vary for individuals depending on their disease status, age, body weight,
gender or general health
 Some people have none while other experience mild effects which are unpleasant but
often manageable
 Most side effects occur within the first few weeks of starting ART and then improve
after a few weeks or months
 Common side effects include:
i. Headache
ii. Loss of appetite

iii. Skin rash
iv. Fatigue
v. Nausea
vi. Vomiting
vii. Diarrhoea
viii. Muscle pains
 Side effects can be mild or severe.
 Severe side effects include:
o Rash all over the body
o Rash in the mouth or eyes
o Constant vomiting
o Inability to eat or retain food
10.9 Actions to be taken when Side effects Occur

a) A patient should continue taking ART as prescribedwithout missing any dosesuntil they
discuss the problems with a clinician.
b) For mild symptoms, a patient should continue taking their ART without missing any
doses, and then discuss the side effects with the clinician during the next appointment.
c) For severe side effects, a patient should return to the clinic immediately, even without a
scheduled appointment, to discuss the next course of action. If the patient is unable to
make it to the clinic immediately, they could call the clinic for assistance/advice.
d) Most side effects are manageable with the assistance of a clinician.
e) Occasionally, the ART prescription can be changed (different ARVs prescribed)when
the side effects become unmanageable
10.10 ART Adherence
The following constitute ART adherence:
a) Following a care plan as agreed with the healthcare team[What, when, how]
b) Attending clinic appointments as scheduled for follow-up purposes
c) Picking up medicines and taking them as prescribed (from VCT centres, designated
pharmacies etc.)
d) Getting lab tests according to the recommended schedule (monitoring VL and CD4 cell
count)
e) Following nutritional recommendations (proper nutrition is important for providing the

body with the required nutrients and keeping healthy)
f) ART should be taken at the correct time of day e.g.
 If prescription is once per day, the patient should pick a convenient time that is
easy to remember e.g. at breakfast, during supper etc.

 If prescription is totake twice in a day, the patient should find convenient time to
allow approximately 12 hours between the doses say 7am and 7pm; 8 am and 8
pm etc.
g) If one misses a dose, dose should be taken as soon as patient remembers (but not just a
few hours to next dose) then return to regular schedule.
h) No double-dose of ART to make up for a missed doses
i) ART must be taken according to dietary restrictions
j) Some: With food
k) Some: Empty stomach
l) Some: doesn’t matter
m) Patient should tell clinician about other drugs they are taking because some medications
interact with ART and make them ineffective
n) No use of alcohol
10.11 Factors that interfere with good adherence
a) Stigma: hiding to avoid people finding out patient’s HIV status
b) Disclosure: When people closest to patient like family and close friends do not know
patient’s HIV status
c) Change in routine: if daily routine suddenly makes it difficult to remember schedule
d) Travel: frequent travel, or unexpected travel – inadequate drugs for entire journey
e) Alcohol and drug use: makes it difficult to remember schedule
f) Caregiver changes: e.g. child carer
g) Side effects: Patients can abandon treatment to reduce the side effects
h) Pill burden/palatability: numbers, taste, smell
i) Distance: HIV clinic/VCT – when these are far the patient may not be in a position to
go there as frequently as necessary
j) HIV knowledge: lack of understanding about HIV, ART
k) Mental health disorders: e.g. depression – impairs decision making and conscious
actions
l) Religious beliefs: e.g. after “faith-healing

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HOLISTIC CARE FOR PEOPLE WITH HIV

Holistic: Relating to or concerned with complete systems:

 Comprehensive Integrated Aggregate

To provide support that looks at the whole person’s wellbeing including:

Physical Emotional Mental Social Spiritual

The eight components of holistic care of a PLHIV are:

1. Antiretroviral Therapy (ART)

UCC 101 LECTURE NOTES – Page 1

LECTURE 10: ANTIRETROVIRAL THERAPY (ART)

 ART is a combination of 3 or more different medicines.

10.2 Eligibility (who qualifies for ART)

10.3 Benefits of ART

10.4 Timing of Commencement (starting) of ART

10.5 Role /Effect of ART

UCC 101 LECTURE NOTES – Page 2

10.6 How ART Should be Taken

 Correct dose as prescribed by a clinician (Not less and not more)

10.7 Duration of ART

10.8 ART Side Effects

 Unintended/undesirable/adverse secondary effect which occurs in addition to the

UCC 101 LECTURE NOTES – Page 3

10.9 Actions to be taken when Side effects Occur

10.10 ART Adherence

The following constitute ART adherence:

b) Attending clinic appointments as scheduled for follow-up purposes

e) Following nutritional recommendations (proper nutrition is important for providing the

f) ART should be taken at the correct time of day e.g.

UCC 101 LECTURE NOTES – Page 4

10.11 Factors that interfere with good adherence

a) Stigma: hiding to avoid people finding out patient’s HIV status

c) Change in routine: if daily routine suddenly makes it difficult to remember schedule

e) Alcohol and drug use: makes it difficult to remember schedule

f) Caregiver changes: e.g. child carer

h) Pill burden/palatability: numbers, taste, smell

j) HIV knowledge: lack of understanding about HIV, ART

l) Religious beliefs: e.g. after “faith-healing

UCC 101 LECTURE NOTES – Page 5

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