NCLEX Review Guide: HIV/AIDS Medications

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

• Zidovudine (AZT) was the first HIV medication and requires monitoring for bone marrow suppression leading to anemia and neutropenia.
• Tenofovir and Emtricitabine combination is commonly used in first-line therapy and requires renal function monitoring due to nephrotoxicity risk.
• NRTIs work by mimicking natural nucleosides and incorporating into viral DNA, causing chain termination during reverse transcription.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Efavirenz commonly causes CNS side effects including vivid dreams, dizziness, and confusion, especially during initial weeks of therapy.
• Rilpivirine must be taken with food and cannot be used with proton pump inhibitors due to absorption issues.
• NNRTIs bind directly to reverse transcriptase enzyme, causing allosteric inhibition without incorporating into DNA.

Protease Inhibitors (PIs)

• Ritonavir is primarily used as a booster to increase levels of other protease inhibitors through CYP3A4 inhibition.
• Most PIs cause lipodystrophy syndrome with fat redistribution, hyperlipidemia, and insulin resistance requiring regular monitoring.
• PIs prevent viral maturation by blocking the protease enzyme that cleaves viral polyproteins into functional proteins.

Laboratory Monitoring Requirements

1. Monitor CD4+ count and viral load every 3-6 months to assess treatment effectiveness
2. Check complete blood count regularly, especially with zidovudine for bone marrow suppression
3. Monitor liver function tests as many HIV medications can cause hepatotoxicity
4. Assess renal function with tenofovir-containing regimens due to nephrotoxicity risk
5. Screen lipid panels and glucose levels with protease inhibitor therapy

HAART (Highly Active Antiretroviral Therapy)

• Combination therapy typically includes 2 NRTIs plus either 1 NNRTI or 1-2 PIs to prevent resistance development.
• Adherence is critical - missing doses can lead to viral resistance and treatment failure requiring complex salvage regimens.
• Treatment should begin immediately upon HIV diagnosis regardless of CD4+ count according to current guidelines.

Special Populations

• Pregnant women require specific regimens avoiding teratogenic drugs like efavirenz during first trimester.
• Pediatric dosing is weight-based and many formulations come in liquid preparations for children who cannot swallow pills.
• Elderly patients may require dose adjustments due to decreased renal and hepatic function affecting drug clearance.