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Review of Antiretroviral Therapy in Adults

Review of Antiretroviral Therapy in Adults. HAIVN Harvard Medical School AIDS Initiative in Vietnam. Learning Objectives. By the end of this session, participants should be able to: Explain the criteria for starting ART Identify the first line ARV regimens

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Review of Antiretroviral Therapy in Adults

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  1. Review of Antiretroviral Therapy in Adults HAIVN Harvard Medical School AIDS Initiative in Vietnam

  2. Learning Objectives By the end of this session, participants should be able to: • Explain the criteria for starting ART • Identify the first line ARV regimens • Describe the common side effects caused by NRTIs and NNRTIs • Describe the protocol for performing routine follow-up with ARV patients

  3. Drug Classes of Antiretrovirals (ARV) • Nucleoside Reverse Transcriptase Inhibitors (NRTI) • Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) • Protease Inhibitors (PI) • Fusion/Entry Inhibitors • Integrase Inhibitors

  4. ARV Drugs Currently Available in the World and Vietnam

  5. Goals of ARV Therapy • Inhibit HIV replication • As low as possible (undetectable) • For as long as possible • Allow recovery of the immune system • Prevent opportunistic infection • Improve survival, health and quality of life

  6. When to Start ART? • ARV therapy is never an emergency • Patients with high CD4 are not at risk for OIs and can delay ARV treatment • Decide when to start ARV based on:

  7. When to Start ARV in Vietnam Patients with: • CD4 ≤ 350 cells/mm³ irrespective of clinical stage • Clinical stage 3 or 4 irrespective of CD4 cell count Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011

  8. First Line ARV Regimens in Vietnam (1) 2 NRTI + 1 NNRTI Lamivudine (3TC) Tenofovir (TDF) Zidovudine (AZT) Efavirenz (EFV) Nevirapine (NVP) Stavudine (D4T) is no longer recommended as a first line ARV Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011

  9. First Line ARV Regimens in Vietnam (2) TDF or AZT EFV or NVP + + 3TC Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011

  10. First Line ARV Regimens in Vietnam (3) Priority Regimens Alternative Regimens TDF/3TC/EFV TDF/3TC/NVP AZT/3TC/EFV AZT/3TC/NVP Modification and Supplement to the Guidelines for Diagnosis and Treatment of HIV/AIDS, MOH November 2011

  11. Side Effects of 1st Line ARVs

  12. Monitoring Patients on ART

  13. Monitoring: How Often? • If the clinical situation is stable:

  14. What to Monitor? (1) Adherence Monitoring • Assess missed doses • Provide counseling about adherence, prevention, and healthy living Clinical Monitoring • Weight, temperature • WHO Clinical Stage • ARV side effects or toxicity • Signs of IRIS

  15. What to Monitor? (2) Laboratory Monitoring:

  16. Key Points • Patients with clinical stage 3 or 4 or CD4 ≤ 350 should start ART • Two priority first ARV regimens in Vietnam: • TDF + 3TC + EFV • TDF + 3TC + NVP • All ART patients need routine clinical and laboratory monitoring

  17. Thank You! Questions?

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