Antiretrovirals for HIV/AIDS - Integrase strand transfer inhibitors: Nursing pharmacology

Antiretrovirals are medications used to treat infections caused by retroviruses. This is a group of RNA viruses that includes human immunodeficiency virus or HIV, which can cause acquired immunodeficiency syndrome, or AIDS.

Now, antiretrovirals include different classes of medications, among which some of the most commonly used are integrase strand transfer inhibitors.

OK, so integrase strand transfer inhibitors, or ISIS for short, end in the suffix gravire. This class of antiretrovirals includes raltegravir, doletegravir, Evatrevir, and Bictegravir, which comes in combination with antiretrovirals from the class of nucleoside and nucleotide reverse transcriptase inhibitors, or NRTIs, namely racytabine and tenofovir.

Integrase strand transfer inhibitors are taken orally. Once administered, they work by blocking the action of the viral enzyme integrase, which allows the virus to insert and integrate its genome into the host's cell DNA.

As a result, blocking this process prevents the virus from multiplying, which halts the infection. Now, common side effects of integrase inhibitors include headache, insomnia, and gastrointestinal side effects such as nausea, vomiting, and diarrhea, as well as elevated liver enzymes.

In addition, clients taking these medications can develop hypersensitivity reactions, as well as excessive inflammatory response called immune reconstitution syndrome, that can also cause flare-ups of a previously known infection like tuberculosis.

Now, some integrate strand transfer inhibitors can have specific side effects. Raltegravir and doletegravir can cause hyperglycemia, while Rtegravir can also cause rhabdomyolysis, and Doletegravir may cause acute liver failure.

Finally, clients on elvitegravir can also develop acute liver failure and may experience depression and suicidal ideation.

Regarding contraindications for integrase inhibitors, precautions should be taken during pregnancy and breastfeeding, as well as in children and in clients with hepatic or renal impairment.

Now, when caring for a client prescribed raltegravir as part of their antiretroviral regimen for HIV, start your assessment by asking your client about symptoms such as fatigue, fever, and mental status changes.

Also, assess for the presence of opportunistic infection and review their nutrition status to determine if they have any nutritional deficiencies or weight loss.

In addition, be sure to obtain their weight and vital signs. And lastly, review their most recent laboratory test results, including CD4 T cell count, HIV RNA levels, CBC, glucose, hepatic and renal function, and CK levels.

Moving on to client education. Explain that the medication works along with other medications in their antiretroviral regimen to help prevent HIV replication.

Remind them that their antiretroviral regimen won't cure their HIV infection, and that it won't prevent them from infecting others.

So they should notify sexual partners about their diagnosis. And be sure to take precautions to prevent transmission, like using condoms.

Next, instruct your client to take their medication consistently, twice daily, with or without food, and with an 8 ounce glass of water.

If they are prescribed the oral suspension, instruct your client to pour the medication packet into 10 mL of water, using the provided mixing cup.

And then place the cap on the cup and swirl the contents gently for about 45 seconds. And then use the provided oral syringe to measure the correct dose.

Lastly, be sure to emphasize the importance of consuming the mixture within 30 minutes of mixing. Be sure to promote adherence to their medication regimen by assisting your client to develop a schedule for taking multiple prescribed medications.

Then, let your client know about some of the common side effects they may experience during therapy, including headache, insomnia, and gastrointestinal side effects, such as nausea, vomiting, and diarrhea.

And instruct them to contact their healthcare provider if these become persistent. In addition, advise them to immediately notify their healthcare provider if they experience symptoms of rhabdomyolysis, such as unusual muscle pain and weakness or dark-colored urine, as well as symptoms of a severe hypersensitivity reaction, which could present with an unusual rash, blistering, or the presence of mouth, throat, or nasal sores.

Finally, during antiretroviral therapy, be sure to monitor your client for side effects and evaluate for the desired therapeutic effect of improvement in their CD4 T cell count, decreased HIV RNA, and improved immune function and quality of life.

All right, as a quick recap, Integrase strand transfer inhibitors are antiretroviral medications used to treat HIV and include raltegravir, Dolettegravir, Elvitegravir, and Bictegravir.

These medications work by blocking the action of the viral enzyme integrase, which allows the virus to insert and integrate its genome into the host's cell DNA.

This prevents the virus from multiplying, which ultimately halts the infection. When caring for a client receiving an integrase strand transfer inhibitor, nursing considerations include performing a baseline assessment, monitoring for the development of side effects, and evaluating for the desired therapeutic effect.

Client education is focused on safe self-medication administration, scheduling of multiple medications, preventing transmission of HIV and identifying side effects that should be reported to their healthcare provider.