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.

Okay, so integrase strand transfer inhibitors, or INSTIs for short, end in the suffix “-gravir”. This class of antiretrovirals includes raltegravir, dolutegravir, elvitegravir, and bictegravir, which comes in combination with antiretrovirals from the class of nucleoside and nucleotide reverse transcriptase inhibitors or NRTIs, namely emtricitabine 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 integrase strand transfer inhibitors can have specific side effects. Raltegravir and dolutegravir can cause hyperglycemia, while raltegravir can also cause rhabdomyolysis, and dolutegravir 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.