HIV & Transplant Drugs

Question 1

Anti-Retroviral Therapy (ART)

Answer 1

Drugs:

• Enfuvirtide
• Maraviroc
• Zidovudine
• Delavirdine
• Raltegravir
• Ritonavir

Indications:

• HIV-infected individuals
• HIV-infected pregnant patients
• History of an AIDS-defining illness (inflammatory, infectious, cancer)
• Serodiscordant couples (mixed serostatus)

Adverse Effects:

• Hepatotoxicity
• Nephrotoxicity
• Osteopenia => early onset osteoporosis and fractures
• Dyslipidemia (early onset coronary artery disease diseases (CAD, angina, MI))
• Fat redistribution syndrome (lipodystrophy); lipoatrophy on face, arms, legs, and buttocks, lipohypertrophy on abdomen, breasts, and buffalo hump –> body image issues
• Insulin resistance => Diabetes Mellitus

Nursing:

• Pt may be noncompliant (viral rebound, immune decompensation & clinical deterioration)
• HIV effects CNS –> cognitive ability may deteriorate a little & play a role in noncompliance
• Look at how the stigma of the disease is affecting the pt

“Heberle Never Offered Drawing Lessons In Los Angeles”
Hepatox, Nephrotox, Osteopenia, Dyslipidemia, Lipoatrophy, Insulin Resistance, Lipohypertrophy,

Question 2

Basiliximab

Answer 2

• Used for induction therapy = intense immunosuppression during the initial transplant period

Question 3

Maintenance Drugs for Transplant

Answer 3

Drugs:

• Tacrolimus: IV, PO
• Cyclosporine: IV, oral solution
• Azathioprine: PO(no IV form in the US)
• Mycophenolate mofetil PO, IV

Contraindications:
- Pregnancy & breastfeeding

Side effects:

• Hirsutism (male pattern hair growth) –> reversible with discontinuing the medication
• Gingival hyperplasia: requires good dental hygiene and routine check-ups

Adverse reaction:

• Photosensitivity
• RF, hepatotoxicity, dysrhythmia, HTN
• Blood dyscrasia: thrombocytopenia, anemia, leukocytopenia
• Lymphoma and other malignancies

Nursing:

• Monitor for rejection (malaise, fever, pain, organ dysfunction)
• Patient and family should know these sign/symptoms
• Provide contact information for the transplant team, contact with any sign of rejection
• Very strict adherence to drug regimen
• Highly protein bound
• Many drug-drug interactions
• Toxicity with malnutrition

Harry, Ron & Hermione Beat Bad Guys
Hagrid Like Defending Potter’s People –> HTN, Lymphoma, Dysrhythmia, Protein-bound, Photosensitivity

Question 4

Acute Rejection for Transplant

Answer 4

IV corticosteroids