J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy. He comes to your office for a routine physical exam and blood work.
World Health Organization Postexposure Prophylaxis Guideline Development .
The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Diagnosis: Asymptomatic HIV Infection In this discussion forum: Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection. Discuss when prophylaxis for infection is indicated ie daily bactrim Discuss the drug therapy a CNP would likely prescribe and why. Discuss the parameters for monitoring success of the therapy. Discuss health promotion recommendations you would consider for J. P.World Health Organization Postexposure Prophylaxis Guideline Development .
Discussion 6
Insight Start Study Group (2015) recommends initiating pharmacotherapy in patients with asymptomatic HIV infection with the primary goal of suppressing the viral load in plasma to undetectable levels. For the entire treatment period, the existing standard of care according to Margolis, Koup & Ferrari (2017) is to administer at least three medications concurrently.World Health Organization Postexposure Prophylaxis Guideline Development .
Tenofovir and emtricitabine are the HIV prophylaxis that I would prescribe for his partner because he is at high risk of getting the infection (Marrazzo et al., 2015). Emtricitabine is FDA-approved in conjunction with other antiretroviral medications for the treatment of HIV infection in adults, children, and infants.World Health Organization Postexposure Prophylaxis Guideline Development . It is accessible in co-formulated dosage with tenofovir with or tenofovir, efavirenz, elvitegravir, and cobicistat. Tenofovir is a variant of the nucleotide monophosphate that contains two extra phosphates to be fully active (Marrazzo et al., 2015). These compounds suppress both HIV-1 and HIV-2, and some have comprehensive action against other retroviruses in humans and animals; lamivudine, emtricitabine, and tenofovir are effective against HBV and herpes viruses.World Health Organization Postexposure Prophylaxis Guideline Development .
A CNP should potentially administer and begin antiretroviral drugs, two nucleosides, and 1 NRTI therapy for HIV-positive and asymptomatic patients more than ten years of age with a CD4 T cell count lower than 350. It includes 300 mg of Zidovudine P.O. twice a day, 300 mg of Lamivudine P.O. once a day and 200 mg of Nevirapine P.O. twice a day. This is the standard and most cost-effective treatment to be given. This treatment is also efficient and effective in minimizing viral loads and inhibits viral replication.World Health Organization Postexposure Prophylaxis Guideline Development .
Monitoring therapy success focuses on improving CD4 T cells count and reducing the viral load that can cube identified in blood tests (Margolis et al., 2017). J.P.’s CD4 T cells should optimally increase to more than 350 cells/mm3, and the viral load should ideally be less than 50 copies/mL or up to undetectable. This would suggest as good intervention with no further signs or symptoms shown.World Health Organization Postexposure Prophylaxis Guideline Development .
The WHO now suggests an early introduction of antiretroviral therapy (ART) to provide more patient-friendly antiretroviral medications for adults and teenagers. The earlier antiretroviral treatment strengthens the immune system and decreases the risk of HIV-related mortality and illness (Ford et al., 2015). It also reduces the chance of transmission of HIV and T.B. Powerful advice is also to participate in fitness and physical activity. Eat a healthy and nutritious diet, with foods high in vitamins and fiber.
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