03.02 management of patients on antiretroviral drugs initiat
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This document discusses guidelines for managing patients on antiretroviral therapy (ART). It explains that ART involves lifelong treatment to suppress HIV and allow immune recovery. Close monitoring is important to assess treatment response and side effects. The goals of ART are to suppress viral replication, restore immune function, and improve quality of life. Adherence is key to achieve these goals.
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HAART, or highly active antiretroviral therapy, involves using a combination of antiretroviral drugs to treat HIV. The goals of ART include increased survival, improved quality of life, reduction of viral load, immune reconstitution, and limiting drug toxicity while maintaining treatment options and adherence. Commonly used drug classes include NRTIs, NNRTIs, integrase inhibitors, and protease inhibitors. Treatment involves monitoring viral load, CD4 count, adverse effects, and potential treatment failure or immune reconstitution inflammatory syndrome. Guidelines provide recommendations on treatment initiation and first, second, and third-line regimens for both adults and children.
Current Indian Guidelines for Antiretriviral Therapy 2012
The document outlines current Indian guidelines for antiretroviral therapy (ART). ART involves the use of combination drug regimens to suppress the HIV virus and improve health outcomes. The guidelines recommend initiating ART early, with preferred first-line regimens including tenofovir/emtricitabine plus efavirenz or nevirapine. Patients on ART require monitoring of viral load and CD4 counts, and clinicians must watch out for potential complications and drug interactions. ART should be changed if the initial regimen fails or becomes suboptimal due to toxicity, interactions or other issues.
Adults and Adolescents ART Guidelines AI.pptx
Adult ART according to the the new 2022 guidelines.Viral load monitoring now is categorized as target not detectable,low viraemia and high viraemia.EAC sessions now given to both low and high viraemia recipients of care and monthly repeat viral load is collected for monitoring.
Switching to second line is only done when there is high viraemia on the second repeat viral load after EAC sessions.
Urgent Care of Patients Receiving Cancer Immunotherapy: Recognition and Manag...
Urgent Care of Patients Receiving Cancer Immunotherapy: Recognition and Manag...PVI, PeerView Institute for Medical Education
Evan J. Lipson, MD, Andrew Stolbach, MD, MPH, and Trish Brothers, BSN, RN, OCN®, prepared useful practice aids pertaining to oncologic emergencies for this CME/MOC/CNE/CPE activity titled "Urgent Care of Patients Receiving Cancer Immunotherapy: Recognition and Management of Immune-Mediated Adverse Reactions in the ED." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at http://bit.ly/2TGpnYl. CME/MOC/CNE/CPE credit will be available until February 21, 2020.Cco treatment simplification_downloadable
This document discusses treatment simplification strategies for HIV management. It defines treatment simplification as changing an established effective therapy to reduce pill burden, dosing frequency, or other requirements to enhance tolerability. Optimal candidates are those with controlled viremia and no tolerability issues. Simplification strategies discussed include within-class changes like protease inhibitor substitutions and out-of-class changes such as switching from a protease inhibitor regimen to an NNRTI or integrase inhibitor. Clinical trials support the efficacy and safety of certain simplification approaches.
Tuberculosis Treatment Symposia - The CRUDEM Foundation
Tuberculosis Treatment Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
MDR/XDR by Dr Tasleem Arif
overview of MDR and XDR,the present approach towards MDR/XDR management,the ppt dedicated towards those who have been suffered at the hands of TB
Mdr, xdr by dr tasleem arif
The document discusses definitions, types, epidemiology, causes, and management of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). It defines MDR-TB as resistance to at least isoniazid and rifampicin, and XDR-TB as MDR-TB plus resistance to a fluoroquinolone and one second-line injectable drug. It notes that MDR-TB prevalence is highest in previously treated patients and discusses the role of laboratory testing in designing effective treatment regimens. It provides guidelines for managing MDR/XDR-TB, including using a combination of effective drugs and directly observed therapy.
Hiv.ppt
The document outlines national guidelines for antiretroviral therapy (ART) in India. It notes that India has the third highest number of people living with HIV globally. The goals of ART are to improve quality of life, reduce HIV-related illness and mortality, and suppress viral load. People are recommended to start ART if their CD4 count is below 350 or if they have WHO Stage 3 or 4 disease. First-line ART regimens typically include two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. Patients are monitored regularly after starting ART to assess clinical status, adherence, and CD4 count. Treatment is changed if adverse effects occur, if treatment fails to suppress viral load
Anti retroviral therapy in children
The document discusses management of HIV in children in India. It describes three cases: 1) a 2.5 year old girl with failure to gain weight and recurrent infections who should start ART based on her clinical staging and CD4 count, 2) a 6 year old boy with pulmonary tuberculosis who should start anti-TB treatment first before ART to reduce the risk of immune reconstitution inflammatory syndrome (IRIS), and 3) a 6 year old boy who developed anemia likely due to zidovudine toxicity and requires substitution of his antiretroviral regimen. The document provides guidelines on when to start ART in children, appropriate first-line regimens, managing drug toxicities and co-infections like tuberculosis,
HIV Salvage Therapy (Holden Young - Roseman University of Health Sciences)
HIV is a virus that attacks the immune system and can lead to AIDS if untreated. Salvage therapy involves using alternative treatment options for patients with multidrug-resistant HIV after previous treatments have failed or resulted in incomplete viral suppression. Two potential salvage therapy drugs are fostemsavir and ibalizumab, which work by blocking HIV's attachment to CD4 cells. Clinical trials found that both drugs led to decreases in viral load when added to optimized background regimens in treatment-experienced patients with multidrug-resistant HIV. Salvage therapy aims to maximally suppress the virus or reduce it to the lowest level possible.
Adult HIV: Preparation for antiretroviral treatment
Adult HIV was developed by doctors and nurses with wide experience in the care of adults with HIV, under the auspices of the Desmond Tutu HIV Foundation at the University of Cape Town. It covers: introduction to HIV infection, management of HIV-infected adults at primary-care clinics, preparing patients for antiretroviral (ARV) treatment, ARV drugs, starting and maintaining patients on ARV treatment, opportunistic infections
7. When to start ART (Eligibility)Rev.pptx
This document provides guidance on when to start antiretroviral therapy (ART) for people living with HIV. It discusses that ART should be initiated as soon as possible for eligible patients to achieve viral suppression and prevent clinical complications, but is not generally an emergency. It outlines the medical eligibility criteria for starting ART based on CD4 count and clinical stage for both adults and children. It also discusses important considerations for selecting an appropriate first-line regimen, including potential medical contraindications to specific antiretrovirals, as well as assessing non-medical barriers to adherence. The key steps are to evaluate if a patient meets medical criteria for treatment, has any medical reasons they cannot start first-line drugs, consider special situations like
Changing Anti-Retroviral Therapy
1. Mikael, a 28-year-old male with AIDS, was hospitalized for toxoplasmosis while on ART. A change in ART is recommended due to clinical treatment failure from a new opportunistic infection.
2. Factors to consider when changing ART include prior treatment history, resistance testing, side effects, adherence barriers, and monitoring procedures. Reasons for changing include treatment failure, toxicity, and co-morbidities like pregnancy or tuberculosis.
3. Yared, a 30-year-old man stable on ART for 4 years, shows immunologic and virologic treatment failure. Additional information is needed on his adherence and potential resistance before selecting an alternative regimen.
Hiv recent guidelines naco 2015
This document provides guidelines and statistics related to HIV and ART in India. It discusses:
- Global and national HIV prevalence statistics, with over 2 million people living with HIV in India.
- The national response to HIV/AIDS in India, including establishment of organizations and funding for prevention and treatment programs over time.
- Diagnosis of HIV infection, pre-ART care, CD4 count monitoring, and guidelines for primary opportunistic infection prophylaxis.
- Guidelines for initiation of ART based on CD4 count and clinical staging, including first-line ART regimens, management of HIV-TB co-infection, and changes to WHO recommendations over time.
- Potential immune reconstitution inflammatory syndrome (IR
Similar to 03.02 management of patients on antiretroviral drugs initiat (20)
Marking New Milestones With Immunotherapy in Locally Advanced and Early Lung ...
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Current Indian Guidelines for Antiretriviral Therapy 2012
Current Indian Guidelines for Antiretriviral Therapy 2012
Urgent Care of Patients Receiving Cancer Immunotherapy: Recognition and Manag...
Urgent Care of Patients Receiving Cancer Immunotherapy: Recognition and Manag...
Tuberculosis Treatment Symposia - The CRUDEM Foundation
Tuberculosis Treatment Symposia - The CRUDEM Foundation
HIV Salvage Therapy (Holden Young - Roseman University of Health Sciences)
HIV Salvage Therapy (Holden Young - Roseman University of Health Sciences)
Adult HIV: Preparation for antiretroviral treatment
Adult HIV: Preparation for antiretroviral treatment
More from David Ngogoyo
Unit 1 hiv and reproductive health
HIV and AIDS can have significant impacts on reproductive health. It can increase the risks of maternal and child morbidity and mortality. Pregnancy can also adversely affect the course of HIV by causing declines in CD4 counts during pregnancy. Stigma surrounding HIV/AIDS discourages women from accessing important antenatal care services and prevention of mother-to-child transmission interventions that could reduce transmission risks.
Unit 1 hiv and reproductive health
HIV and AIDS can have significant impacts on reproductive health. It can increase the risks of maternal and child morbidity and mortality. Pregnancy can also adversely affect the course of HIV by causing declines in CD4 counts during pregnancy. Stigma surrounding HIV/AIDS discourages women from accessing important antenatal care services and prevention of mother-to-child transmission interventions that could reduce transmission risks.
Unit 2 mtct and prevention strategies
The document discusses factors that increase mother-to-child transmission (MTCT) of HIV and strategies to reduce transmission. It states that MTCT can occur during pregnancy, labor and delivery, or postnatally through breastfeeding. Factors that increase risk include high maternal viral load, low CD4 count, advanced HIV disease, STIs, and certain delivery factors. The four key elements for prevention are preventing HIV infection in women, preventing unintended pregnancies in HIV-infected women, preventing transmission from mother to infant, and supporting mothers and families.
Unit 4 care of the hiv infected mother
The document discusses the care of HIV-infected mothers during pregnancy, labor, delivery, and postpartum, including the use of antiretroviral therapy (ART). It covers pre-pregnancy counseling, antenatal care, intrapartum care during delivery, and postpartum care of both mother and baby. The goal is to reduce mother-to-child transmission of HIV through various interventions during these stages, including ART, treatment of other infections, modified obstetric practices, and post-exposure prophylaxis for the newborn.
Unit 6 infant feeding and pmtct
The document discusses infant feeding and prevention of mother-to-child transmission (PMTCT) of HIV. It outlines national guidelines for HIV and infant feeding, including promoting exclusive breastfeeding for the first six months unless replacement feeding is acceptable, affordable, feasible, sustainable and safe. The risks and benefits of different infant feeding options like breastfeeding and replacement feeding are presented. Guidelines for counseling mothers on feeding choices and providing follow-up support are also described.
Unit 1 hiv and reproductive health
HIV and AIDS can have significant impacts on reproductive health. It can increase the risks of maternal and child morbidity and mortality. Pregnancy can also adversely affect the course of HIV by causing declines in CD4 counts during pregnancy. Stigma surrounding HIV/AIDS discourages women from accessing important antenatal care services and prevention of mother-to-child transmission interventions that could reduce transmission risks.
Unit 5 drug regimens for pmtct
The document describes various drug regimens used for the prevention of mother-to-child transmission (PMTCT) of HIV during pregnancy, childbirth, and postpartum. It discusses the use of antiretroviral therapy (ART) and prophylaxis with drugs like nevirapine and AZT to reduce transmission. Common regimens involve mothers taking antiretrovirals during late pregnancy and labor, and giving the infant prophylaxis after birth. The risks and benefits of different drug options are considered, as well as monitoring treatment to support both mother and child.
Unit 3 counseling for pmtct
The document discusses counselling and testing in the context of preventing mother-to-child transmission (PMTCT) of HIV. It covers the benefits of testing, approaches to testing such as opt-in and opt-out, algorithms for using multiple rapid HIV tests, diagnosing HIV in infants exposed to HIV, and the timing of testing including pre-pregnancy, antenatal, intrapartum, and postpartum. General information is also provided on confidentiality, the types of counselling given before and after testing, and working with couples to involve male partners.
Module 10 hiv and aids legal and ethical issues gsn
This document discusses the legal and ethical issues surrounding HIV/AIDS and antiretroviral therapy (ART) in Kenya. It covers several key topics: the linkages between HIV/AIDS, human rights, and public health; legal and ethical issues in HIV/AIDS testing, confidentiality, and discrimination; challenges in accessing affordable ART; and the roles and responsibilities of medical practitioners in administering ART while respecting patients' legal and ethical rights. Government guidelines and international standards are relied upon in the absence of comprehensive HIV/AIDS legislation in Kenya.
Module 10 hiv-aids legal & ethical issues
This document discusses various legal and ethical issues related to HIV/AIDS, including:
1. The linkages between human rights and HIV/AIDS, noting that human rights protections are important for reducing stigma and empowering at-risk groups.
2. Issues around HIV testing, confidentiality, and the roles of criminal law, highlighting the importance of voluntary testing and informed consent.
3. Ethical considerations regarding biomedical research on HIV/AIDS and the need to balance research advancement with human subject protections.
4. Special circumstances that raise complex issues, such as providing care to victims of rape or reducing mother-to-child transmission through antiretroviral treatment.
Module 9 adherence & psychosocial counselling
The document discusses adherence counseling for antiretroviral (ART) treatment. It defines adherence and describes how at least 95% adherence is needed to suppress viral loads and avoid resistance. Barriers to adherence like socioeconomic factors, mental health issues, and stigma are discussed. Effective counseling techniques are described to help patients overcome barriers, integrate medications into daily routines, and promote family support to improve long-term adherence.
Module 7 prevention of hiv
This document outlines various strategies for preventing HIV infection. It discusses biological, social, and occupational risk factors for HIV transmission and then describes several prevention strategies including voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), STI diagnosis and treatment, condom promotion, blood safety, harm reduction programs for intravenous drug users, advocacy, behavior change communication, and post-exposure prophylaxis (PEP). The overall goal is to reduce transmission by addressing risk factors and implementing multiple evidence-based prevention approaches.
Module 5 comprehensive care gsn
The document discusses comprehensive care for patients with HIV/AIDS, which should address physical, social, psychological/emotional, and spiritual needs. It emphasizes treating the whole person by considering their relationships and involving family/friends on a multi-disciplinary care team. The team should provide medical care, counseling, social support, rehabilitation, palliative care, and involve community services and support groups.
Module 8 nutrition and hiv 2
This document discusses the relationship between nutrition and HIV/AIDS, the goals and strategies for proper nutrition for people living with HIV/AIDS (PLWHA), their specific nutrient requirements, and how to manage AIDS-related symptoms and medication interactions through diet. The key points are:
1) Proper nutrition is important for PLWHA to maintain a strong immune system and delay the progression of HIV to AIDS. Their diets need to provide adequate energy, protein, fat, vitamins and minerals.
2) Nutrient requirements vary depending on disease stage but aim to prevent weight loss, malnutrition and related complications. Small, frequent meals and nutrient-dense snacks can help meet higher calorie and protein needs.
3) Diet
Module 4 hiv infection & art in children
This document provides an overview of managing HIV infected children. It covers the epidemiology and transmission of HIV in children, the natural progression of disease, diagnosis and staging, prevention and treatment of common HIV conditions, and antiretroviral therapy for children. Key points include mother-to-child transmission being the most common mode of transmission, diagnostic criteria involving virologic tests for children under 18 months and antibody tests after 18 months, and natural history patterns including rapid, intermediate, and slow disease progression in African children.
Participants workbook
This document provides instructions and case studies for trainees to practice completing comprehensive care clinic patient cards. The case studies describe two patients' visits to care clinics, including their medical history, test results, treatment, and progress. Trainees are asked to use the information from the case studies to fill out blank patient cards. They may find that some information is missing or extra from what is needed on the cards. The goal is to practice accurately documenting patient information for reporting and monitoring purposes.
Participants notes
The documents provide training materials for participants on Kenya's antiretroviral therapy (ART) program and data collection system. The training covers:
1) Background on Kenya's ART program and scale-up goals, challenges in providing treatment, and objectives of monitoring and evaluation.
2) Modules on collecting ART data through registers, cards, and reporting forms, and how the data flows through the system.
3) Calculation and interpretation of ART indicators to monitor program accessibility, success, support areas, and detect drug resistance.
The materials aim to familiarize participants with Kenya's national ART monitoring system and how to record and report patient data to track program performance.
Indicators manual
This document contains indicators and definitions for monitoring antiretroviral therapy (ART) programs in Kenya. It provides details on 14 indicators for tracking things like the entry points of patients enrolled in comprehensive HIV care, the percentage of positive patients referred from voluntary counseling and testing who register for care, and numbers of patients eligible for and starting ART. The goal is to monitor patient flows and identify areas where counseling, referral, and initiation of treatment can be improved to ensure all HIV-positive patients receive appropriate care and treatment.
Facilitators workbook
1. Use the pre-ART and ART registers to fill out measures on the monthly summary sheet, including the number of new patients enrolled in HIV care, cumulative patients ever enrolled, patients eligible but not started on ART, and patients started on ART or PEP this month.
2. The number of patients eligible but not started on ART is found by counting those in the pre-ART register with an eligibility date but no ART start date.
3. The number currently on ARVs is found by counting patients in the ART register with an ARV regimen listed for the terminal month.
4.
Facilitators guide
The HIV/AIDS situation in Kenya is serious. [1] Approximately 1 million Kenyans are currently living with HIV/AIDS out of the total population of 32 million. [2] It is estimated that 100,000 new adult infections and 30,000 new child infections occur annually. [3] HIV prevalence varies significantly by region, from 1% in North Eastern province to 15% in Nyanza province.
More from David Ngogoyo (20)
Module 10 hiv and aids legal and ethical issues gsn
Module 10 hiv and aids legal and ethical issues gsn
03.02 management of patients on antiretroviral drugs initiat
- 28. ART and TB: When to start Start anti-TB treatment Consider clinical status: start ART as appropriate CD4 count not available Start anti-TB treatment Start ART after completion of TB treatment CD4 count 200-350/mm 3 Start anti-TB treatment Start ART after intensive phase CD4 count 100-200/mm 3 Start anti-TB treatment Start ART as soon as possible CD4 <100/mm 3 Treatment Recommendation CD4 Count
- 40. Summary Schedule of Laboratory Monitoring X X 1 X (if on TDF) X X 6m X X X Fasting lipids & glucose (PIs) X X X X (if on NVP) X (if on NVP) X ALT(LFT) X 1 X 1 X 1 X 1 X 1 X Pregnancy test X (if on TDF X (if on TDF) X (if on TDF X (if on TDF) X (if on TDF) X Serum Creatinine X X X X (if on AZT) X (if on AZT) X CBC + Differential X X X X CD4 24m 18m 12m 3m 1-2 months Baseline Test
Editor's Notes
- Time to the lowest viral load attained depends on potency of drugs, adherence , pre-treatment viral load, , resistance, presence of OIs, drug pharmacokinetics
- * e.g pregnant mother in the first trimeatre with TB who requires both anti-TB and ARV treatment to be commenced. Less potent than standard dual class regimens ABC+3TC+AZT (Trizivir TM) Higher failure rates in patients with VL>10 5 , those with prior NRTI use Utility mainly in some cases of treatment simplification/ cases of drug interactions*/ switch for metabolic side effects New studies suggest that this is an area that needs further investigation DART trial CROI 2005 Boston- AZT+TDF+3TC achieved reasonable results in large cohort in Uganda and Zimbabwe. No comparator arm
- Much can be learned form the successful National TB programs which have incorporated use of standardized TB regimens. The success of National TB programs has been due to the simplification of treating many patients. In the last half of 2002 the Kenyan ARV task force made recommendations on standardized ARV regimens. The 1 st line regimen consisting of 2 nucleoside analogues namely stavudine and Lamivudine and Non-Nucleoside analogue either Nevirapine or Efavirenz. This first line regime if properly adhered to should be effective for at least 1 year The second line ARV regime is Protease Inhibitor based: Includes 2 Nucleoside analogues (which should not be in the 1 st line regimen) and a protease inhibitor either Kaletra which contains Lopinavir and ritonavir that boosts blood levels of Lopinavir the pother alternative PI is Nelfinavir. If this 2 regimens fail desinging a third is more difficult with a standardized apprach than an individualised one
- Alternative; TDF/AZT/Kaletra Nelfinavir can be used in case there is no cold storage for Kaletra. All pharmacies should have a refrigerator
- Based on observational studies using both clinical end points as well as surrogate markers (CD4/Viral load) the limitations of available medication CD4 count given greater weight as a determinant of when to start treatment. Outcome best if treatment is started at a CD4 count >200 cells/mm 3 Viral suppression achieved even when treatment started at low CD4 counts Phillips AN JAMA. 2001;286:2560-2567 Hogg et al JAMA 2001;286:2568-2577 Patients started on treatment using WHO GL Symptomatic patients benefit more from treatment than asymptomatic ones taking into account starting CD4 count
- All patients with a CD4 count < 200 should be started on treatment.
- X1: If clinically indicated Serum Creatinine not needed for standard 1 st line; required more regularly in patients on TDF. Red X are for tests necessitated by those particular drugs. Most patients can be adequately monitored 6 monthly and as clinically indicated