Highly Active Antiretroviral Therapy (HAART) involves using a combination of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease. HAART decreases the viral load, improves immune function, and prevents opportunistic infections. The goals of HAART are to prolong life, improve quality of life, maximize viral suppression, and reconstitute the immune system. Current guidelines recommend starting HAART for all HIV patients regardless of CD4 count. Proper counseling, adherence, monitoring, and management of side effects are important for the success of HAART.
MANAGEMENT OF HIV FALLS UNDER THREE MAJOR CATEGORIES
1.POST EXPOSURE PROPHYLAXIS(P.E.P)
2.TREATMENT/MANAGEMENT OF HIV-AIDS
3.TREATMENT OF ADJOINING CONDITIONS
eg-
-Fungal Infections
-Bacterial infections
-Viral infections
-NEOPLASIAS
-misc.( recurrent apthos ulcers, xerostomia,salivary G. enlargement)
Lizzy Schmidt, Director of the Woman's Program at Philadelphia FIGHT's Jonathan Lax Center, presented on HIV Treatment and PrEP at the June 2015 Ryan White Part A Planning Council meeting.
MANAGEMENT OF HIV FALLS UNDER THREE MAJOR CATEGORIES
1.POST EXPOSURE PROPHYLAXIS(P.E.P)
2.TREATMENT/MANAGEMENT OF HIV-AIDS
3.TREATMENT OF ADJOINING CONDITIONS
eg-
-Fungal Infections
-Bacterial infections
-Viral infections
-NEOPLASIAS
-misc.( recurrent apthos ulcers, xerostomia,salivary G. enlargement)
Lizzy Schmidt, Director of the Woman's Program at Philadelphia FIGHT's Jonathan Lax Center, presented on HIV Treatment and PrEP at the June 2015 Ryan White Part A Planning Council meeting.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
1. D R A B H I S H E K K G U P T A
Highly Active Antiretroviral
Therapy (HAART)
2. Introduction
The use of multiple drugs that act on different viral
targets is known as highly active antiretroviral
therapy (HAART)
HAART decreases the patient's total burden of HIV,
maintains function of the immune system, and
prevents opportunistic infections that often lead to
death
3. History
The first effective therapy against HIV was the nucleoside
reverse transcriptase inhibitor (NRTI) zidovudine (AZT)
To distinguish from this early anti-retroviral therapy (ART),
the term highly active anti-retroviral therapy (HAART) was
introduced
Hammer and colleagues and Gulick and co-
investigators illustrating the substantial benefit of
combining 2 NRTIs with a new class of anti-
retrovirals, protease inhibitors, namely indinavir. This
concept of 3-drug therapy was quickly incorporated into
clinical practice and rapidly showed impressive benefit with
a 60% to 80% decline in rates of AIDS, death, and
hospitalization.
4. Goals of Antiretroviral Therapy
The currently available ARV drugs cannot eradicate
the HIV infection from the human body
Clinical goals : Prolongation of life and improvement
in quality of life
Virological goals : Greatest possible reduction in
viral load for as long as possible
Immunological goals : Immune reconstitution that is
both quantitative and qualitative
Reduction of HIV transmission in individuals :
Reduction of HIV transmission by suppression of
viral load
5. Therapeutic goals : Rational sequencing of drugs in a
fashion that achieves clinical, virological and
immunological goals while maintaining treatment
options, limiting drug toxicity and facilitating
adherence
9. Current guidelines: when to start ART
Current US DHHS guidelines (published April 8,
2015) state:
Antiretroviral therapy (ART) is recommended for all
HIV-infected individuals to reduce the risk of disease
progression.
AIDS-defining condition
Pregnancy
Symptomatic from HIV including any of the
following:
1. HIV-associated neurocognitive disorder (HAND)
10. 2. Severe thrombocytopenia
3. HIV-associated nephropathy
4. HIV-related malignancies
5. Chronic hepatitis B or C infection and,
6. Age 50 or older
Patients with seronegative partners should be
counselled
Decisions to initiate ART should be individualized,
particularly for long-term nonprogressors or and for
patients with potential barriers to adherence
11. Current World Health Organization guidelines
(dated June 30, 2013)
Initiate ART if CD4 cell count ≤500 cells/ml
• As a priority, initiate ART in all individuals with
severe/advanced HIV disease (WHO clinical stage 3 or 4)
or CD4 count ≤ 350 cells/mm
Initiate ART regardless of WHO clinical stage or CD4 cell
count in
• Active TB disease
• HBV co-infection with severe chronic liver disease
• Pregnant and breastfeeding women with HIV
• HIV-positive individual in a serodiscordant partnership
(to reduce HIV transmission risk)
12. When to start ART in Adults and Adolescents
WHO Clinical Stage WHO Clinical Stage
HIV infected Adults & Adolescents (Including pregnant women)
Clinical Stage I and II Start ART if CD4 < 350 cells/mm3
Clinical Stage III and IV Start ART irrespective of CD4 count
For HIV and TB co-infected patients
Patients with HIV and TB co-infection
(Pulmonary/ Extra-Pulmonary)
Start ART irrespective of CD4 count
and type of tuberculosis (Start ATT
first, initiate ART as early as possible
between 2 weeks to 2 months when TB
treatment is tolerated)
For HIV and Hepatitis B and C co-infected patients
-Without any evidence of chronic
active Hepatitis
Start ART if CD4 < 350 cells/mm3
-With documented evidence of chronic
active Hepatitis
Start ART irrespective of CD4 count
13. Counseling and Education Before
Initiating ART
RECOMMENDATIONS: Counselling and education
should include the following:
Basic education about HIV, CD4 cells, viral load, and
resistance
Available treatment options and potential risks and
benefits of therapy
The need for strict adherence to avoid the
development of viral drug resistance
Use of safer-sex practices and avoidance of needle-
sharing activity, regardless of viral load, to prevent
HIV transmission or super-infection
14. BENEFITS AND RISKS OF EARLY ART IN
ASYMPTOMATIC HIV-INFECTED PATIENTS
Early therapy = initiation at CD4 counts >500
cells/mm3 )
Benefits of early therapy
Earlier treatment reduces both HIV-related and non-
HIV-related morbidity and mortality
Delay or prevention of immune system compromise
Possible lower risk of antiretroviral resistance
Decreased risk of sexual transmission of HIV
15. Disadvantages of early therapy
Potential drug-related reduction in quality of life in
otherwise asymptomatic individuals
Possibility of greater cumulative side effects from
ART
Possibility for earlier development of drug resistance
and limitation in future antiretroviral options if
adherence and viral suppression are suboptimal
Possibility for earlier onset of treatment fatigue
Higher prescription drug costs for the individual
16. Potential barriers to adherence include:
Communication difficulties that arise when the
patient’s attitude about disease and therapy is
different from that of the provider’s. Without open
and nonjudgmental communication from the
healthcare team, patients may not trust or may
misunderstand the prescribed regimen
Language or literacy barriers
Unstable living situations (including limited or absent
social support)
Discomfort with disclosure of HIV status, which may
become known when medications are taken
17. Inability to set long-term goals
Inadequate knowledge about disease and
effectiveness of medications or healthy living,
including a patient’s lack of belief in his/her ability
to take medications regularly
Difficulty accessing adequate healthcare
Housing, food, lack of childcare, or other immediate
life needs, which are viewed as more pressing than
taking the medications regularly
19. VIROLOGIC AND IMMUNOLOGIC MONITORING FOR NON-PREGNANT PATIENTS
HIV RNA Levels
(copies/mL)
CD4 Lymphocyte Count
(cells/mm3 )
Baseline
All patients Yes Yes
Treatment Monitoring
Following: (1) initiation
of ART or (2) a change in
ART regimen after
virological failure with
new resistance to prior
ART
Within 4 weeks of
initiation of ART or
change in regimen.
At least every 8 weeks
until complete
suppression is
documented
Repeat at 12 weeks and
then every 4 months until
CD4 >200 cells/mm3 on
two measurements
obtained at least 4 months
apart, then monitor as
below once suppressed
Following a change in
ART to simplify
treatment regimen or
reduce toxicity for
patients with suppressed
virus
Within 4 weeks after
change in regimen
Monitor as below for
suppressed
20. Patients on ART who
achieve complete
suppression
At least every 4 months
after complete
suppression .
May extend intervals to
every 6 months in
selected stable patients
with CD4 counts >200
cells/mm3 after 1 year
of complete suppression
If CD4 300 to 500
cells/mm3 :At least
every 6 months .
If CD4 >300 to 500
cell/mm3:At least every
12 months.
If CD4 >500 cells/mm3
:further monitoring is
optional
Patients Not on ART:
all HIV-infected
patients should be
offered ART regardless
of CD4 count
If CD4 ≤500 cells/mm3:
At least every 4 months
If CD4 >500 cells/mm3:
At least every 6 months
If CD4 ≤500
cells/mm3: At least
every 4 month.
If CD4 >500 cells/mm3:
At least every 6 month
21. HIV Resistance Assays
Clinicians should perform resistance testing under
the following circumstances:
At baseline, regardless of whether ART is being
initiated (genotypic testing)
In patients experiencing treatment failure or
incomplete viral suppression while receiving ART
(genotypic and/or phenotypic testing)
Genotypic assays detect mutations in the genes of the
reverse transcriptase and protease enzymes, as well
as the gp41 domain for the currently available fusion
inhibitors
22. Phenotypic assays directly measure susceptibility of
the patient’s HIV strain to specific individual drugs
compared to sensitive HIV
23. Classes of drugs
There are five classes of drugs, which are usually used
in combination, to treat HIV infection
1. Nucleoside reverse transcriptase inhibitors
(NRTI) and nucleotide reverse transcriptase
inhibitors (NtRTI)- are nucleoside and nucleotide
analogues which inhibit reverse transcription. HIV is
an RNA virus and hence unable to become integrated
into the DNA in the nucleus of the human cell; it
must be "reverse" transcribed into DNA. Since the
conversion of RNA to DNA is not done in the
mammalian cell it is performed by a viral protein
which makes it a selective target for inhibition.
24. NRTIs are chain terminators such that once
incorporated, work by preventing other nucleosides
from also being incorporated into the DNA chain
because of the absence of a 3’ OH group. Both act
as competitive substrate inhibitors. Examples of
currently used NRTIs includes Zidovudin, Abacavir,
Lamivudine, Emtricitabine and tenofavir.
2. Non-Nucleoside reverse transcriptase
inhibitors (NNRTI)- Inhibit reverse
transcriptase by binding to an allosteric site of the
enzyme; NNRTIs act as non-competitive
inhibitors of reverse transcriptase
25. NNRTIs can be further classified into 1st generation and
2nd generation NNRTIs.
1st generation NNRTIs include Nevirapine and
Efavirenz.
2nd generation NNRTIs are Etravirine and Rilpivirine.
HIV-2 is naturally resistant to NNRTIs.
3. Protease inhibitors- block the viral protease enzyme
necessary to produce mature virions upon budding
from the host membrane. Particularly, these drugs
prevent the cleavage of gag and gag/pol precursor
proteins
26. Examples of HIV protease inhibitors are Lopinavir,
Indianavir, Nelfinavir, Amprenavir and Ritonavir.
Darunavir and Atazanavir are currently recommended
as first line therapy choices.
Resistance to some protease inhibitors is high.
4. Integrase inhibitors (also known as integrase
nuclear strand transfer inhibitors or INSTIs)-
Raltegravir became the first to receive FDA
approval in October 2007. As of early 2014, two
other clinically approved integrase inhibitors
are elvitegravir and dolutegravir.
27. Entry inhibitors- (or fusion inhibitors) interfere
with binding, fusion and entry of HIV-1 to the host
cell. Maraviroc and enfuvirtide are the two currently
available agents in this class.
Maraviroc works by targeting CCR5, a co-receptor
located on human helper T-cells.
Enfuvirtide is a peptide drug that must be injected
and acts by interacting with the N-terminal heptad
repeat of gp41 of HIV to form an inactive hetero six-
helix bundle, therefore preventing infection of host
cells.
28. Regimens
Most current HAART regimens consist of three drugs:
2 NRTIs ("backbone")+ a PI/NNRTI/INSTI ("base").
Initial regimens use "first-line" drugs with a high efficacy
and low side-effect profile.
The US DHHS preferred initial regimens for adults and
adolescents in the United States, as of April 2015, are:
tenofovir/emtricitabine and raltegravir (an integrase
inhibitor)
tenofovir/emtricitabine and dolutegravir (an integrase
inhibitor)
abacavir/lamivudine (two NRTIs) and dolutegravir for
patients who have been tested negative for the HLA-
B*5701 gene allele
29. tenofovir/emtricitabine, elvitegravir (an integrase
inhibitor) and cobicistat (inhibiting metabolism of
the former) in patients with good kidney function
(gfr > 70)
tenofovir/emtricitabine, ritonavir,
and darunavir (both latter are protease inhibitors)
The WHO preferred initial regimen for adults and
adolescents as of June 30, 2013 is:
tenofovir + lamivudine (or emtricitabine) + efavirenz
30. For Children
The WHO & DHHS recommends for children less
than 3 years:
abacavir (or zidovudine) + lamivudine + lopinivir/
ritonivir
For children 3 years to less than 10 years and
adolescents <35 kilograms:
abacavir + lamivudine + efavirenz
43. Do not start ART in the presence of an active OI. In
general, OIs should be treated or stabilized before
commencing ART. Mycobacterium avium complex
(MAC) and progressive multifocal
leukoencephalopathy (PML) are exceptions, in
which commencing ART may be the preferred
treatment.
Manage OIs before Starting
ART
48. HIV and Hepatitis Co-infection
HIV modified the natural history of HBV infection,
higher rate of progression to advance liver disease
among co infection.
Choice of ART- ARV with anti HBV activity such as
3TC and TDF
First line regime- TDF + 3TC +EFV
Alternative – AZT+ 3TC+EEV
No ARV drugs are active against HCV infection , but
they decline the progression
51. Second line regime
A second-line regimen should be recommended only
by CoE/ ART plus Centre.
When failure has been identified clinically or
immunologically, many patients can be expected to
have significant NRTI resistance at the time of
switching
Cross resistance exists between d4T and AZT; thus
NRTI-component in the second-line regimens should
be either ddI/ABC or TDF/ABC.
High level AZT/3TC resistance reduces susceptibility
to ABC.
52. NNRTI (such as EFV and NVP): usually there is
complete cross-resistance
56. Final words
HIV care requires, as always, partnerships and open
communication. The provider can make
recommendations most likely to lead to positive
outcomes only if the patient's own point of view and
social context are well known.
Guidelines are only a starting point for medical
decision making. They can identify some of the
boundaries of high-quality care but cannot substitute
for sound judgment.