Management
of HIV and AIDS
GOALS:
•Prompt treatment of HIV related diseases
•Prevention of HIV related diseases
•Control of HIV infection
•Restoration of immune status
•Provision of psychosocial support
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Goal: Prompt Treatment of HIV Related
Diseases
• Is the patient symptomatic or asymptomatic?
• Complete history and physical examination
• Include baseline neurologic and mental status exam
and valuation of risky behavior
• Fever? Lymphadenopathies? Cough? Neurologic
symptoms? Retinitis (floaters, retinal,
exudates/hemorrhage), oral thrush? Dysphagia?
Diarrhea? Weight Loss?
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Goal: Prompt Treatment of HIV related
Diseases
•Are the symptoms AIDS related?
•Evaluate immune status
• Tools for immune status evaluation
• CD4+ T call count
• Clinical Condition
• WBC
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Screen for common conditions
▪ Tuberculosis
▪ Hepatitis B infection (HBs Ag)
▪ STI
▪ Pap smear (for females)
▪ Other screening tests (CBC, urinalysis, stool
exam)
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Prevention of HIV related diseases
Provide prophylaxis against opportunistic infection
▪ Isoniazid Preventive Therapy (IPT)
▪ Co-trimoxazole Preventive Therapy
▪ Mycobacterium avium complex (MAC)
Health Promotion
• Balance diet
• Sleep and rest
• Exercise
• Vaccine
• Healthy lifestyle
• Prevention of STIs
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Control of HIV infection and restoration
of immune status
ARV therapy (based on Philippine DOH
guidelines)
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
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HIV Replication Cycle
Fusion
Inhibitor
Enfuvirtide
(ENF, T- 20)
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HIV Replication Cycle
CCR5 Antagonist
Maraviroc (MVC)
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REV0601 HIVM SLS08
HIV Replication Cycle
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REV0601 HIVM SLS08
HIV Replication Cycle
Reverse transcriptase inhibitors
1. Nucleoside reverse transcriptase
inhibitors (NRTI)
Tenofovir (TDF)
Zidovudine (AZT, ZDV)
Abacavir (ABC)
Lamivudine (3TC)
Emtricitabine (FTC)
2. Non-nucleoside reverse
transcriptase inhibitore (NNRTI)
Efavirenz (EFV)
Nevirapine (NVP
Rilpivirine
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HIV Replication Cycle
Integrase
Inhibitor
Raltegravir
(RAL)
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HIV Replication Cycle
Protease inhibitors (PI)
Lopinavir (LPV)
Darunavir (DRV)
Ritonavir (RTV)
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Limitations ART
▪ Not curative (latent infected cells)
▪ HIV drug resistance and intra-class cross
resistance
▪ Short term and long term toxicities
Rationale for ART
• Effective ART with virologic suppression improves and preserves immune
function in most patients, regardless of baseline CD4 count
• Earlier ART initiation may result in better immunologic responses
and clinical outcomes
• Reduction in AIDS- and non-AIDS-associated morbidity and mortality
• Reduction in HIV-associated inflammation and associated
complications
• ART strongly indicated for all patients with low CD4 count or
symptoms
• ART can significantly reduce risk of HIV transmission (PREVENTION)
• Recommended ARV combinations are effective and
well tolerated
May 2014 www.aidsetc.org
Goal of treatment guideline
• To ensure that ARVs are being given SAFELY – toxicity,
immune reconstitution diseases
And
• EFFECTIVELY – durable response, prevention of HIV
drug resistance
Tools to Achieve Treatment Goals
•Selection of ARV regimen
•Maximizing adherence – > 95%
•Pretreatment resistance testing
May 2014 19 www.aidsetc.org
How to Start ART SAFELY and EFFECTIVELY
1. Prevent / minimize toxicity
2. Prevent IRID
3. Prevent HIVDR
4. FIRST LINE FOREVER
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
How to START ART SAFELY and EFFECTIVELY
Is the patient physically ready to START ARV?
▪ Prophylaxis (IPT, CPTP
▪Treatment of Co-infection
CMV (fundoscopy)
Cryptococcosis (blood CALAS)
Tuberculosis – within 2 weeks
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
How to START ART SAFELY and EFFECTIVELY
Is the patient psychologically / emotionally ready
to start ARV?
• Discuss and resolve issues concerning being HIV
positive (survival, work / workplace, education /
career, disclosure, relationship, self-esteem, etc.)
Asymptomatic
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
Adherence counseling
• Success of ARV therapy largely depends on patient’s
adherence to treatment
• 95% adherence rate prevents development of drug
resistance
• Conduct adherence counseling before and during treatment
• Benefits of treatment
• Management of possible side effects
• Adherence issues
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
END
NATIONAL HIV, AIDS and STI PREVENTION AND CONTROL PROGRAM
