| Learning Objective #1: Understand the differences in efficacies of treatment options available for HIV-positive persons | |||
| Learning Objective #2: Understand the recommendations of the best combinations of Highly Active AntireTherapy (HAART) for HIV-positve persons, based on research and the latest guidelines |
Objective: The goal of this paper is to provide scientifically-based treatment guidelines for mid-level health care providers for the initiation of antiretroviral therapy in HIV-positive adults.
Design: An in-depth literature review was done of HIV clinical drug trial research reports and studies within scholarly health journals from 1997-2000. A comparative design was used to evaluate and compare the efficacies and adverse effects of antiretroviral treatments studied.
Population, Sample, Setting, Years: Within the studies reviewed, the populations included HIV-positive men and women, however, most studies only included treatment-naïve individuals. Most of the studies occurred in multiple healthcare settings and occurred over several years, varying from 1995-2000.
Intervention and Outcome Variables: The intervention variable being studied was antiretroviral therapy. The outcome variables for each study included HIV viral load and CD4 count.
Methods: A literature review and a comparative analysis of the studies was conducted. Then a table was generated to reflect antiretrovirals being studied, the sample, methodology, findings, and limitations. A written management protocol was developed for mid level providers based on the research findings and the Department of Health and Human Services 2001 guidelines.
Findings: Patients less than forty years old, who frequently missed clinic appointments, and injection drug-users were more at risk for treatment failure. Combinations of either, two nucleoside reverse-transcriptase-inhibitors (NRTI’s) and one protease inhibitor (PI) or two NRTI’s and a non-nucleoside reverse-transcriptase-inhibitor (NNRTI) demonstrated the greatest potency in producing a durable virologic response. Indinavir is a PI that was able to produce a favorable response with fewer side effects than other PI’s.
Conclusions: There are many non-medical factors to be considered before the initiation of antiretroviral therapy. HAART combinations of more than two NRTI’s have the greatest ability to produce a potent, sustained virologic response, decreasing viral loads to undetectable levels, especially when used as first-line therapy.
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Sigma Theta Tau International
10-12 July 2003