HIV/AIDS

Elaine Kauschinger PhD, MS, ARNP, FNP-BC

Assistant Professor of ClinicalLead Faculty, Family Nurse Practitioner Program

University of MiamiSchool of Nursing & Health Studies

Part 3: Clinical Management of HIV Infection

Natural History of HIV Infection

MOST HIGHLY

INFECTIOUS INFECTIOUS

SERO-

EXPOSURE -> CONVERSION-> ASYMPOMATIC-> SYMPOMATIC-> AIDS-> DEATH

0-3 months

2-6 months

8-10 years 2-3 years

10-20 years

Time (in years)

CCR5 Antagonist Mechanism of Action

Fusion Inhibitor Mechanism of Action

Highly Active Antiretroviral Therapy (HAART)

6 classes of HIV medications:Nucleoside/nucleotide analogs (“nukes”)

Nonnucleoside reverse transcriptase inhibitors (NNRTI’s) (“non-nukes”)

Protease inhibitors (“PI’s”)

Fusion entry inhibitors

CCR5 Inhibitors

Integrase Inhibitors

Treatment Key….YNEED THREE!

(Three drugs))

DHHS Guidelines: When to Initiate Medications

All patients with a CD4 counts between 350 & 500 cells/mm3

All patients with a history of an AIDS-defining illness or with a CD4 count <350 cells/mm3

Patients with CD4 counts >500 cells/mm3 • 50% of panel recommendation therapy while

50% view therapy as optional – NA-ACCORD study; ART Cohort Collaboration

Please continue to part 3