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P A R T 2  Chemotherapeutic agents

The evidence

BOX 10.3

infected with HIV are urged not to breastfeed. Teno­ fovir, zidovudine and emtricitabine should be used with caution in the presence of hepatic dysfunction or severe renal impairment. Zidovudine should also be used with caution with any bone marrow suppression. Adverse effects Serious-to-fatal hypersensitivity reactions have occurred with abacavir, and it must be stopped immediately at any sign of a hypersensitivity reaction (fever, chills, rash, fatigue, GI upset, flu-like symptoms). Serious pancreatitis, hepatomegaly and neurological problems have been reported with didanosine, which is why its use is limited to the treatment of advanced infections. Emtricitabine has been associated with severe and even fatal hepatomegaly with steatosis. Severe hepatomegaly with steatosis has been reported with tenofovir, so it must be used with extreme caution in any individual with hepatic impairment or lactic acidosis. People also need to be alerted that the drug may cause changes in body fat distribution, with loss of fat from arms, legs and face and deposition of fat on the trunk, neck and breasts. Severe bone marrow suppression has occurred with zidovudine. Clinically significant drug–drug interactions Tenofovir can cause large increases in the serum level of didanosine. If both of these drugs are given, tenofovir with repeated exposures to infections that naturally deplete the immune system. It was not until several years later that the human immunodeficiency virus (HIV) was identified. Since then, it has been discovered that HIV infection is rampant in many African countries. The infection has also spread throughout Australia and New Zealand in populations that are not homosexual or intravenous drug users and who have good nutrition and hygiene habits. As healthcare practitioners have learned, HIV is not particular about the body it invades. Once introduced into a body, it infectsT cells and causes HIV infection. The evidence shows that when a person is diagnosed with HIV infection, the health professional faces a tremendous challenge in providing education and support.The person and any significant others should be Public education about AIDS When AIDS was first diagnosed in the early 1980s, it was found in a certain population in NewYork City.The people in this group tended to be homosexuals, intravenous drug users, and debilitated persons with poor hygiene and nutrition habits. Originally, a number of healthcare practitioners thought that the disease was a syndrome of opportunistic infections that occurred in a population

should be given 2 hours before or 1 hour after didano- sine. Severe toxicity can occur if abacavir is combined with alcohol; this combination should be avoided. Didanosine can cause decreased effects of several anti- biotics and antifungals; any antibiotic or antifungal started with didanosine should be evaluated carefully. There is an increased risk of potentially fatal pancreatitis if stavudine is combined with didanosine and increased risk of severe hepatomegaly if it is combined with other symptomatic HIV infection in combination with other antiretrovirals; prevention of maternal–fetal HIV transmission. Actions: A thymidine analogue that is activated to a triphosphate form, which inhibits the replication of various retroviruses, including HIV. Pharmacokinetics: Route Onset Peak Oral Varies 30–90 minutes IV Rapid End of infusion T 1/2 : 30 to 60 minutes; metabolised in the liver and excreted in the urine. Adverse effects: Headache, insomnia, dizziness, nausea, diarrhoea, fever, rash, bone marrow suppression. counselled about the risks of transmission and reassured about ways in which the virus is not transmitted.They will need to learn about drug protocols,T-cell levels, adverse drug effects and anticipated progress of the disease.They also will need consistent support. Many communities have AIDS support groups and other resources that can be very helpful; the health professional can direct the person to these resources as appropriate. The combinations of drugs that are being used today and the constant development of more drugs make the disease less of a death sentence than it was in the past. The result, however, is that many people must take a large number of pills each day, at tremendous cost and inconvenience. Many people today do live for long periods with HIV infection. An AIDS vaccine is currently being studied and offers hope for preventing this disease in the future. Public education is key for promoting the acceptance and care of people with HIV infection or AIDS, who need a great deal of support and assistance. Health professionals can be role models for dealing with people with HIV and can provide informal public education whenever the opportunity presents. Prototype summary: Zidovudine Indications: Management of adults with