Antiretrovirals for HIV/AIDS: Integrase Strand Transfer Inhibitors

Overview

• Antiretrovirals treat infections from retroviruses, including HIV.
• Integrase strand transfer inhibitors (INSTIs) are a key class of antiretrovirals.
• INSTIs end in the suffix '-gravir'.

Common Drugs

• Raltegravir (Isentress)
• Dolutegravir (Tivicay)
• Elvitegravir (Vitekta)
• Bictegravir (Part of Biktarvy)

Mechanism of Action

• Integrase inhibitors block HIV integrase enzyme.
• Prevents viral genome integration into host DNA.
• Stops viral replication.

Indications

• Used in combination with other antiretrovirals to treat HIV.

Administration

• Taken orally (PO).

Side Effects

• Common: Headache, insomnia, nausea, vomiting, diarrhea, elevated liver enzymes.
• Specific:
  • Raltegravir: Hyperglycemia, rhabdomyolysis.
  • Dolutegravir: Hyperglycemia, acute liver failure.
  • Elvitegravir: Acute liver failure, depression, suicidal ideation.

Contraindications & Precautions

• Caution in pregnancy and breastfeeding.
• Avoid in children and those with hepatic or renal impairment.

Nursing Considerations

Assessment & Monitoring

• Assess symptoms: fatigue, fever, mental status changes.
• Check for opportunistic infection and nutritional status.
• Monitor weight, vital signs.
• Review lab results: CD4 count, HIV RNA levels, CBC, glucose, liver and renal function, CK levels.
• Evaluate therapeutic response: improved CD4 count, decreased HIV RNA, enhanced immune function.

Client Education

• Purpose: Prevents HIV replication; not a cure.
• Take consistently, twice daily, with or without food.
• Oral suspension instructions: Use mixing cup, add to 10 mL water, swirl gently, consume within 30 minutes.
• Develop medication schedule.
• Monitor side effects and report severe symptoms like rhabdomyolysis or hypersensitivity reactions.

Authors and Contributors

• Evode Iradufasha, MD
• Elijah Lee, MScBMC
• Content Reviewers: Antonella Melani, MD; Lisa Miklush, PhD, RNC, CNS; Gabrielle Proper, RN, BScN, MN

Additional Information

• INSTIs are part of the broader antiretroviral therapy (ART) regimen.
• They play a critical role in managing HIV/AIDS by inhibiting key viral processes.

Important Reminders

• Regular monitoring and adherence to the medication regimen are crucial for effectiveness.
• Patient education is essential to ensure adherence and manage expectations regarding treatment outcomes.