Page 7 - Nursing Matters June 2021 Vol 12

current issues

(NTDs) with DTG use in early pregnancy. (EFV), RAL, darunavir and ritonavir- has proven more tolerable than EFV, a
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Whilst the most recent data shows no boosted atazanavir, as well as several drug dominating first-line ART in South
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statistically significant difference in the treatment-switch studies in patients failing Africa for many years, allowing for better
prevalence of NTDs in infants of women first-line ART. 12–14 Additionally, clinical adherence with its use.
on DTG compared with those on non- trials are underway using DTG in a two-
DTG regimens, weight gain with DTG drug treatment regimen in efforts to What is a viral load (VL)?
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use remains a concern. InSTI-related decrease long-term drug exposure and
weight gain was first noted in mid-2018 toxicity. Viral load is a well-recognised marker of
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and thought to be a drug class side HIV control and a vital part of monitoring
effect. As evidence emerged, it became In 2019, the South African Department a patient’s response to ART. The lower the
clear that certain drugs were more likely of Health published updated ART viral load result, the better a patient’s HIV
to result in weight gain than others. DTG, clinical guidelines, which included DTG control with resultant relief offered to the
it appears, is the main culprit, followed as an option for first, second and third- immune system.
closely by RAL. Available data shows line ARV regimens. The primary goals
women, particularly those of African of ART continue to place emphasis on Undetectable viral loads imply that ART
descent, are at increased risk of weight the reduction of HIV-related conditions has reduced the number of HIV particles
gain, as well as those with lower CD4 (including opportunistic infections such in a patient’s bloodstream to such a low
cell counts and higher viral loads at as tuberculosis), minimisation of the level that it can no longer be detected by
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ART initiation. In addition, concomitant development of resistance to ARVs, and standard blood tests. Whilst important
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tenofovir alafenamide fumarate (TAF) improvement in patients’ quality of life. to emphasise that this does not imply
use (a kidney friendly alternative to These goals align with the UNAIDS cure from HIV, it does indicate that viral
TDF) appears to further amplify weight 90-90-90 targets that aim to have the levels in the body are low enough to
gained. majority of PLWH test to confirm their prevent transmission through sex and
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status, be effectively linked to care and HIV is unlikely to be transmitted from a
Dolutegravir has proven beneficial readily initiate ART to achieve viral pregnant mother to her unborn child. This
in multiple randomised control trials, suppression. DTG has proven crucial in suppression, however, is not permanent,
justifying its use in PLWH who are both attempting to achieve and maintain viral and should patients stop or interrupt ART,
ART naïve and experienced. These suppression, and in doing so reduce the viral load will once again increase,
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include trials comparing DTG to efavirenz HIV-related mortality. In addition, DTG making HIV transmittable. 18

HIV Nursing Matters | June 2021 | page 5