No abstract

Treatment for HIV infection in the past 3 years has significantly improved the prognosis of people infected with HIV. Protease inhibitors have played a critical role in this improved prognosis. Recent findings indicate, however, that protease inhibitors may cause significant alterations in lipid metabolism. This study reviewed the incidence of lipid abnormalities associated with the use of three different protease inhibitor therapies and identified that 56% of those who were assessed had abnormal elevated lipids. Following initiation of the protease inhibitor, a significant increase in cholesterol was found in 80% of the patients on norvir/saquinavir, 51% of patients on indinavir, and 47% of patients on nelfinavir. These lipid alterations have added a new and unexpected health risk for HIV-infected persons. The risks of therapy with protease inhibitors may have a greater life-threatening potential than the disease itself. This article will review the published findings suggestive of protease inhibitor hyperlipidemia and will highlight the findings of these events in a clinical setting. The purpose of this article is to alert the nursing community of this potential serious side effects and to make recommendations that may be put into practice so that complications may be reduced.

In the past 3 years, treatment for HIV infection has significantly improved the prognosis for HIV-infected persons. The administration of protease inhibitors for the treatment of HIV infection has had a significant role in the reduction of AIDS-related complications. Recent findings have indicated that protease inhibitors may significantly increase lipids to levels that pose a health risk that may be greater than the illness itself. This article reviews the initial findings of a study that investigated the impact of interventions for the treatment of protease inhibitor-related hyperlipidemia. The purpose of the study was to determine if initiation of interventions based on the National Cholesterol Education Program Guidelines would be effective in lowering protease inhibitor-related hyperlipidemia without disrupting the effectiveness of the HIV therapy. A total of 45 HIV-infected individuals who were taking a protease inhibitor and had abnormally elevated lipids were enrolled into this study. Mean serum cholesterol level prior to initiation of a protease inhibitor regimen was 170 mg/dl as compared to a mean cholesterol at time of enrollment of 289 mg/dl and triglycerides of 879 mg/dl. Interventions included diet and exercise and the prescription of gemfibrozil alone or in combination with atorvatstatin. During the course of the study, overall intervention significantly reduced serum cholesterol level to 201 mg/dl (p. 01) over a study period of ten months. Case studies of five medical events related to hyperlipidemia are included. Currently, 26 participants continue in the study. Sixteen participants discontinued protease inhibitor therapy during the course of the study and thus ended their participation.

Assessment of the status and prognosis of an HIV-infected individual traditionally has been difficult for the clinician. The use of markers of disease progression such as CD4+ has been found to not be a complete indicator of the status of an HIV-infected individual. As a result, determining appropriate therapy for the treatment of this viral infection has been both unpredictable and challenging. Recent development of a laboratory assay has brought a new tool in the management of HIV. The assay is a quantitation of the amount of detectable HIV RNA and estimates the amount of HIV viral load or HIV viral burden present in the blood. Since the development of this assay, HIV RNA quantitation has rapidly become an important surrogate marker of HIV infection. In addition, this quantitation is used to determine the effectiveness of anti-HIV therapies. Understanding the differences and results of quantitative assays is imperative in the management of HIV-infected patients. This article summarizes the events leading to the creation of quantitative assays, explanations and comparisons of the current quantitative assays, and nursing considerations for the implications and uses of viral load markers.