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Acquired immune deficiency syndrome (AIDS) is a chronic and progressive disease with multiple complications. Human immunodeficiency virus (HIV) infection and AIDS are managed with a variety of medications, each with its own specific mechanism of action (MOA) and related adverse effects.
End Stage Renal DIsease and HIV
End stage renal disease (ESRD) is also a chronic disease with multiple complications. However, when the two disease states are present in a single patient, proper management becomes increasingly complicated. One percent of ESRD cases in the United States can be contributed to HIV (Pastan & Bailey, 1998). Although this may not seem like a significantly large subset of patients, the population is growing, and more patients have been presenting with both AIDS and ESRD. Currently, there are three classes of approved antiretrovirals in the United States. The three classes include: nucleoside reverse transcriptase inhibitors (NRTIs); protease inhibitors (PIs); and the newest class, non-nucleoside reverse transcriptase inhibitors (NNRTIs). This article reviews the various HIV medications and their respective MOAs, adverse event profiles, and available dosing recommendations for patients receiving hemodialysis (HD).
Nucleo-side Reverse Transcript-ase Inhibitors
The NRTIs make up the first class of antiretroviral agents. These medications disrupt the reverse transcription process by incorporating themselves into the DNA virus. The newly formed but deficient DNA cannot produce a new virus. The agents in this class include: zidovudine (Retrovire), didanosine (Videx), zalcitabine (Hivid*), stavudine (Zerit), lamivudine (Epivir), lamivudine/ zidovudine (Combivir), and the newest NRTI, abacavir (Ziagen).
Dosing issues for NRTIs. The medications in this class are normally dosed two or three times a day without regards to food. However, didanosine differs in the fact that it must be taken on an empty stomach, and it may be dosed once a day in an attempt to enhance compliance ("Drugs for HIV infection," 2000). Most of the agents in this class require a decreased dose and/or an extended dosing interval in patients with renal insufficiency (Lacy, Armstrong, Goldman, & Lance, 1999). However, when administering NRTIs in a patient receiving HD, it is best to dose the NRTI after the HD session (Aronoff et al., 1999). Although there is no available information on the HD dosing of Combivir, due to the fact that the components of Combivir (zidovudine/lamivudine) are dosed after a...