Reference — Pharmacology
HIV Antiretroviral Therapy Reference
ART combines drugs from different classes to attack HIV at multiple points in its life cycle. Nurses don’t pick the regimen, but they carry the adherence message, catch the interactions, and recognize the side effects — the three places ART succeeds or fails.
Educational use only. Specific regimens, dosing, and prophylaxis decisions are provider- and guideline-directed and change over time; verify against current references. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Major Drug Classes
| Class | Examples | Notes |
|---|---|---|
| NRTIs (nucleoside RT inhibitors) | Tenofovir, emtricitabine, abacavir, lamivudine | Backbone of most regimens; abacavir needs HLA-B*5701 screening for hypersensitivity; tenofovir watch renal/bone |
| NNRTIs | Efavirenz, rilpivirine, doravirine | Efavirenz: vivid dreams, CNS effects, take at bedtime; many drug interactions |
| INSTIs (integrase inhibitors) | Dolutegravir, bictegravir, raltegravir | Preferred first-line; separate from polyvalent cations (antacids, calcium, iron) that bind them |
| PIs (protease inhibitors) | Atazanavir, darunavir (often ritonavir-boosted) | Metabolic effects (lipids, glucose), GI upset; major CYP450 interactions |
| Entry / fusion inhibitors | Maraviroc, enfuvirtide | Used in specific/resistant cases |
Why Combination & Adherence
HIV mutates rapidly. Hitting it with three active drugs from different classes (cART/HAART) suppresses replication so completely that resistance can’t get a foothold — but only if levels stay therapeutic. Inconsistent dosing lets partially-suppressed virus mutate around the drugs, and resistance to one agent can extend to others in its class. That is why “take it every day, on time” is not a suggestion: missed doses are how a curable-to-control disease becomes drug-resistant.
Interactions & Monitoring
Watch for CYP450 interactions (especially with PIs and NNRTIs), St. John’s wort (contraindicated — drops ART levels), and cation-containing products that bind integrase inhibitors (separate dosing from antacids, calcium, magnesium, iron). Monitoring includes CD4 count and viral load trends, plus class-specific labs: renal function and bone with tenofovir, lipids and glucose with PIs, liver function broadly.
PrEP & PEP
PrEP (pre-exposure prophylaxis) is daily medication for HIV-negative people at ongoing risk — highly effective with adherence. PEP (post-exposure prophylaxis) is a short course started as soon as possible — ideally within hours and no later than 72 hours — after a high-risk exposure, including occupational needlesticks. After an exposure: wash/irrigate the site, report immediately, and start the institutional protocol — the clock matters.
NCLEX Pearls
- ✦Combination therapy + strict adherence prevents resistance — the single most-tested ART principle.
- ✦St. John’s wort is contraindicated with ART; separate integrase inhibitors from antacids, calcium, and iron.
- ✦PEP must start ASAP after exposure — within 72 hours — so an occupational needlestick is a report-now event.
- ✦Abacavir requires HLA-B*5701 testing before use to avoid a dangerous hypersensitivity reaction.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Institute for Safe Medication Practices (ISMP) · FDA prescribing information · The Joint Commission — National Patient Safety Goals. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →