Enfuvirtide

INTRODUCTION

Indications

Management of HIV infection in combination with other antiretrovirals in patients with evidence of progressive HIV-1 replication despite ongoing treatment.

Action

Prevents entry of HIV-1 into cells by interfering with the fusion of the virus with cellular membranes. Therapeutic Effects: Decreased replication of the HIV virus. Slowed progression of HIV infection with decreased occurrence of sequelae. Improved CD4 cell count.

Adverse Reactions/Side Effects

CNS: fatigue. EENT: conjunctivitis. Resp: cough, pneumonia, sinusitis. GI: diarrhea, nausea, abdominal pain, anorexia, dry mouth, pancreatitis, weight loss. Local: injection site reactions. MS: myalgia, limb pain. Misc: hypersensitivity reactions, herpes simplex.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor any breathing difficulties; notify physician immediately if patient experiences signs of pneumonia (cough, fever, chills, chest pain during inspiration and expiration).

• Assess any muscle or limb pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor fatigue and weakness. Some degree of fatigue is expected, but excessive or unusual fatigue should be reported.

• Monitor subcutaneous injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Implement resistive exercises and other therapeutic exercises as needed to maintain muscle strength and function and to prevent muscle wasting associated with HIV infection and AIDS.

Patient/Client-Related Instruction

• Emphasize the importance of taking enfuvirtide as directed even if the patient is asymptomatic and that this drug must always be used in combination with other antiretroviral drugs. Do not take more than prescribed amount and do not stop taking without consulting health care professional.

• Inform patient that enfuvirtide does not cure HIV or AIDS or prevent associated or opportunistic infections. Enfuvirtide does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom, and to avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.

• Advise patient about the likelihood of GI reactions (nausea, diarrhea, dry mouth). Instruct patient to report severe or prolonged GI problems or signs of pancreatitis such as upper abdominal pain (especially after eating), indigestion, weight loss, and oily stools.

• Instruct patient to report other troublesome side effects such as prolonged or severe sinus inflammation, eye irritation, or aggravation of herpes simplex infections.

Pharmacokinetics