Pharmacologic: nucleoside reverse transcriptase inhibitors
HIV infection (with other antiretrovirals). Chronic hepatitis B.
Active drug (tenofovir) is phosphorylated intracellularly; tenofovir diphosphate inhibits HIV reverse transcriptase resulting in disruption of DNA synthesis. Therapeutic Effects: Slowed progression of HIV infection and decreased occurrence of sequelae. Increased CD4 cell count and decreased viral load. Decreased progression/sequelae of chronic hepatitis B infection.
CNS: depression, headache, weakness. GI: HEPATOMEGALY (with steatosis), diarrhea, nausea, abdominal pain, anorexia, vomiting, flatulence. GU: renal impairment. F and E: LACTIC ACIDOSIS, hypophosphatemia. Derm: rash. MS: ↓ bone mineral density.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for signs of enlarged, fatty liver (hepatomegaly with steatosis) that can progress to liver dysfunction and liver failure. Signs of liver disease include anorexia, abdominal pain, abdominal swelling (ascites), severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.
Monitor signs of lactic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.
Assess signs of low phosphate levels (hypophosphatemia), including skeletal muscle dysfunction or weakness, respiratory muscle weakness, and mental status changes such as irritability and confusion that progresses to delirium and coma. Report these signs to the physician.
Implement resistive exercises and other therapeutic exercises as tolerated to maintain bone mineral density, increase muscle strength and function, and prevent muscle wasting associated with HIV infection and AIDS.
Because of the risk of lactic acidosis, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).
Emphasize the importance of taking tenofovir 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 tenofovir does not cure HIV or AIDS or prevent associated or opportunistic infections. Tenofovir does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom and avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.
Instruct patient to report signs of kidney impairment, including bloody urine, increased urinary frequency, cloudy urine, decreased urine output, and edema/fluid retention.
Instruct patient to report other troublesome side effects such as prolonged or severe headache, depression, skin rash, or GI problems (diarrhea, nausea, vomiting, flatulence, ...