Introduction to Arvs - Botswana Teen Club

Introduction to Antiretrovirals 

(ARVs) 

Teen Club Community Partners Training 

Programme 

What is Anti-Retroviral Therapy 

(ART) 

� Anti-Retroviral Therapy (ART) is the 

use of at least three different 

medications known as Anti-RetroViral 

drugs (ARVs) in order to suppress the 

replication of HIV. 

� Treatment with these combinations of 

drugs is also known as Highly Active 

Antiretroviral Therapy (HAART). 

Why do we need ARVs? 

Without ARVs, 

patients with 

HIV 

eventually 

become sick 

and die 

Objectives 

By the end of the session participants 

will be able to: 

� Discuss how ARVs work and how 

they should be taken 

� Identify difficulties associated with 

taking ARVs 

� Name common ARVs used in 

Botswana 

What is Anti-Retroviral Therapy 

(ART)? 

� ART is not a cure. 

� ART must be taken for life and is 

costly. 

� ART is also used in the prevention of 

mother to child transmission 

(PMTCT). 

Why do we need ARVs? 

� Without treatment mortality for 

HIV infected babies is as high as 

40 percent in the first year of life! 

� Anti-retroviral drugs can 

significantly improve the quality 

of life of HIV infected children. 

1

With ARVs, People With HIV Can Live 

Long, Healthy Lives 

The child on ARVs 

can have a 

normal, healthy 

life 

How should ARVs be taken? 

� The patient must take three different ARV 

drugs. The medicines do not work well if 

you take only one or two. 

� ARVs usually work in combination because 

of the nature of the replication cycle of the 

HIV. 

� If the ARV that operates at a particular site 

of the CD4 cell fail to stop some of the 

virus, the other ARVs in the combination 

will operate at the other sites to make the 

virus inactive. 

� Another way to 

explain the 

importance of taking 

all three ARVs is to 

compare the ARVs to 

the three legs of a 

cooking pot. 

� If a pot is balancing 

on three stones and 

you take one away, 

the pot will spill. 

What do ARVS do? 

� They keep the virus 

from multiplying 

� A good way to think 

about how ARVs 

work is that they 

keep the virus 

“sleeping” 

How to educate caregivers and children on 

taking all the three drugs! 

Look at the soldier in the 

picture. 

He is wearing three things: 

a hat, a shirt and pants 

You can tell young patients 

that ARVs are like the 

soldier’s hat, shirt and 

pants. If the soldier lost his 

pants, it would be harder 

for him to work! 


HAART refers to taking three effective 

antiretroviral medicines together 

The classes of ARV drugs are: 

� Nucleoside Reverse Transcriptase 

Inhibitors (NRTIs), 

� Non-Nucleoside Reverse 

Transcriptase Inhibitors (NNRTIs) 

� Protease Inhibitors (PIs). 

� Fusion Inhibitors 

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Most ARVs need to be 

taken twice a day, every 

day in order to work. 

This picture shows how 

the virus stays “sleeping” 

when the medicines are 

taken correctly. 

What happens if the ARVs are not 

taken correctly? 

When the ARVs are not 

taken correctly, the virus 

“wakes up” and begins 

making more copies of 

itself. 

When the virus “wakes up,” it 

can attack the CD4 cells 

again. 



The virus may also become resistant to 

the medicines. 

This means that the virus has become 

“tricky” and has learned to get away 

from the medicines. 

When resistance to the medicines 

occurs, the medicines will not work 

anymore, even if they are taken 

perfectly again. 

If resistance occurs, the child will have to 

change to different medicines 

ARV Dosing in children 

� ARV dosages are based on the 

child’s weight or body surface area, 

depending on the drug. 

� Dosing is rechecked at every visit 

and adjusted for weight gain. 

� WHO Pediatric Dosing Guides are 

now used to determine appropriate 

doses. 



This picture shows a 

mother who has 

forgotten to give ARVs 

to her child. The child’s 

virus is waking up. 

First and Second Line regimens in 

Botswana 

� The first HAART regimen that a patient 

takes is First Line for that patient. 

� If the virus becomes resistant to the First 

Line drugs, the patient has to move to 

Second Line drugs. 

� It is important to take 2 nd line medicines 

perfectly because if the patient becomes 

resistant to 2 nd line medicines, a 3 rd option 

may not be available. 

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For many patients is not easy to take 

ARVs correctly. 

� Sometimes it is hard to remember to 

take the medicines twice a day, 

every day 

� Children may have problems 

swallowing pills, especially around 

other people. 

� Children may not like the taste of the 

liquid medicines 

� Some children, especially older 

ones, may hide their pills 

What are some ways to overcome the 

difficulties? 

� Ask the doctor or pharmacist if there are 

other options for a child who does not like 

his medicines. 

� If a child does not like to take liquid medicines, 

there may be a pill form that the child can take 

� If the pills are too big for the child to swallow 

easily, there might be a liquid medicine that the 

child can take 

� Allow the child to take medicines with a 

favorite food or drink if the medicines taste 

bad 

For some patients, it will be more difficult to 

take medicines because of side effects. 

� Side effects are problems that happen 

because of the medicines. 

� Most side effects are temporary and only 

happen while the body is getting used to 

the medicines. 

� Side effects should always be reported to 

the doctor or nurse so that appropriate 

treatments can be given. 

What are some ways to overcome the 

difficulties? 

� Use an alarm as a reminder (cell 

phone alarm) 

� Have another responsible adult help 

remind the child 

� Teach children how to take their 

medicines so that they can remind 

their caregivers if the caregivers 

forget 

� But remember, the caregiver must 

watch the patient take the medicine 

every time! 

When children or their caregivers travel, 

sometimes the medicines are not taken correctly. 

It is important to 

always plan 

ahead to make 

sure that the child 

will continue to 

take the ARVs 

correctly even 

during holidays. 

This picture illustrates some common 

side effects of ARVs 

•Headache 

•Diarrhea 

•Vomiting 

•Rash 

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Different medicines have different side 

effects 

� The doctor may change medicines if 

the side effects are too severe or do 

not go away 

� It is very important that the doctor is 

notified before the caregivers decide 

to stop a medicine! 

The next few slides will show ARVs that 

are commonly used in Botswana 

� Medicine names can be confusing 

� Each medicine usually has more than one name 

� We try to use the simplest name when we talk to 

patients to make it easier for them to remember 

� If a different company makes the medicines, 

they may look different 

� If medicines look different from what the patient is 

used to taking, they should always ask the 

pharmacist, the doctor, or the nurse if the 

medicines are the right medicines 

� That way, they can be sure that they are taking the 

correct medicine 

ARV interactions with other medicines 

can be a problem 

� ARVs can have interactions with other 

medicines making them either more toxic 

or less effective for the patient 

� Thus, the doctor should always be notified 

regarding: 

� Any other medications the patient is currently 

taking 

� Such as treatment for tuberculosis 

� Alternative medicines given to the patient 

� Herbal remedies 

� Traditional healer potions 

AZT (zidovudine, retrovir) 

d4T (stavudine, zerit) 3TC (lamivudine, epivir) 

5

NVP (nevirapine, viramune) EFV (efavirenz, stocrin) 

Kaletra (lopinavir/ritonavir, Aluvia) 

Special note: Should be 

taken with food and must 

not be taken at the same 

time as DDI 

Review Question #1 

What are two things that can happen when a 

person on ARVs does not take the 

medicines correctly? 

Answers: 

1. The HIV “wakes up” and attacks the CD4 

cells, making the body weak. 

2. The HIV becomes “tricky” and learns 

how to get away from the medicines so 

that the medicines may not work 

anymore, even when taken correctly 

again. 

DDI (didanosine, videx) 

Special note: 

Must be taken on an 

empty stomach (at 

least an hour before 

and two hours after 

meals) 


Which of the following is true regarding side 

effects of ARVs? 

a. Most go away after a few days or weeks 

b. If a person has a side effect, he should 

stop the medicines without notifying the 

doctor or nurse 

c. A person with side effects should discuss 

them with the doctor or nurse 

d. Both a and c are true 

6


Which of the following is true regarding side 

effects of ARVs? 

a. Most go away after a few days or weeks 

b. If a person has a side effect, he should 

stop the medicines without notifying the 

doctor or nurse 

c. A person with side effects should discuss 

them with the doctor or nurse 

d. Both a and c are true 

Key Points 

� ARVs keep the HIV from attacking the 

body and allow people with HIV to live 

long, healthy lives 

� Missing doses can cause the virus to 

become resistant to the medicines so that 

the medicines will not work anymore 

� There are many challenges associated 

with taking ARVs that health care 

providers must address 

Discussion Question #3 

What information do you find most 

important to share with children and 

families in your community about 

ARVS 

THANK YOU 

� Thank you to all our partners 

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Introduction to Arvs - Botswana Teen Club

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