Many community pharmacists wonder what they can and should do for their patients who have HIV.
Sometimes, pharmacists face so many barriers when they try to accomplish clinical tasks in community settings that they either give up or don't know where to start. When patients are infected with HIV, pharmacists may perceive that treatment is so complicated they should leave decisions and interventions to the experts. However, patients with HIV can now expect to live to see old age, and this now-chronic disease needs linkages in the community health network. Pharmacists are among the most accessible of health care providers, and can provide a valuable service.
Many community pharmacists wonder what they can and should do for their patients who have HIV. In an interview, Jeffrey R. Aeschlimann, PharmD, who is on the faculty of the University of Connecticut's Schools of Medicine and Pharmacy, discussed 3 ways in which community pharmacists can help.
Aeschlimann's first tip is that pharmacists can emphasize perfect adherence—a lofty goal— at every visit. Aeschlimann indicated that most patients with HIV are usually engaged with practices or clinics that offer a variety of support services. They may have adherence nurses or case managers who follow patients to ensure that they take their medications consistently and correctly, but the approach needs to be transdisciplinary. That is, a variety of different health care professionals need to emphasize adherence in a consistent and ongoing manner. Although perfect adherence is probably not possible, good support from community pharmacists can help patients keep their adherence above the 95% mark.
"We only have a finite number of medications. If the virus develops resistance, patients will need to move on to new regimens that are more difficult to take or more toxic," Aeschlimann said, adding that the first regimen prescribed for a patient needs to strike a balance between pill burden and remaining aware of the potential for adverse effects. Fortunately, most patients are now started on regimens that are much simpler than those employed in the past. In fact, patients may be able to take 1 combination drug tablet once a day. Stressing that patients need to stay on their first regimen for as long as possible is very important. Taking medication exactly as prescribed decreases the likelihood that resistance will develop.
Aeschlimann's second tip is for pharmacists to encourage patients to contact their health care providers any time they experience anything that may be an adverse drug reaction or an emerging problem. Prescribing providers can assess the situation with lab testing or hold medications for a short time. All health care providers need to educate individuals with HIV who are on treatment that no question is unreasonable. Patients need to contact their prescribers as soon as they suspect they're having problems with medication. Early intervention is important.
Aeschlimann also noted, "Pharmacists usually look at the drug interactions identified in their proprietary dispensing software, but they need to ask questions about the other things patients take." Patients take supplements and over-the-counter medications that can and do interact with antivirals. So here too, HIV is like every other chronic disease. Patients will often use alternative medications and OTCs to self medicate. Pharmacists need to make patients aware not that using these medicaments is wrong, but that they need to take care to use these medicaments carefully. Aeschlimann added that proton pump inhibitors and products that reduce stomach acid are of particular concern, as they may decrease the effectiveness of many HIV medications.
These 3 steps— reinforcing the need for complete adherence, encouraging patients to call if they suspect they are having an ADR, and screening for supplement and OTC medication use— are simple steps that can build trust between patients and pharmacists.