With the growth in pharmacy over the past 10 years, pharmacists are now at the forefront of managing many more disease states than in the past.
Written with Sarah Vines, PharmD Candidate 2020. Harrison School of Pharmacy Auburn University
With the growth in pharmacy over the past decade, we are now at the forefront of managing many more disease states than in the past.
Patients living with HIV/AIDS are among those who can benefit the most from the services that pharmacists have to offer.
Most patients with HIV/AIDS take multiple medications daily to keep their disease at bay.
The major concerns within HIV/AIDS therapy are the treatment of the primary virus, prevention and treatment of other opportunistic infections common with HIV/AIDS, and the treatment of other unrelated comorbidities that the patient might be living with.
Each of these facets brings their own unique drug therapies that must be managed and balanced with each other. There are no better team members to oversee this balancing act than the medication experts, the pharmacists.
The first line pharmacologic treatment for HIV/AIDS today is a class of medications that were introduced in the late 1990s known as antiretrovirals, or ARVs.1,2 To give perspective on just how drastically HIV/AIDS therapy has changed recently; globally in 2000, there were fewer than 1 million patients taking ARVs of the estimated 27.7 million living with HIV/AIDS.2 Currently worldwide, there are an estimated 36.7 million people living with HIV/AIDS and of those approximately 18.2 are on ARVs.2
The number of AIDS-related deaths in 2016 was 48% lower than in 2005.2
We can attribute this decline to the numerous new drugs on the market, as well as the team based approach to patient care that has emerged.3
ARVs, like most medications on the market today, have the potential for side effects.1 Selecting the HIV/AIDS treatment regimen is often dictated by viral strain, response to previous medicaitons, and patient and virus specific factors. However, any regimen could be selected, but if the patient cannot tolerate or is unwilling to manage the side effects, the medication will not have the opportunity to benefit the patient. Pharmacists can help determine if a patient’s symptoms are from the ARV therapy, or from something else entirely. Many times a patient with HIV/AIDS may not even have noticeable physical manifestations of an adverse reaction to treatment, but examination of labs by a clinical pharmacist can pinpoint early signs of serious problems that can be managed, prevented, or if need be, result in a switch to a new ARV regimen.3
Furthermore, medication adherence plays a vital role in the success, or failure, of HIV/AIDS therapy.
Side effects, cost of the medications, and a general lack of understanding of the importance of taking their medications daily could make it very easy for a patient with HIV/AIDS to be non-adherent to their medications.
Pharmacists are intimately familiar with the effects of missing even one dose of a medication and can explain this importance to patients on a deeper level. Patients who are nonadherent are at a much greater risk for disease progression as well as transmitting the virus to others.
It is ideal for a patient with HIV/AIDS to have multiple office visits with a primary physician, as well as a clinical pharmacist specialized in HIV/AIDS therapy, to explain the intricate details so that patients get the most out of their medication therapy.
Also, pharmacists are familiar with cost saving alternatives and patient discount programs that can help remove the financial burden as a reason for non-adherence.
It is very clear that the saying, “it takes a village”, absolutely applies to the management of HIV/AIDS, and pharmacists are one of the most valuable members of that village!
Centers for Disease Control and Prevention. HIV/AIDS: Statistics Center.
. Accessed on: 9 November 2017.
UNAIDS. Fact Sheet- Latest statistics on the status of the AIDS epidemic.
. Accessed on 28 November 2017.
3. Saberi P, Dong BJ, Johnson MO, Greenblatt RM, Cocohoba JM. The impact of HIV clinical pharmacists on HIV treatment outcomes: a systematic review. Patient Preference Adhere. 2012;6:297-322. doi:10.2147/PPA.S30244.
4. Vanmali RS, Mayer SD, Fugit AM. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic. Inov Pharm. 2013;4(1): Article 109. http://pubs.lib.umn.edu/innovations/vol4/iss1/10