Beyond Viral Suppression: Holistic HIV Care and Remaining Treatment Gaps

In "Beyond Viral Suppression: Holistic HIV Care and Remaining Treatment Gaps," our experts look past viral load to the needs of the whole patient.

Dr. Burkhart explains why DHHS guidelines increasingly emphasize cardiovascular risk, metabolic monitoring, and drug interactions alongside antiretroviral selection. For a long time, therapy focused only on suppressing the virus. Now, people with HIV are living much longer, so clinicians must account for diabetes and hepatic, renal, and cardiovascular conditions. He argues that pharmacists are accountable for covering the whole patient. Patients often see multiple providers, and a single physician may not know the full medication list. The pharmacist, however, sees every prescription come through. That vantage point makes pharmacists essential for catching drug interactions, monitoring toxicities, checking in with patients, and relaying findings to prescribers.

Dr. Madison underscores the demographic shift driving this change. More than half of people living with HIV are now 50 or older. She cites projections shared at the most recent International AIDS Conference that, by 2030, over half of people with HIV worldwide will be older than 50.

Dr. Astle then addresses which gaps remain despite today's highly effective therapies. He says the answer encompasses tolerability, pill burden, drug interactions, and comorbidities together. He describes this as an exciting time, with options that differ in dosing duration, long-acting properties, and subcutaneous versus intramuscular administration. The goal is to meet patients where their needs are. Injection site reactions are an important tolerability consideration with long-acting agents.

He also highlights drug interactions in aging populations with cardiovascular risk. Commonly used, well-established statins carry significant interactions with antiretrovirals. Managing lipid-lowering and cardiovascular agents alongside HIV therapy is therefore a critical area for pharmacists. Dr. Madison agrees, noting that these overlapping risks are exactly why pharmacists must review every medication a patient takes rather than the antiretroviral regimen alone.

Up next, in "Lenacapavir for HIV Treatment vs Prevention: Avoiding Pharmacy Dispensing Errors," Dr. Nguyen explains where confusion arises when one molecule carries two very different indications.

Funding supported by Gilead. Content independently developed by Pharmacy Times