New Guidelines List 3 Ways Pharmacists Can Help HIV Patients
Highly active antiretroviral therapy has dramatically curtailed HIV transmission and AIDS mortality.
Highly active antiretroviral therapy (HAART) has dramatically curtailed HIV transmission and AIDS mortality.
Transmission and mortality have plateaued at 50,000 new cases and around 15,000 deaths annually since 2000.
Despite past public health initiatives' success, new challenges include treatment of an aging population, the use of pre-exposure prophylaxis, and optimal initiation of therapy.
The pharmacist’s role in HIV patient care includes selecting individualized treatment regimens, counseling patients, monitoring for treatment responses and adverse effects, evaluating regimens for potential drug-drug interactions, and identifying opportunities for regimen simplification.
The American Journal of Health-Systems Pharmacists recently published an update to its guidelines on pharmacist involvement in HIV care. These pharmacist-specific guidelines complement but do not replace the US Department of Health and Human Services’ management guidelines on effective therapy.
Here are 3 key takeaways for pharmacists.
1. Put a pharmacist on every HIV care team.
Pharmacists can improve HIV patient care as members of interdisciplinary teams. The new guidelines support pharmacists who are entering or expanding their roles on HIV care teams.
The US Centers for Disease Control and Prevention bolsters pharmacists’ roles by stating that pharmacists can recommend, provide, and assist in the interpretation of HIV testing. Community pharmacists can also penetrate difficult-to-reach patient populations that are particularly susceptible to HIV infection.
Pharmacists interested in proficiency in HIV may also want to consider the American Academy of HIV Medicine HIV Pharmacist credentialing.
2. Start HAART early.
A recent landmark study found that HAART should start when the patient is willing and able to be adherent to therapy. This approach replaces the outdated theory that patients should delay starting HAART until their lab work reaches an arbitrary CD4+ count.
An important early intervention is tackling mother-child transmission. All health care team members need to identify infected mothers and ensure that they have comprehensive perinatal care and postpartum follow up.
3. Spark a dialogue about HIV.
Pharmacists have frequent contact with patients and are able to initiate discussions about HIV. The new guidelines recommend that pharmacists use available tools to enhance counseling, such as resources from the University of California, San Francisco's Clinician Consultation Center.
HIV patients are more likely to develop cardiovascular disease, renal failure, osteoporosis, diabetes, and certain cancers because of the combined effects of disease-induced immunosuppression and HAART's adverse effects. Pharmacists can identify patients at particularly high risk and recommend screening.
In addition, pharmacists can help the 1 in 4 HIV patients who are coinfected with hepatitis C virus (HCV). Pharmacists can weigh in on whether to treat HCV simultaneously (with high pill burden and drug-drug interactions) or defer HAART in treatment-naïve patients until they are cured of HCV infection.
Pharmacists may also recommend syringe exchange programs or dispense clean syringes without a prescription depending on local availability and laws.
Pharmacists play a key role in present and future HIV treatment challenges to provide comprehensive care and improve outcomes. They have a unique blend of accessibility, clinical skills, advanced medication knowledge, and desire to take part in collaborative practice.