Improve HIV Treatment and Outcomes With Pharmacist-Assisted Medication Management
Despite the progress made since AIDS was first diagnosed, it still ranks in the top 10 leading causes of death for people aged 25 to 54. About 50,000 new cases are diagnosed in the United States yearly—a rate that has remained steady for the last decade. Early treatment with antiretroviral therapy (ART) leads to viral suppression and a normal life expectancy in nearly all patients, but significant challenges remain because many don’t start ART. Compounding pharmacists have a vital role to fill. Through medication management and outreach, you can help improve HIV treatment and outcomes for patients with HIV/AIDS.
Advances in Research and Pharmaceuticals
Efforts to reactivate latent HIV-infected cells in order to kill them—the shock-and-kill approach—have been hindered by lack of acceptable pharmaceuticals. The existing latency-reversing agents either aren’t strong enough or they trigger a dangerous immune response. In September 2015, Cell Host and Microbe published a study that changed the game. When researchers combined the Smac mimetic SBI-0637142 with a histone deacetylase inhibitor, the drugs reawakened the virus without activating the immune system.1
Smac mimetics aren’t the only game in town, as researchers are also making progress with proteins that induce suppression and reduce the viral load. The National Institutes of Health announced the development of an engineered protein that attaches to HIV-infected helper T cells, then activates and destroys the virus.2 Another group of researchers reported in Science Translational Medicine that they tested the VRC01 antibody in HIV-infected individuals and found that it didn’t help those on ART, but it did result in viral suppression in untreated patients.3
Pharmacist Involvement Leads to Better Outcomes
Reaching out to patients with HIV or AIDS has a significant impact—perhaps more than many realize. Fewer than 33 percent of those diagnosed with HIV receive ART and 37 percent of those who start treatment don’t continue to seek regular care from a physician.4 A computer model created by specialists at Johns Hopkins projected that two steps—increased HIV screening and encouraging retention in care—could cut the incidence of HIV in half. Compounding pharmacists may address both factors. Even if establishing an HIV screening outreach isn’t possible, you can intervene to improve medication compliance, encourage ongoing care, and reduce drug-drug interactions.
When pharmacists get involved, patients may achieve earlier viral suppression. In one HIV clinic, treatment-naïve patients beginning ART reached viral suppression faster when treatment was managed by pharmacists rather than a primary care provider.5 But here’s another piece of information that illustrates the critical role of compounding pharmacists and offers a new group of patients for your business: when health care providers were surveyed, 34 percent were not familiar with pre-exposure prophylaxis. This means many partners of HIV-infected patients won’t receive the treatment that nearly eliminates their risk of becoming infected with HIV.6
Tips for Building HIV/AIDS Outreach
It’s easy to lose sight of the fact that HIV/AIDS is still shrouded in stigma and false information. As you reach out to these patients, never underestimate the impact of negative societal attitudes. For example, it’s estimated that about half of those infected with HIV remain undiagnosed because they’re afraid to come forward for testing.7 Outreach is essential but it must be tempered with an understanding of the patient’s concerns about being labeled with HIV. It’s also imperative for counseling to take place in an environment that’s completely private.
Medication Review: If you currently fill prescriptions for HIV/AIDS medications, schedule regular appointments to review medications. Use this time to discuss the promising long-term outcomes that are possible with viral suppression and the importance of sticking with treatment to maintain suppression. Ask about problems they might have accessing care or paying for medications. Be prepared with a list of references to physicians and clinics in your area, as well as referrals for prescription assistance or co-pay programs.
If your patient doesn’t show up for scheduled medication management, follow-up with a personal phone call. This may be a good opportunity to establish a telemedicine protocol, as it allows you to talk while letting the patient pick a location that’s private.
During medication review, ask about HIV-related health problems, especially skin conditions that are common in HIV patients. As a compounding pharmacist, you can offer individualized treatment options to improve their health. Skin problems that plague HIV patients include:
- Oral candidiasis: Thrush is common in people with AIDS and often hard to treat. You can compound antifungal medications such as fluconazole and itraconazole in custom doses.
- Prurigo nodularis: This condition is often a sign that the patient’s immune system is very weak, so be sure they’re taking antiretroviral drugs and urge them to see their doctor. The intensely itchy nodules are treated with topical steroids. Most patients don’t know that you can compound topical treatments using bases that are soothing to skin and mix multiple pharmaceuticals for optimal results.
- Photodermatitis: While it’s more common in people with darker skin, photodermatitis may occur in anyone with HIV. It’s usually treated by protecting the skin from sun exposure.
Outreach Advertising: A good way to reach out is with posters that are displayed in a consistent location and changed on a regular basis to draw attention. Poster ideas include:
- Ask a simple question, such as “Do You or Someone You Know Have Questions About HIV/AIDS?”
- Announce new treatments and emerging research with a brief attention-grabbing headline.
- Provide relevant health information, for example, “Low Vitamin D Thwarts HIV Treatment”
- Target partners of people with HIV/AIDS by posting about pre-exposure prophylaxis.
Keep the posters uncluttered by including only a large headline or question, followed by a phone number, a statement that it’s a free consultation and assurance of confidentiality.
Medication Management and Counseling Make a Difference
Compounding pharmacists have many chances to touch the lives of their patients, but when your patient has HIV/AIDS, you also have the unique opportunity to prolong life. When efforts are expanded to include their partners, you boost a family’s quality of life. Along the way, you support your business by tapping into a very large group of new patients.
Pharmaceutica North America provides a diverse line of quality products, including APIs, delivery systems and custom compounding kits designed to support your patient care and business. Contact us today to learn more about our pharmaceuticals.
- “BIRC2/cIAP1 is a Negative Regulator of HIV-1 Transcription and Can Be Targeted by Smac Mimetics to Promote Reversal of Viral Latency,” September 2015, http://www.ncbi.nlm.nih.gov/pubmed/26355217 ↩
- “Activation and Lysis of Human CD4 Cells Latently Infected With HIV-1,” October 2015, http://www.nature.com/ncomms/2015/151020/ncomms9447/full/ncomms9447.html ↩
- “Virologic Effects of Broadly Neutralizing Antibody VRC01 Administration During Chronic HIV-1 Infection,” December 2015, http://stm.sciencemag.org/content/7/319/319ra206 ↩
- “The HIV/AIDS Epidemic in the United States,” April 2014, http://kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states/ ↩
- “Outcomes of Pharmacist-Assisted Management of Antiretroviral Therapy in Patients with HIV Infection: A Risk-Adjusted Analysis,” September 2015, http://www.ajhp.org/content/72/17/1463.abstract ↩
- “Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition – United States, 2015,” November 2015, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w ↩
- “Which Psychological Factors are Related to HIV Testing? A Quantitative Systematic Review of Global Studies,” November 2015, http://link.springer.com/article/10.1007/s10461-015-1246-0/fulltext.html ↩