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Opportunities Abound for Increased Pharmacists’ Role in Treating Patients with HIV

May 23, 2016
"Shara Elrod, Pharm.D. (standing left) and Elizabeth Sherman, Pharm.D  (seated right), administer a rapid HIV test to a patient.

Shara Elrod, Pharm.D. (standing left) and Elizabeth Sherman, Pharm.D (seated right), administer a rapid HIV blood test to a patient.

AN AGING POPULATION OF PATIENTS with human immunodeficiency virus (HIV), comorbidities, and increasingly complex drug regimens is making pharmacists an “indispensable partner in HIV care,” according to a recent editorial in AJHP.

Patients with HIV are living longer thanks in part to more-effective antiretroviral therapy. According to the National Institutes of Health, more than half of all individuals with HIV are now at least 50 years of age. A significant proportion of new infections are also occurring in older adults.

The AJHP editorial accompanies a new set of ASHP guidelines outlining the many roles — from HIV testing to helping patients achieve better drug adherence — that pharmacists are taking on as part of interprofessional teams in caring for individuals with HIV.

“Pharmacists in all care settings are well positioned to meet the unique needs of HIV-infected patients because the cornerstone of effective HIV care is individualized and complex medication therapy,” said Elizabeth Sherman, Pharm.D., Assistant Professor of Pharmacy Practice at Nova Southeastern University’s College of Pharmacy, Fort Lauderdale, Fla., and co-author of the ASHP guidelines. “This is precisely the area in which we, as pharmacists, are educated to assist.”

The Effect of Comorbidities on HIV Care

Jason Schafer, Pharm.D., MPH, BCPS, AAHIVP

Jason Schafer, Pharm.D., MPH, BCPS, AAHIVP

Jason Schafer, Pharm.D., MPH, BCPS, AAHIVP, lead author for the new “ASHP Guidelines on Pharmacist Involvement in HIV Care” and Associate Professor of Pharmacy Practice in the Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, said a graying population brings with it an increasing number of comorbid health conditions. This is another area in which pharmacists are bringing their clinical expertise to bear.

“Pharmacists can improve care and outcomes for many of the comorbid conditions that we see in HIV patients, such as heart disease, cancer, and diabetes,” explained Dr. Schafer.

A 2015 study showed as much, demonstrating that when pharmacists were involved in interdisciplinary care for HIV patients who also had diabetes, hypertension, or hyperlipidemia, patients’ lipids were better managed, smoking cessation rates increased, aspirin was used more appropriately, and the cost of care per patient was $3,000 lower than when care did not involve a pharmacist.

Helping Patients Navigate the Healthcare System

One important function pharmacists can play as part of an interdisciplinary HIV care team is to screen and test for HIV and comorbidities and help patients receive treatment as early as possible, said Dr. Schafer. “For HIV specifically, the earlier patients connect with an appropriate provider, the sooner they can start antiretroviral therapy, and the better their outcomes are likely to be.”

Alice Pau, Pharm.D., (third from left) participates in clinical patient rounds at the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Alice Pau, Pharm.D., (third from left) participates in clinical patient rounds at the National Institute of Allergy and Infectious Diseases, National Institutes of Health.

AJHP editorial co-author Alice Pau, Pharm.D., Clinical Staff Scientist and Pharmacy Specialist in the Division of Clinical Research at the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., added that pharmacists are also well-positioned to ensure that HIV treatment is seamless across the continuum of care.

The need is great, according to Dr. Pau, because her team often finds that patients who come in for treatments after hospitalization are discharged without having their prescriptions filled, leading to a lapse of weeks without treatment.

“As pharmacists, we can work collaboratively with a social worker or case manager at discharge to help ensure patients have their prescriptions filled or have arrangements in place to get them filled outside the hospital,” she said.

More and More Physicians Relying on Pharmacists

A large number of comorbidities and the use of polypharmacy in patients with HIV mean that physicians are relying more than ever on pharmacists’ drug expertise, according to AJHP editorial co-author Henry Masur, M.D., Program Support Specialist at NIH’s Critical Care Medicine Department.

“It’s hard for primary care physicians to remain up-to-date on the efficacy and safety of HIV medications and on the increasingly complex pharmacokinetic interactions and overlapping toxicities of drugs in multidrug regimens for patients who also have comorbidities,” he said.

ASHP guidelines co-author Dr. Sherman noted that pharmacists also can improve care of patients with HIV by identifying potential drug interactions, helping to ensure treatment adherence, linking patients with appropriate care, or providing a host of other services. The results are impressive: greater HIV viral suppression, reduced rates of viral resistances, increases in patient survival, improvements in quality of life, and fewer secondary HIV transmissions.

Dr. Sherman’s own experience caring for patients and helping other providers optimize their treatments has confirmed pharmacists’ valuable role in caring for patients with HIV. “I’ve learned what a pharmacist can be: an ally to the HIV patient, a service to the community, and a pioneer who is contributing to a rapidly growing body of clinical knowledge,” she said.

–By David Wild

 

 

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