WEEK 8 - The Role of a HIV Pharmacists

Question 1

How has HIV and its treatmnet changed over the years

NOTE: Background INFO

Answer 1

• Life expectancy has increased progressively since the 1980s
  
  • due to treatment options, ↓ SE and ↑ adherance
• Adherance improved as pill burden ↓
  
  • previously had to take up to 20 diff. pilss at diff. intervals a day, now can take 1 pill which delivers multiple drugs

Question 2

What do HCP assess in HIV patients

inc. how often to assess

Answer 2

1. CD4 count
   
   • HIV targets CD4+ T cells infecting + destroying them
     How often to test:
   • < 200 cells/mm3 = 3 to 6 months
   • 200-350 = annually
   • > 350 = on 2 tests more than a year apart = NO tests required
2. Viral load
   
   • a measure of the level of virus in the bloodstream
   • lab tests can NOT detect HIV in blood if < 20 copies or 50ml

Question 3

What is the AIM of HIV treatment

Answer 3

1. Maintain high level of CD4 cells
2. Ensure patient has an undetectable viral load
   - Undectable = HIV is untransmittable

Question 4

Describe ways the pharmacist can contribute to the quality of patient care and improve outcomes for patients with HIV infection

6 Things

Answer 4

1. Help reduce stigmas associated with HIV
   
   • people may not prioritse their HIV care, adherance to treatment or face mental difficulties due to stigmas
   • people may experince lonliness, fear of being treated differently or even refused treatment due to status
   • avoid using stigmatising language
2. Support patient with treatment adherance
3. Clinical checking of Rx for ART
4. Multi-disciplinary Team Meetings (MDTs)
5. HIV Clinic Activities
6. Responding to medication queries

Question 5

What factors influence adherence

Answer 5

• Mental health
• Socioeconomics e.g. housing, homelesness
• Pharmacology e.g. SE, interactions
• Cognition
• Physical healths e.g. difficulties swallowing, unwell
• Beliefs
• Personal experiences e.g. badd or good

Phamracists Need:
- Person centred care
- MDT working
- Patient advocacy
- Shared decision making

Question 6

Changes in mnedication to improve adherance

2 Changes

Answer 6

1. ↓ pill burden via combining multiple drugs into 1 pill
2. Long-acting Injectable therapy
   - e.g. Cabotegavir and Rilpivirine
   - introduced in 2022 (UK)
   - DOSE: 2 IM injections every 2 months (in a clinic)
   - Given to those with physical or psychological barriers to takinig
   - SE: injection-site reactions e.g. pain, reddness
   - Has a higher failure rate compared to other therapies ~ may become detectable after 3 years
   - OPTIONAL TOLERABILITY ASSESSMENT before begun
   - given oral dose for 1 month to see if have any reactions
   - HOWEVER patient can begin injections immediately if preffered

Question 7

Discuss management strategies for HIV and viral hepatitis

Question 8

Apply principles of evidence-based practice to address actual and potential problems with individual patients’ therapy and advice on appropriate drug therapy for infection