Date Published: October 31, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Alexis E. Horace.
Pharmacists have made many contributions to HIV/AIDs research and are still showing their significance as members of the healthcare team through innovative clinical trials. Pharmacists are showing advances in several healthcare settings including inpatient, outpatient, and community pharmacies. Because of the complex regimens of highly active antiretroviral therapy (HAART), the increased life span of patients living with HIV, and other concomitant medications taken for comorbid disease states, there is a high risk for health-related complications and the development of adverse events. These adverse events may lead to decreased adherence to HAART, which may cause the development of HIV drug resistance. Pharmacists are providing examples through growing research on how they help combat medication-related errors and also continue to contribute as healthcare providers as a part of a holistic healthcare team.
With the invention and administration of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) has transformed from an acute disease to a chronic disease. The Centers for Disease Control and Prevention estimate that between the years 1996–2003, HAART extended life expectancy of patients living with HIV from 10 to 20 years . Care for patients infected with HIV has shifted from primarily requiring acute treatment in the inpatient setting to needing chronic treatment in the primary and ambulatory care settings. During this time, pharmacists have assumed larger roles as members of healthcare teams who specialize in caring for patients of this population. The responsibilities of pharmacists surpass caring for HIV patients in a community pharmacy setting and have evolved into participating in direct patient care in hospitals and outpatient clinics.
Patients with chronic disease states are at risk for medication-related errors upon admission to the hospital . Drug interactions with HAART can significantly increase or decrease therapeutic levels of medications  putting patients at risk for adverse effects or the development of HIV-1 viral resistance. An adherence rate of 95% to antiretroviral (ARV) therapy is recommended in order to sustain acceptable CD4 counts and viral load levels . The medication-related errors that occur during inpatient hospital stays are more detrimental than they may appear on the surface . Early retrospective studies documenting the need for pharmacy intervention report clinically significant error rates in prescribing ARVs of 5.8% over a 2-year period and 26% over a 1-year period [21, 22]. Because of the impact these errors can make on the health of HIV positive patients, research has emerged showing how the participation of pharmacists decreases these risks.
Care for patients with HIV/AIDs extends beyond the inpatient setting to outpatient settings as rates for developing opportunistic infections continue to decrease . There are now opportunities for pharmacists to participate in the continuity of care for these patients as they transition from one area of healthcare to another. One study reports discrepancy rates as high as 53% when comparing community pharmacy and outpatient clinic medication records for patients on AVs . In addition to the monitoring patient tolerance of these complex ARV regimens and identifying drug-drug interactions between ARVs and medications taken for other chronic disease states, pharmacists also have opportunities to assist in adherence counseling and help to optimize drug therapy. Taking AVs is a long-term commitment and requires excellent adherence. The level of patient adherence is crucial in optimizing therapeutic outcomes . Length of therapy, psychological comorbidities, larger pill burden, increased frequency of administration, and baseline viral loads with associated resistance patterns are determinants of adherence . In a retrospective study (n = 80) that reviews adherence by use of refill data, more patients receiving counseling from a pharmacist refilled their prescriptions in a timely manner than those who did not (P < 0.05) . Currently there are many effective medications used to treat HIV, however these medications may result in significant harm (increased toxicity) or viral resistance when they are not prescribed, administered, or taken correctly [20, 33, 34]. Pharmacists are taking a larger responsibility in caring for patients with HIV, and studies revealing our efforts are increasing. Nonetheless, many of these efforts go undocumented. There are clinical trials published supporting the use of pharmacists in both inpatient and outpatient clinical settings; however, knowledge of the usefulness of these services is often overlooked. Pharmacists are knowledgeable about medications and their management, providing a unique advantage when caring for patients with this disease state. Most studies published showing the effectiveness of pharmacists in treating patients with HIV are limited by their small study size and short duration. Some studies reported outcomes for patients with improvements in CD4+ cells and viral suppression, which can be attributed to the influence of pharmacist recommendations and collaborative efforts. These studies should spur efforts to increase research in using pharmacists as accessible and valuable resources for helping to manage patients with HIV. Another possible area of research could include using pharmacists as resources to enhance continuity of care from the hospital setting to the outpatient clinic setting, acting as guides to provide complete medication reconciliation and possibly decrease drug-related errors. There is also a lack of data researching pharmacy services in areas such as hospice and dialysis centers. These areas are also new realms for research regarding the influence of pharmacists in practice. Pharmacy as a profession is continuously evolving and pharmacists are increasingly seeking opportunities to become more involved in direct patient care. Though there are still many opportunities for research into pharmacists' involvement in care of patients with HIV, pharmacists are currently making vast improvements in the level of patient-centered care they provide for patients living with this complex disease state. Source: http://doi.org/10.1155/2012/869891