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HIV/AIDS Treatment – Pharmacists Can Make a Difference
Reproduction in whole or in part without permission is prohibited.
Page 1
HIV/AIDS Treatment- Pharmacists can
make a Difference
A Patient Centered Approach to HIV
for Pharmacists & Techs
Peter A. Kreckel
Adjunct Assistant Professor of Pharmacology
Department of Physician Assistant Sciences
St Francis University
PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing
pharmacy education
Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the companies that support
educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product discussed. Participants should verify all
information and data before treating patients or employing any therapies described in this educational activity.
This program has been
supported by an educational
grant from Boehringer-Ingelheim
HIV/AIDS Treatment- Pharmacists can make a Difference
A Patient Centered Approach to HIV for Pharmacists & Techs
Accreditation:
Pharmacists: 0798-0000-10-062-L02-P
Pharmacy Technicians: 0798-0000-10-062-L02-T
CE Credits: 1 contact hour
Target Audience: Pharmacists & Technicians
Program Overview:
Pharmacists can make a difference in the management and treatment of HIV/AIDS. However, many pharmacists find
themselves uncomfortable with their level of knowledge in the area of HIV either because they did not receive any HIV
training in their formal education or simply because of the rapid on-going advancements in this therapeutic area. This
program will educate pharmacists and pharmacy technicians on HIV treatment principles, provide an update on
pharmacotherapy, and the challenges associated with HIV treatment so they can more comfortable respond to HIV patients
and providers in their role as pharmacist and technician.
Objectives:
• Describe the primary goals of antiretroviral (ARV) treatment and the rationale for prescribing combination therapy.
• Provide an update on antiretroviral therapy (ARV) for HIV to include their mechanisms of action, efficacy, dosing, safety and
tolerability profiles.
• Recognize possible drug interactions between different antiretrovirals and interactions between antiretrovirals and other
medications.
• Describe the pharmacist’s critical role in counseling and educating HIV patients on drug treatment strategies to improve the
patient outcomes and medication adherence.
This program has been
supported by an educational
grant from Boehringer-Ingelheim
HIV/AIDS Treatment- Pharmacists can make a Difference
A Patient Centered Approach to HIV for Pharmacists & Techs
PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing
pharmacy education
Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the companies
that support educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product discussed.
Participants should verify all information and data before treating patients or employing any therapies described in this educational activity.
This program has been
supported by an educational
grant from Boehringer-Ingelheim
Speaker: Peter A. Kreckel R.Ph. is a graduate of the University of Pittsburgh, Bachelor of Science in Pharmacy, Magna
Cum Laude, Class of 1981. He served as the President of the Pharmacy School Class of 1981 for 3 years, and President
of the Pharmacy School Student Council for 2 years. During this time he received the Upjohn Achievement Award for
leadership and academic achievement. In addition to managing a retail pharmacy, pharmacist Kreckel is an Adjunct
Assistant Professor of Pharmacology, Department of Physicians Assistant Sciences, St. Francis University. His
assignments include teaching a HIV pharmacotherapy course for Physician Assistant students, currently doing their
clinical rotations, that are pursuing a Masters of Medical Science Degree from St. Francis University.
Speaker Disclosure: Mr. Kreckel has no actual or potential conflicts of interest in relation to this program.
GOALS of HIV DRUG THERAPY
GOAL: to extend life and the quality of life
1981- 1991: only 44% were living after
diagnosis.
1996-2000: 85% of patients were living after
diagnosis
HIV/AIDS Treatment – Pharmacists Can Make a Difference
Reproduction in whole or in part without permission is prohibited.
Page 2
Primary Goals of ARV therapy
CD4 count: 700-1000/mm3 (about a pea-size drop of blood)
CD4 cells are a type of lymphocyte (white blood cell). They are an important part of the immune system. CD4 cells are sometimes called T-cells. T-4 cells, also called CD4+, are “helper” cells. They lead the attack against infections.
Patients need this count to be HIGH
Some clinicians use CD4% normal range:20-40%. Less than 14% shows significant immune damage.
Suppress HIV levels (viral load) below the limit of detection (<50 copies HIV RNA), or as low as possible for as long as possible
HAART therapy can be compared to a Canoe approaching a
waterfall! The canoeists are paddling upstream to avoid the
waterfalls.
CD4 count= the distance to the falls (the longer the better)
Viral load = the speed of the river (the lower the better)
HAART therapy= the stronger the paddlers the longer until you go over the falls.
HIV/AIDS Treatment – Pharmacists Can Make a Difference
Reproduction in whole or in part without permission is prohibited.
Page 3
CD4 Levels and opportunistic
infections
Most health care providers prescribe drugs to prevent opportunistic infections at the following CD4 levels:
Less than 200: pneumocystis pneumonia (PCP)
Less than 100: toxoplasmosis
Less than 50: mycobacterium avium complex (MAC)
Because they are such an important indicator of the strength of the immune system, official treatment guideline in the US suggest that CD4 counts be monitored every 3 to 4 months.
Treatment and prevention of
Opportunistic Infections
Disease Primary
Treatment
Prophylaxis
Pneumocystis
jiroveci (PCP)
CD4<200
Trimeth/Sulfa-DS
(2) q8h x21 days
Trimeth/SulfaDS
daily or 3 x week.
Dapsone 100mg qd
Toxoplasmosis
CD4<100
Pyramethamine +
sulfadiazine
Trimeth/Sulfa DS
q24hr.
Mycobacterium
avium (MAC)
CD4<50
Clarithro 500 q12
Azithro 600 qd +
ethambutol
CLAR 500q12h Azith
1200/week
Tuberculosis INH + RIF+PZA
(adjust if on PI)
INH-300 q24 +
pyridoxine
When to Start HAART????
HIV
symptoms?
CD4 count Start
Treatment?
Comments
Yes Any Yes ANY AIDS defining
illness, start treatment.
No <200 Yes
No 200-
350
Yes* New DHHS
recommendation
No 350< No** Maybe if CD4 decreasing rapidly
or viral load >100,000 copies/ml
When the CD4 count goes below 350, most
health care providers begin HAART
Should we wait to start HAART?
HIV-related morbidity and mortality derive not only from immune deficiency but also from direct effects of HIV on specific end organs and the indirect effects of HIV-associated inflammation on these organs. In general, the available data demonstrate that:
Untreated HIV infection may have detrimental effects at all stages of infection.
Treatment is beneficial even when initiated later in infection. However, later therapy may not repair damage associated with viral replication during early stages of infection.
Earlier treatment may prevent the damage associated with HIV replication during early stages of infection.
Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary
Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary) Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
Pneumocystis carinii pneumonia
Pneumonia, recurrent
Progressive multifocal leukoencephalopathy
Salmonella septicemia, recurrent
Toxoplasmosis of brain
Wasting syndrome due to HIV
HIV/AIDS Treatment – Pharmacists Can Make a Difference