Basic HIV Guidelines for Community Pharmacists

HIV is a virus that uses the human immune system (specifically CD4 cells) to replicate. This weakens immune function and can lead to many opportunistic infections. A prescribed combination of antiretroviral medications (sometimes referred to as an HIV cocktail) can slow disease progression and prolong survival by decreasing viral replication. This regimen is specifically chosen by incorporating the individual’s medical history, resistance patterns or genetic predispositions to optimize activity against the virus and to minimize toxicities for the patient.

As a community pharmacist involved in HIV care, it is important that you review the following:

  1. Treatment involves three or more antiretrovirals. There are various classes of antiretrovirals currently available (see: www.cfenet.ubc.ca for more information).
    1. nucleoside/ nueleotide reverse transcriptase inhibitors (NRTIs) such as zidovudine (AZT), lamivudine (3TC), tenofovir and abacavir;
    2. protease inhibitors (PIs) such as atazanavir, lopinavir, and ritonavir;
    3. non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine and efavirenz;
    4. fusion inhibitor enfuvirtide (Fuzeon) injection; 
    5. entry inhibitor maraviroc; 
    6. integrase inhibitor raltegravir.
  2. Adherence is the most important factor in HIV treatment success. Missing doses (i.e. entire days or not taking all pills) can lead to resistance and further complicate treatment choices.
    1. All or Nothing Rule – the prescribed antiretroviral regimen must be given in its entirety to ensure the virus is being treated adequately. Even if only ONE of the medications is missing, then none of the other meds should be given. This will minimize opportunities for resistance. 
    2. Timing – Ideally, it is best to have patients take their pills around the same time each day to create a routine and ensure even drug levels; however, if they are late, it is ok to take a daily dose as soon as they remember within the same day. Do not double doses to catch up.
  3. Resistance – The HIV virus can change into a different form, which is not easily controlled by the current regimen. Cross-resistance may also result in the virus becoming resistant to other medications the patient has never taken before but might need in the future. Resistance can arise from poor adherence, long-term use of the same regimen or contracting a resistant virus from a new source. The doctor can order blood tests (aka genotyping) to confirm viral resistance to specific medications.
  4. Side Effects – Do not suggest stopping HIV medications in response to side effects. Always ask the patient to consult with the doctor or HIV pharmacist before stopping medications. Call the outpatient pharmacist at St. Paul’s Hospital. The pharmacist can give advice on how to manage side effects or how to decrease the chances of HIV resistance. 
  5. Drug Interactions - Prescription and non-prescription medications, herbal products and street drugs can interact with HIV medications. Consult with the outpatient pharmacy at St. Paul’s Hospital to ensure drug interactions with antiretrovirals are avoided or managed appropriately.

St. Paul’s Hospital Outpatient Pharmacy Hotline
1-888-511-6222
Consult with one of our HIV pharmacists to get advice regarding antiretrovirals or if you would like more resources.

HIV101.ca is sponsored by the STOP HIV/AIDS pilot project which is funded by the Government of British Columbia supporting Northern Health, Vancouver Coastal Health, the Provincial Health Services Authority, Providence Health Care, and the BC Centre for Excellence in HIV/AIDS. The STOP HIV/AIDS project aims to expand HIV testing, treatment, and support in British Columbia.
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