Pharmacist-directed care for HIV patients provides earlier viral suppression

HIV patients whose antiretroviral therapy was initiated and managed by pharmacists achieved earlier viral suppression compared with those managed by a primary HIV clinician, according a report published in the September 1 issue of the American Journal of Health-System Pharmacy.

In a retrospective cohort analysis, Ofir Noah Nevo, PharmD, and colleagues reviewed the electronic health records of patients who had been treated at an HIV primary care clinic in southern California, which had three clinical pharmacists who managed the antiretroviral therapy. Eligible patients were treatment-naïve, HIV-positive, and had started antiretroviral therapy between January 1999 and March 2013. Their baseline, pre-treatment viral load had to be recorded.

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More than 1,700 treatment-naïve patients were identified, and 1,255 were included in the analysis as their viral load had been documented before and after antiretroviral treatment was initiated, the authors noted.

“The PAM [pharmacist-assisted management] group achieved viral suppression 1.41 times faster than the non-PAM group,” according to Nevo, a pharmacy resident at the University of California San Diego, and colleagues.

Pharmacist-directed management also was associated with more frequent monitoring of patients’ viral loads during the first six months of antiretroviral therapy. With more follow-up visits, pharmacists could provide more education and support for HIV patients, which could help with medication adherence and management of any side effects, the authors said.

In addition to time to viral suppression following antiretroviral therapy, the authors also compared the median times to the first regimen change in the two treatment groups. In the pharmacist-directed care group, the median time for the first regimen change was 100 months, longer than in the control group in which the median time was 44 months.

“We speculate that several factors may have contributed to this finding: initial selection of more potent or better-tolerated regimens, more effective management of adverse effects and toxicities through more frequent monitoring, and more intensive adherence counseling than was available for the control patients,” Nevo and colleagues reported.

“Our results validate that pharmacist activities help optimize patient outcomes and provide an example of successful long-term use of a recently described model of care,” Nevo said.

The study was supported by the Clinical Investigation and Biostatistics Core of the University of San Diego Center for AIDS Research (CFAR), the University of North Carolina at Chapel Hill CFAR, and the CFAR Network of Integrated Clinical Systems.