Next week I will lead the discussion with a patient I worked-up on Friday. Adherence is one of the key points of discussion. My preceptor and I had a discussion about how one can check adherence. This is the list we came up with:
1. Pill count
2. Timing (including interaction with other drugs)
3. Ease of administration, is patient okay with remembering? (Ways they can remember: blister packing, dosettes, timer, team-up with roommate/partner)
4. Have they missed any doses?
5. Missed vs. late doses
6. If applicable are they taking doses with or without food

Drug Interactions: Taking any other drugs?
Experiencing any side effects?
Review the labs
What is the plan for this patient?

Other topics discussed:
Pathophysiology of HIV:
Good source:
When to start therapy?

When should you genotype a patient?
1. Baseline: May be the patient has primary resistance
2. Suspected resistance: virologic failure
Best scenario when patient is on treatment when he/she shows first sign of virologic breakthrough
Routine check for CD4/viral load: every months unless patient is <40 (undetectable), then every 2-3 months

Recommendations for initiating Antiretroviral treatment (ART) in treatment-naive adults with HIV-1 infection:
ART recommended regardless of CD4 count:
Symptomatic HIV disease
Pregnant women
HIV-1 RNA >100 000 copies/mL
Rapid decline in CD4 cell count, >100/uL per year
Active hepatitis B or C virus coinfection
Active or high risk for cardiovascular disease
HIV associated nephropathy
High risk for secondary HIV transmission e.g. serodiscordant couples
New recommendations:
Antiretroviral therapy (ART) is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count:
CD4 count 500 cells/mm3 (BIII)

Drugs available through BC Centre for Excellence:

About rajwantminhas

I just finished my pharmacy degree at UBC. I am excited to be part of Lower Mainland Pharmacy Services. My goal is to get exposed to different kinds of disease states, medications and become better at applying my knowledge. Patient interaction is another aspect that I am going to strive to get better at. I am looking forward to this intense year and learning tonnes!

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