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: http://www.niaid.nih.gov/topics/hivaids/Pages/Default.aspx
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
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
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: http://www.cfenet.ubc.ca/sites/default/files/uploads/HIV-AIDS%20Drugs%20available%20through%20the%20BC-CfE.pdf