The Pharmaceutical Journal Vol 267 No 7167 p425-429
29 September 2001

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HIV pharmacists

A wider role

From Mr D.A Ogden, MRPharmS

On behalf of the UK HIV Pharmacy Association I would like to comment on the rather disappointing report (PJ, 8 September, p327), based on a lecture given by Michael Madalon at the International Pharmaceutical Federation Congress in Singapore, on the role of pharmacists in HIV prevention and treatment.

Mr Madalon’s experience as a member of the multidisciplinary team is very different from our UK experience. If the article was meant to inform our members then I feel I should highlight some areas which were lacking. Many pharmacists working in the field of HIV in the UK, invest more time and effort in the stages before monitoring of compliance to drug therapy becomes necessary. Typically, they are working with prescribers to optimise drug selection for individual patients, counselling of the patient including a lifestyle assessment, working out timings of doses in relation to food and other daily events, and side effect management. In addition to a tailored regimen, the pharmacist can often support the patient by provision of compliance aids and various clock/alarm products. It is on this individualised basis that patients will be more likely to adhere (a more suitable term than compliance).

The strategies for monitoring adherence presented by Mr Madalon were more of a text book summary on the strategies best used in patients with pulmonary tuberculosis rather than HIV. He rightly points out that directly observed therapy is more applicable to captive populations and in Europe has only been applied on any larger scale to intravenous drug users, with HIV, motivated more by daily opioid substitute. His final and fifth strategy was that therapeutic drug monitoring should be used, an approach more akin to anticonvulsants than antiretrovirals, and says no more about adherence in HIV patients than which drugs they may have taken in the past two days.

Mr Madalon’s final remarks on the lack of utility of CD4 cell counts and HIV-1 viral load were astonishing. Any patient on combination treatment for more than six months with a detectable viral load should draw a pharmacist’s attention. Among the likely causes of this are drug resistance, poor absorption and, of course, non-adherence to therapy.

David Ogden
Chairman,
UK HIV Pharmacy Association

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