Pharmacists are key players in difficult HIV drug regimens - Brief Article

The human immunodeficiency virus treatment regimen known as the "drug cocktail," a high-powered combination of several specific drugs, is considered the most effective tool to date to fight HIV/AIDS. But many patients find staying on the regimen difficult. Treatment can involve taking up to 20 pills a day, and side effects can include diarrhea, vomiting, stomach enlargement, hunchback and fatigue.

At the same time, however, these difficult regimes can place the pharmacist and the pharmacy in a central role: keeping patients on these much-needed, and often higher-priced, drugs.

Fifty-seven percent of those being treated with drug cocktails found it "somewhat difficult" to adhere to their drug plan, according to a GlaxoSmithKline survey of 371 self-identified respondents with HIV Problems included having to take too many pills (67 percent), side effects (61 percent), food restrictions (55 percent), pill frequency (49 percent) and the strict timetable for taking them (48 percent).

"Everything must be planned in advance," said study participant David Morris, who has been taking anti-AIDS drugs for 15 years. "I'm constantly thinking about what medicines I need, what time to take them, when and what I can eat. It's not as simple as people think. Almost every HIV positive patient gets what I call 'battle fatigue' or AIDS fatigue." Morris takes about l40 pills a week.

"It's very important for the drug companies to be involved," Dr. Charles Farthing, chief of staff at the AIDS Healthcare Foundation in Los Angeles, said. "Quite a number of them, including GlaxoSmithKline and Merck, have stepped up to assist in educating patients."

Adherence is paramount

Perry Anderson, senior vice president of specialty drug distributor Chronimed and cofounder of its StatScript chain of chronic care pharmacies, agreed. StatScript, which was founded in Kansas in 1986 after Anderson and his former business partner Phillip Scott found that some pharmacies did not want to serve HIV-positive customers, now has 40 pharmacies in 20 states. "The drug companies have resources that we do not," Anderson said. StatScript regularly partners with Pfizer, GlaxoSmithKline, Serono and the National Institutes of Health.

Adherence to the HIV drug regimen is important because of the limited number of drugs available to treat the virus--a mere 16, according to Farthing. "If a patient is consistently taking less than 100 percent of their meds, the virus will grow and become resistant to the drugs," he said. "When a patient becomes resistant to one drug there can be a cross-resistance to several others."

"Pharmacists are important to adherence," Farthing said. "They can help with counseling about not only the disease but dosage and side effects." He believes pharmacists can assist in many practical ways, including dispensing medication in organizers and keeping records of patient refills. "If a patient is returning to refill his medications every 70 days or 90 days rather than the 60 days indicated, the pharmacist can alert the physician that there is an adherence problem," Farthing said.

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