Early, aggressive treatment of human immunodeficiency virus (HIV) is now the mainstay of therapy in order to prevent long-term infectious and noninfectious causes of morbidity as well as mortality.
Adherence is one of the biggest predictors of success and failure when treating HIV patients. MTM providers should be vigilant for nonadherence and work with both the patient and the physician to design a regimen that is manageable, tolerable, and efficacious.
MTM providers should recognize the importance of careful screening for drug interactions as well as adverse effects when initiating and monitoring HIV medications.
INTRODUCTION TO HUMAN IMMUNODEFICIENCY VIRUS INFECTION
Human immunodeficiency virus (HIV) is a single-stranded RNA retrovirus that causes acquired immunodeficiency syndrome (AIDS) and other HIV-related disorders. HIV is subdivided into 2 distinct types, HIV-1 and HIV-2.1 HIV-1 is more common, more virulent, and easier to transmit. HIV-2 is mostly found on the west coast of Africa, whereas HIV-1 is common throughout the world. The primary modes of transmission are sexual, parenteral, and perinatal. The most common mode of transmission is sexual intercourse, primarily anal and vaginal. The estimated risk of HIV transmission based on type of patient exposure is highlighted in Table 26-1. Some of the factors that influence the probability of transmission include type of exposure, use of condoms, stage of index partner, viral load of index partner, presence of sexually transmitted diseases, and use of antiretrovirals (ARVs).1, 2
Table 26-1.Risk of HIV Transmission Based on Exposure to an Infected Source2 |Favorite Table|Download (.pdf) Table 26-1. Risk of HIV Transmission Based on Exposure to an Infected Source2
|Type of Exposure ||Estimated Risk |
|Parenteral || |
|Blood Transfusion ||92.5% (925 in 1,000) |
|Needle-sharing during injection drug use ||0.63% (1 in 160) |
|Percutaneous exposure (e.g., needle-stick) ||0.23% (1 in 435) |
|Sexual || |
|Receptive anal intercourse ||1.4% (1 in 70) |
|Insertive anal intercourse ||0.11% (1 in 910) |
|Receptive penile-vaginal intercourse ||0.08% (1 in 1250) |
|Insertive penile-vaginal intercourse ||0.04% (1 in 2500) |
|Receptive or Insertive oral intercourse ||Low |
|Other* || |
|Biting, spitting, throwing body fluids, sharing sex toys ||Negligible |
Complications of Human Immunodeficiency Virus
Despite the advent of new antiretroviral therapies (ARTs), more aggressive treatment guidelines, and public education, many patients continue to develop complications from the virus. Approximately 20% of patients with HIV are undiagnosed and therefore may not present until they develop AIDS-defining conditions.3 Patients whose immune systems become compromised and develop AIDS usually present with opportunistic infections or infection-related cancers. AIDS is defined by a CD4 count of less than 200 cells/mm3, a CD4 percentage less than 14, ...