Early, aggressive treatment of HIV is now the mainstay of therapy in order to prevent the long-term infectious and noninfectious causes of morbidity and mortality.
Adherence is one of the major predictors of success and failure when treating HIV patients. Medication therapy management (MTM) providers should be vigilant for nonadherence and work with 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 and adverse effects when initiating and monitoring human immunodeficiency virus (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 two distinct types: HIV-1 and HIV-2.1 Type 1 is more common, more virulent, and easier to transmit than HIV-2. HIV-2 is found mostly on the western 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 are type of exposure, use of condoms, stage of index partner, viral load of index partner, presence of sexually transmitted diseases, and use of antiretrovirals (ARV).1,2
TABLE 26-1Estimated Risk of HIV Transmission Based on Exposure to an Infected Source |Favorite Table|Download (.pdf) TABLE 26-1 Estimated Risk of HIV Transmission Based on Exposure to an Infected Source
|Type of Exposurea ||Estimated Risk |
|Blood transfusion ||92.5% (925 in 1000) |
|Needle sharing during injection drug use ||0.63% (1 in 159) |
|Percutaneous exposure (ie, needlestick, sharp)a ||0.23% (1 in 435) |
|Receptive anal intercourse ||1.38% (1 in 73) |
|Insertive anal intercourse ||0.11% (1 in 910) |
|Receptive vaginal intercourse ||0.08% (1 in 1250) |
|Insertive vaginal intercourse ||0.04% (1 in 2500) |
|Receptive or insertive oral intercourse ||Low, accurate estimate unavailable |
|Biting, spitting, throwing body fluids, or sharing sex toys ||Negligible |
Despite the advent of new antiretroviral therapies (ART), 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 have an AIDS-defining condition.3 A patient whose immune system becomes compromised and develops full-blown AIDS usually presents with an opportunistic infection or an infection-related cancer. The definitive diagnosis ...