Download The HIV pharmacist is in - Singapore General Hospital

NOV– DEC 2014
singapore health
NEWS
05
The HIV pharmacist is in
Pharmacists trained in HIV drugs counsel patients warded for the disease on
how to take their medication
By suki lor
A
Photo: alvinn LIM
ll drugs, including seemingly
innocuous supplements, can
interact with each other. Taken
together, some might reduce the
effectiveness or increase the toxicity of other drugs. Patients whose
immune systems have been
weakened by the human immunodeficiency virus (HIV) are
highly susceptible to numerous
infections, so such drug interactions can be especially dangerous for them.
Dedicated HIV pharmacists
with detailed knowledge of HIV
drugs play an important role in
ensuring that patients suffering
from this complex condition know
and understand the proper way to
take their medications. At Singapore
General Hospital (SGH), a small team of
HIV speciality pharmacists have been
looking after this growing group of
patients since February.
“We provide drug counselling to HIV
inpatients who are newly started on
drugs or patients who have a change
in their drug regime, in particular HIV
medications, or medications to prevent
opportunistic infections (infections that
people with healthy immune systems
don’t normally get),” said Ms Cheryl Lim
Li Ling, Senior Clinical Pharmacist, SGH.
People become infected with HIV
through unprotected sexual contact with
infected partners or sharing of needles as
the virus is transmitted through infected
blood, semen and vaginal secretions.
HIV destroys CD4 cells, a type of white
blood cell that helps the body fight disease. Many HIV patients suffer from other
conditions like hypertension, diabetes
and heart problems, in part because
According to Ms Cheryl Lim Li
Ling, Senior Clinical Pharmacist,
incorrect drug usage can lead to
drug resistance and the patients
might have to go on to second-line
drugs which can be expensive.
they are
usually older,
between 35
and 50, when diagnosed. They might
also have hepatitis B or
C (also transmitted through
needle sharing or unprotected
sex). Because of their weak immune
systems, HIV patients tend to be easily
infected with other diseases like pneumocystis pneumonia (a form of pneumonia) and tuberculosis (TB).
Some commonly prescribed medications for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV
drugs. The HIV pharmacist will then look
to replace them with drugs with a lower
risk of interaction. If the patient is suffering from multiple medical conditions,
the pharmacist will ensure he knows how
to take his medications. One HIV patient,
said Ms Lim, was taking nine different
drugs at least once a day, as he also suffered from TB.
With multiple drugs, it is easy to get
the drug regime wrong – once a day
instead of three times, three tablets
instead of one, or forgetting to take the
medication altogether. Incorrect usage
can lead to drug resistance. When that
happens, the patients might have to go
on to second-line drugs which can be very
expensive, Ms Lim said. She is one of three
specially trained HIV pharmacists who
counsel patients warded at the hospital,
about five a day on average. “As we are
pretty new, we are looking at just newlydiagnosed patients for now,” Ms Lim said.
For such
patients,
t h e p ha rmacis t s have
devised a workflow
encompassing counselling on the need for
antiviral therapy and prophylaxis, which is protective or preventive treatment. “If they have a low CD4
count, we will suggest initiating prophylaxis drugs to prevent incidents of opportunistic infections,” said Ms Lim.
A significant proportion of HIV cases
are diagnosed only at an advanced
stage, according to a Singapore
progress report submitted to
UNAIDS, the United Nations
agency dealing with HIV and
Acquired Immune Deficiency
Syndrome (AIDS). In 2012, 48
per cent of new cases already
had late-stage HIV.
Th e CD 4 count in di cates how strong someone’s
immune system is and how
advanced the disease is. The
lower the count, the more prone
the patient is to different types of
infections. Without proper treatment, HIV will progress to AIDS. By
the time AIDS develops, the immune
system would have already become
severely damaged.
Sur veys in the US and UK have
showed that with HIV pharmacists, the
number of medication errors fell while
drug adherence improved as patients
had a better understanding of the drugs
they were taking, Ms Lim said.
The SGH team is hoping to expand the
service to patients seen at SGH’s specialist clinics, especially since the number
of HIV patients diagnosed is expected
to increase.
Since voluntary opt-out screening for
HIV infection started being performed
routinely for adult patients at public hospitals, more than 100,000 HIV screening
tests have been done between 2011 and
2013, of which 0.1 per cent were found to
be HIV-positive.
HIV infection mostly through sex
Number of newly
diagnosed HIV cases
20112012 2013
461
469
454
Number of people
living with HIV
3,811
4,193
6,229
Total number of
diagnosed cases
2011
2012
2013
Male
Female
1985-2013
430437 428 5,654
3132 26 575
Mode of transmission
Heterosexual sex
Homosexual sex
Bisexual sex
Intravenous drug use
Blood transfusion
Renal transplant overseas
Perinatal (mother to child)
Others/Uncertain
210
220
181
3,741
195
210
209
1,712
42
27
38
446
4
2
4
115
0
0
0
3
0
0
0
5
0
0
0
31
1010 22 176
Ministry of Health, UNAIDS