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 The leading web portal for pharmacy resources, news, education and careers March 21, 2018
Pharmacy Choice - HIV/AIDS Disease State Management - March 21, 2018

HIV/AIDS Disease State Management

HIV/AIDS: Moving Into the Primary Care Setting
by Alan P. Agins, BS, MS, PhD President - PRN Associates, Ltd. - Continuing Medical Education

Twenty-eight years ago, while Kim Carnes was belting out the number one Billboard hit of 1981, Bette Davis Eyes, we heard the first reports of an unusual cancer (Kaposi’s Sarcoma) and an increase in PCP pneumonia cases seen only in patients with weakened immune systems. Since most of the early cases were reported in homosexual men, one term coined originally for the disease was gay-related immune deficiency disorder or GRID. A year later the name was changed to AIDS, and a year or two after that, HIV was discovered as the virus that caused the disease. Since the beginning of the epidemic in 1981, more than one million people have been diagnosed with AIDS in the US, and approximately 600,000 of those people have died. Current estimates suggest that there are more than 1.1 million people in the US living with HIV/AIDS (CDC estimates > 450,000 of those have AIDS).

For definition, the term HIV/AIDS represents all people who are infected with HIV (HIV positive). Conversely, AIDS is defined as being 1) HIV positive, 2) having a CD4 count of < 200/ul and 3) having at least one of twenty-six CDC-defined illnesses (opportunistic infections, cancers, etc). Most people live with HIV for several years before developing AIDS.

Currently, there are six different classes of antiretroviral drugs for treating HIV/AIDS. Good compliance is critical, but side effects can be significant. And, drug interactions, not only between antiretroviral drugs but with other primary care medications for depression, anxiety, lipid management, glycemic control, infections, etc can be remarkably complicated.

The three major antiretroviral classes, comprising about two dozen total drugs, include:

Nucleoside Reverse-Transcriptase Inhibitors (NRTIs or "nukes") are analogs of the various nucleosides (and some nucleotides) building blocks for DNA replication. Essentially the NRTIs lack the 3’ OH group on the pentose sugar (the attachment site for the 5' phosphate of the next nucleotide) and as a result, when incorporated into the chain they cause premature termination of reverse-transcriptase-mediated DNA synthesis. The “nukes” are considered the backbone of all combination therapies (cocktails) for HIV/AIDS and usually two or more different ones are used in combination.

Non-Nucleoside Reverse-ranscriptase Inhibitors (NNRTIs or "non-nukes") are direct inhibitors of the enzyme, reverse transcriptase. When combined with the "nukes" the likelihood of successful viral replication decreases significantly.

Protease inhibitors (PIs) - When HIV proteins are produced during viral replication, a number of them are translated as single, large polypeptides that need to be cut into smaller, functional proteins. Protease is the enzyme responsible for those post-translational modifications. PIs block that important step and significantly reduce viral replication. Protease Inhibitors are used in combination with the "nukes". Unfortunately, both the "nukes" and the PIs increase the risk for cardiovascular side effects, such as development of some or all of the metabolic syndrome morbidities.

In addition to the three major classes of antiretroviral drugs, there is currently one approved Integrase Inhibitor, one Fusion Inhibitor and one CoReceptor blocker. These drugs are generally reserved for treatment-experienced patients when the other classes display diminished efficacy or for those who develop chronic tolerability problems.

From about 1996, with the development of the protease inhibitors and the implementation of a multidrug "cocktail" approach (HAART – highly active antiretroviral therapy), the rate of AIDS cases (and deaths) has fallen dramatically. In recent years, the annual number of deaths from AIDS has hovered around 15,000 (which incidentally is less than the annual mortality rate for MRSA infections). With recent estimates of between 40,000 and 60,000 new HIV infections annually this means that the number of persons living with HIV/AIDS will continue to rise into the future and greater numbers of primary care professionals will need to become involved with their auxiliary care.

Please visit to register for one of
Alans's live online webinars about HIV/AIDS.

Links - HIV/AIDS
Center For Disease Control Divisions of HIV/AIDS Prevention The National Center for HIV, STD and TB Prevention. AIDS Gateway to the Internet

AIDS Education Global Information System (AEGiS) utilizes a combination of FidoNet® (connecting over 32,000 electronic bulletin boards in 66 countries) and Internet communication tools. In this way, we seek to relieve some of the suffering and isolation caused by HIV/AIDS, and foster the understanding and knowledge that will lead to better care, prevention, and a cure.

UNAIDS leads, strengthens and supports an expanded response aimed at preventing the transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities to HIV/AIDS, and alleviating the impact of the epidemic. is a group of individuals closely linked to the communities of people living with HIV, hepatitis B, and hepatitis C virus infection.

If you would like to contact us please go to our Contact Page.


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