Antiretroviral Medication Knowledge Among New York State Pharmacists

Abstract

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) remain the leading causes of morbidity and mortality in the United States. As of December 2004, an estimated 944 306 persons had received a diagnosis of AIDS of which more than half (529 113; 56%) have died. Approximately 1.1 million people are currently infected with HIV in the United States, including 21% who are unaware of their positive status. The New York City AIDS case rate (41/100 000 population) is more than 3 times the national average and is 45 times the Healthy People 2010 Goals. Clearly, HIV/AIDS remains an important therapeutic area for pharmacists to remain updated. Recently the Centers for Disease Control and Prevention (CDC) revised HIV-testing recommendations for pregnant women and patients in health care settings. These recommendations suggest that separate written consent for HIV testing should not be required and general consent for medical care should be considered sufficient to encompass consent for HIV testing. The objectives of these recommendations are to increase HIV screening, foster earlier detection of HIV infection, identify and counsel persons with unrecognized HIV infection, and provide them with access to medications and necessary services. Medication access is extremely important because antiretroviral therapy (ART) has dramatically improved survival rates. The CD4 T-cell count (or CD4 count) serves as the major clinical indicator of immune function in HIV-infected patients. A normal CD4 count for most laboratories ranges from 800 to 1050 cells/mm. Prior HIV treatment guidelines recommended ART when the CD4 cell counts dropped below 200 cells/mm. However, guidelines available at the time of this project recommended ART initiation in people with CD4 cell counts less than 350 cells/mm or in people with CD4 cell counts >350 cells/mm with specific conditions. A recent landmark study showed a statistically significant improved survival benefit (70%; P 350 cells/mm and reinstitution of ART when CD4 cell counts dropped below 250 cells/mm) resulted in a greater risk of virologic failure. Uninterrupted ART results in better health and survival. In light of the recommendations to initiate ART earlier, it is likely that more patients will receive ART, resulting in increased numbers of ART prescriptions. The inappropriate use of these medications can lead to virologic failure, drug interactions, adverse drug reactions, and inappropriate dosing, potentially resulting in increased morbidity and mortality. It is therefore important that all pharmacists be knowledgeable about antiretroviral medications to reduce and prevent medication misadventures. A survey of pharmacists in Arizona conducted by Katz and colleagues in 1993 found that pharmacists felt prepared, comfortable, and possessed positive attitudes regarding the disease state, HIV/AIDS, but had limited knowledge of ART. Our research study is the most recent evaluation of ART medication knowledge in New York State(NYS) licensed pharmacists.