HIV Treatment Monitoring and Adherence

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The HCPLive Peer Exchange: Optimizing Outcomes in HIV Treatment features insight and opinion on the latest developments in HIV research, diagnosis, and management from leading physician specialists.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Collegeville Family Practice in Collegeville, PA, and Medical Director of Health Services at Ursinus College, also in Collegeville, PA.

The panelists are:

• Alfred A. DeLuca, MD, Infectious Disease Specialist at CentraState Healthcare System in Manalapan, NJ
• Ian Frank, MD, Director of Anti-Retroviral Clinical Research and Director of Clinical Core at Penn Center for AIDS Research, and Professor of Medicine at the Hospital of the University of Pennsylvania in Philadelphia, PA
• Paul Sax, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women's Hospital, in Boston, MA

Also participating via video is Amir Qaseem, MD, Director of Clinical Policy for the American College of Physicians, based in Philadelphia, PA.

In this segment, the panelists discuss monitoring and follow-up care in patients with HIV.

Dr. DeLuca says “In the first weeks of new antiretroviral treatment, I’ll have them come back in two to four weeks and do a viral load and a CD4 count to show them that the drug is actually working.” At that time he also discusses any side effects the patient may be experiencing. After that, He says he’ll “monitor them at three-month intervals for a period of time until they’ve been demonstrated to be stable over time.”

If the patient seems to be doing well on the current treatment plan, Dr. Sax says that a patient visit every six months plus laboratory monitoring is adequate. He says that some European colleagues “have already reduced the frequency of the visits to annual,” which is “a real kind of tribute to how successful our treatments are because provided the patient continues to take his or her therapy faithfully, virologic suppression is the rule not the exception.”

Asked about tactics and strategies that can help promote treatment adherence in patients with HIV, Dr. Frank says there are studies that “look at various kinds of intervention, sometimes reminders, watch reminders, and sometimes the studies show success and sometimes it shows the opposite, that people are aggravated by the reminder. I think the most important factor is making sure the patient is well educated and understands the importance of therapy and buys into it. One of the most effective ways to monitor adherence is by calling the pharmacy and asking for dates of refills.”

Dr. Doghramji also asks the panel about HIV screening, noting that “the American Academy of Family Physicians says start screening at age 18, but other governing bodies like the CDC say all the way down to age 13.”

Dr. Frank advises to just select an age at which to initiate screening and then screen everybody for HIV at that age, which helps to destigmatize the testing process. Dr. Sax adds that because “the highest yield for catching new cases of HIV is to do repeat testing in high-risk individuals,” it is important for physicians to communicate with their patients about behaviors and activities that can increase their HIV risk.