HIV management requires team of physicians

December 1, 2016

As new therapies transform HIV management from acute to chronic, primary care physicians have a greater role in supporting the interventions of specialists.

Appropriate management of HIV/AIDS patients requires a multidisciplinary team, and the role of the primary care physicians remains crucial, particularly in the treatment of comorbidities in infected patients.

While many PCPs refer HIV patients to specialists for HIV-targeted therapy, they may still see the patient for ongoing management of chronic or acute, unrelated issues. For this reason, PCPs need to be aware of the therapeutic care paths, complications, and medication interactions possible in HIV management, said Frank Romanelli, PharmD, MPH, BCPS, AAHIVP, professor and associate dean at the University of Kentucky’s College of Pharmacy in Lexington, Kentucky.

Romanelli helped create guidelines for the American Academy of Family Physicians and told Medical Economics that treatment with antiretroviral agents have enabled HIV-positive patients to be managed in a chronic rather than acute manner, and has resulted in a prolonged lifespan for most patients. However, this also makes treatment of secondary diagnoses that much more important.

“These patients will develop many of the same co-morbidities that HIV un-infected patients may develop as they age. More aggressive attention to these co-morbidities is necessary as they may progressive more aggressively in HIV-infected patients is warranted,” Romanelli said. “Closer attention to medication adherence and preventative screenings is necessary. Patients should be particularly cognizant of their immunizations status and timely vaccinations.”

Next: The role of primary care physicians

 

Wendy S. Armstrong, MD, FIDSA, FACP, professor of medicine at Emory University in Atlanta and a member of the Infectious Diseases Society of America, told Medical Economics that although many primary care physicians turn the management of HIV patients over to specialists after diagnosis, PCPs still play a large role in counseling patients on their initial care options immediately after diagnosis.

“PCPs should familiarize themselves with HIV treating facilities in the area to which they can refer patients for care, so that this information can readily be provided to a patient when a new diagnosis of HIV infection is made,” Armstrong said. “When informing a patient of a positive test, it is critical to recognize how difficult this diagnosis is to learn for most, give hope which is appropriate in the current treatment era, emphasize the importance of getting into HIV care and on therapy and give clear instructions and facilitate linkage to care with an HIV treating provider.”

Lines can become blurred between primary care physicians and specialists when it comes to the ongoing care of HIV/AIDS patients, according to Armstrong.

“Some PCPs are capable of providing HIV care for their patients and most HIV-treating providers provide primary care for their patients. Others do not and PCPs co-manage these patients,” Armstrong said. “In addition, patients with therapeutic relationships with their PCP will often want to retain that provider, regardless.”

PCPs are a critical part of the care team alongside HIV providers, Armstrong said, because they have continuity with the patient. PCPs are also essential when it comes to prescribing pre-exposure prophylaxis and educating high-risk patients with strategies to prevent infection.

“The PCP can ensure patients enter care and are started on antiretroviral therapy, can reinforce messages of adherence to therapy and should familiarize themselves with drug interactions and side effects of the HIV regimen the patient is taking. PCPs should remember that because HIV is now a chronic disease, attention to routine screening tests remains necessary,” Armstrong said. “Communication between the HIV treating provider and the PCP is critical and facilitates optimal care for the patient.”