HIV Adherence: How Do You Take Your HAART?

Pharmacists should be asking their patients with HIV not only if they are taking their medications, but also how they are taking them.

Medicine has made great strides in HIV/AIDS, converting it from a near-death sentence in the 1980s and 1990s to a manageable chronic illness today. The key has been the development of oral, combined, highly active antiretroviral therapy (HAART), and more recently, combined HAART formulations.

Although most patients can take oral dosage forms with no problem, swallowing is a barrier for others. The combined HAART formulations are particularly hard to swallow because they are generally larger than single HAART products.

Manipulation of the dosage forms (crushing, breaking, dissolving) can lower viral suppression due to the sensitive pharmacokinetics of these medications.

Now, an article published in the American Journal of Health-Systems Pharmacists lays out the available data on the safe manipulation of oral, combined HAART products.

Twenty-five single-medication HAART products are marketed; 13 of these are available as powders or solutions, 1 is a solution for injection, and 1 is a dissolvable tablet.

Some of the handy facts from the study are:

· Rilpivirine, dolutegravir, and elvitegravir are much smaller tablets than some of the other HAART products.

· Abacavir, etravirine 25 mg tablets, and nevirapine 200 mg tablets are scored, and raltegravir is a chewable tablet.

· All 7 nucleoside reverse transcriptase inhibitors are available as powders or solutions as single products, but not as combined products.

· The only nonnucleoside reverse transcriptase inhibitor available in an alternative formulation is nevirapine.

· The protease inhibitors darunavir, fosamprenavir, lopinavir-ritonavir, and tipranavir are available as powders or solutions.

Roughly half of HAART products are commercially available in alternative dosage forms.

If a patient needs to manipulate a dosage form, then the patient and provider should closely monitor virological and immunological efficacy and toxicity.

The study authors also noted that patients often fail to disclose that they are having trouble swallowing oral dosage forms.

Patients may be crushing or breaking tablets or capsules or even skipping the dose, which is why health care providers need to have a conversation with their patients with HIV about how they are taking their medication.