- 2018 – Pre-Exposure Prophylaxis is now available to those at high risk. See the BC Centre for Excellence in HIV/AIDS “Guidelines for Using Prep” for more information, including the necessary prescription forms.
- 2014 – BC releases new HIV testing guidelines for healthcare providers to encourage all adults in the province to get tested.
- 2011 – The BC Centre for Excellence in HIV/AIDS presents their HIV Primary Care Guidelines, which are constantly monitored and regularly updated.
- BC’s HIV Testing Guidelines (2014)
- HIV Testing Brochure for patients (PDF)
- HIV Informed Consent Form for Patients (PDF)
- HIV Testing in Primary Care (Online course through UBC CPD)
- Clinical Care Options - HIV
- HCV – Determining Fribrosis Staging for Treatment
- NH Specialized Support Team
- BC’s Guidelines for HIV Pre-Exposure Prophylaxis (PrEP)
- Drugs for Chronic Hepatitis C Infection (CADTH)
- HEP Drug Interaction Checker (University of Liverpool)
- HIV Drug Interaction Checker (University of Liverpool)
- HIV/HCV Drug Therapy Guide
- AIDS Education & Training Center
- AIDS Info – U.S. National Library of Medicine
- BC Hepatitis Testers Cohort (UBC Centre for Disease Control)
- British HIV Association (BHIVA)
- Canadian AIDS Treatment Information Exchange (CATIE)
- Centers for Disease Control and Prevention
- International Antiviral Society - USA
- NAM - aidsmap
You play a key role in supporting patients who have HIV. HIV is a virus that uses the human immune system (specifically CD4 cells) to replicate. This weakens immune function and can lead to many opportunistic infections. A prescribed combination of antiretroviral medications (sometimes referred to as an HIV cocktail) can slow disease progression and prolong survival by decreasing viral replication. This regimen is specifically chosen by incorporating the individual’s medical history, resistance patterns or genetic predispositions to optimize activity against the virus and to minimize toxicities for the patient.
- Treatment involves three or more antiretrovirals. There are various classes of antiretrovirals currently available (see: cfenet.ubc.ca for more information).
- nucleoside/ nueleotide reverse transcriptase inhibitors (NRTIs) such as zidovudine (AZT), lamivudine (3TC), tenofovir and abacavir;
- protease inhibitors (PIs) such as atazanavir, lopinavir, and ritonavir;
- non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine and efavirenz;
- fusion inhibitor enfuvirtide (Fuzeon) injection;
- entry inhibitor maraviroc;
- integrase inhibitor raltegravir.
- Adherence is the most important factor in HIV treatment success. Missing doses (i.e. entire days or not taking all pills) can lead to resistance and further complicate treatment choices.
- All or Nothing Rule – the prescribed antiretroviral regimen must be given in its entirety to ensure the virus is being treated adequately. Even if only ONE of the medications is missing, then none of the other meds should be given. This will minimize opportunities for resistance.
- Timing – Ideally, it is best to have patients take their pills around the same time each day to create a routine and ensure even drug levels; however, if they are late, it is ok to take a daily dose as soon as they remember within the same day. Do not double doses to catch up.
- The HIV virus can change into a different form, which is not easily controlled by the current regimen. Cross-resistance may also result in the virus becoming resistant to other medications the patient has never taken before but might need in the future. Resistance can arise from poor adherence, long-term use of the same regimen or contracting a resistant virus from a new source. The doctor can order blood tests (aka genotyping) to confirm viral resistance to specific medications.
- Side Effects
- Do not suggest stopping HIV medications in response to side effects. Always ask the patient to consult with the doctor or HIV pharmacist before stopping medications. Call the outpatient pharmacist at St. Paul’s Hospital. The pharmacist can give advice on how to manage side effects or how to decrease the chances of HIV resistance.
- Drug Interactions
- Prescription and non-prescription medications, herbal products and street drugs can interact with HIV medications. Consult with the outpatient pharmacy at St. Paul’s Hospital to ensure drug interactions with antiretrovirals are avoided or managed appropriately.
- NH Specialized Support Team
- St Paul’s Hospital Outpatient Pharmacy Hotline (1-888-511-6222)