Drug Interactions in Hepatitis C and HIV Treatment
Pharmacists’ Tips for Selecting Appropriate Agents that Play Well
with the Patient’s HIV Regimen
Brittany L Mills, PharmD, MBA, BCACP, AAHIVP
Walgreens
Michelle T Martin, PharmD, BCPS, BCACP
University of Illinois Hospital and Health Sciences System | Chicago College of Pharmacy
The authors report no financial conflicts with any products discussed in this paper.
Introduction
Seasoned health care providers of hepatitis C virus
(HCV) and human immunodeficiency virus (HIV)
co-infected patients are often quite familiar with
drug-drug interactions that can occur with antiviral
treatment. However, with the recent availability of alloral HCV treatment for some genotypes, prescribers
with less experience in antiviral treatment may
engage in HCV care. Several sources offer providers
information and literature support on antiviral drug
interactions. Pharmacists apply clinical knowledge to
make recommendations to prescribers and educate
patients about the importance of full disclosure of
medication and supplement intake. This article will
provide an overview of the role of the pharmacist
in treatment of HCV/HIV co-infected patients,
management of drug interactions, and resources to
assist in detection of drug-drug interactions.
Patient and Provider Education
Proper medication selection is imperative for successful
HCV treatment. A pharmacist can offer invaluable insight
into a patient’s care as part of a multidisciplinary team.
Pharmacists with ambulatory care positions have a
unique opportunity to prescribe or advise on prescribing
at the point when HCV treatment begins. They review
a patient’s current medication profile, recommend
management strategies for drug-drug interactions,
and suggest HCV treatment agents and specific doses.
Community pharmacists have an opportunity to provide
recommendations to the prescriber before a medication
is dispensed to the patient. Pharmacists working in the
community or specialty pharmacy setting have access
to a patient’s refill history and can detect any potential
drug-drug interactions with concomitant medications.
Pharmacists providing medication therapy management
(MTM) services in a variety of settings are also poised to
detect drug-drug interactions and propose management
strategies to providers.
We recommend that a pharmacist interviews the
patient prior to HCV treatment initiation to verify the
patient’s complete medication list, including not only
prescriptions, but also over-the-counter agents and
herbal supplements. The pharmacist can then detect
any potential drug-drug interactions, drug-disease state
warnings, or contraindications. Patients should be given
a written copy of their complete updated medication
list at every visit, be instructed to carry it with them at all
times, and share it with all of their health care providers.
Patients should be educated about the risk of drug
interactions and the potential adverse effect on their
HCV treatment outcome or the serum concentration
of the interacting agent. It is imperative that patients
understand the importance of adherence to maximize
their chance for sustained virologic response (SVR).
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