Managing HIV/AIDS is Challenging for Women, School of Pharmacy Reports

Success in fighting HIV/AIDS in women may require altered strategies, but adherence to medications is still the key

By Steve Berberich
January 26, 2009

Today, any HIV/AIDS patient who sticks with a mediation regimen will be successful in keeping AIDS under control, but adherence is tough for many women, said clinical pharmacist Neha Sheth, PharmD, assistant professor at the University of Maryland School of Pharmacy.

Sheth was among a panel of experts who presented a two-day minimester titled “Women: The Changing Face of HIV/AIDS” this month for students from the University of Maryland schools of social work, dentistry, law, nursing, medicine, and pharmacy.

“As a pharmacist, I think one of our biggest goals is the patient’s adherence and staying focused on why adherence is so important in HIV/AIDS,” said Sheth, who counsels patients on adherence to often complex regimen therapies at the Evelyn Jordan Center in the University of Maryland Medical System.

Thirty years ago, at the start of the epidemic, the HIV virus mostly affected white, gay men in the U.S. But today, older people and young minority women are the most affected. One of every four new cases of HIV in the U.S. is a minority woman.

Sheth, who is credentialed as an HIV Specialist/HIV Expert by the American Academy of HIV Medicine, said the change to the face of the disease has complicated how health care workers try to manage medications for the patients. And strict adherence to taking the medications is more critical with AIDS than with many other diseases, she said. The drugs virtually put the virus in a sleeping mode, so it will not replicate. If the patient breaks the daily regimen of medications, the virus makes a comeback, and often becomes resistant to the drugs.

And, certain psychosocial issues that differentiate the male and female patients translate into differences in how health care workers help them on their HIV medication regimens, she said. More female patients than male patients, for example, are caring for children or are single parents.

There is little gender difference between how the current 23 HIV medications work. But, there is data that show that women cope with the disease a little differently than men, different levels of depression, fear, or social withdraw. The key task then, said Sheth, is to individualize their treatment plans to help them, male or female, overcome their adherence barriers. “You might bring them in for pillboxes, or get them into a support group, for example,” she said.

“We also look at adverse reactions to drugs and how they differ between males and females,” she added. Women may be a little more sensitive to weight distribution changes, such as an enlarged stomach response from some medications.

The first interview with a new HIV/AIDS patient is the most important because the first regimen of therapy for a patient “is always the best bet for having a virologically, biologically suppressed patient,” she said, referring to suppressing the virus in the body to try to keep the patient healthy.

The first thing she asks a patient is, “what do you do every single day? Then I ask, what time do you wake up in the morning? what is the first thing you do? do you work? at night? on weekends? do you travel a lot? Are you working out of a car constantly?” said Sheth. “All of this determines whether they should get a once-a-day or twice-a-day regimen and if they should come back frequently to get a pillbox filled.”

But regardless of gender, lifestyle or other population differences, the end result of a patient failing to stay on a patient-tailored HIV/AIDS medication regimen “is all the same,“ she said. “Non-adherence points to virological failure.”

Between patient encounters, Sheth checks in at the provider desk, offers updates to team members, monitors viral loads, and checks drug absorption mechanisms. Many HIV/AIDS patients may be suffering from other medical problems including hepatitis, diabetes, substance abuse, opportunistic infections and mental health conditions.

Gregory Taylor, MD, associate professor of family medicine at the University of Maryland School of Medicine, works with Sheth at the Jordan Center. He said, “the pharmacist is an extremely valuable member of our team, not only because they look for potential interactions and toxicities of the medications, but they also assist in developing treatment plans, and understanding how the medications affect compliance,” Taylor said. “In addition their direct hands-on education with patients greatly increases the likelihood of the patient being adherent.”

Developed by the School of Social Work, the minimester focused on social, medical, and legal issues that women with HIV/AIDS and their families face. The minimester students then design their own community outreach projects to tackle HIV/AIDS issues from the perspectives of their chosen profession.