CEimpact Podcast

HIV Treatment Updates: Counseling, Adherence, and Clinical Pearls

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HIV treatment has evolved significantly, offering streamlined regimens and improved patient outcomes. This episode will discuss the latest antiretroviral therapy (ART) guidelines, highlighting preferred regimens, key pharmacologic considerations, and practical counseling strategies for pharmacists. Tune in to enhance your clinical knowledge and play a pivotal role in optimizing care for individuals living with HIV. 

Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

Rachel Maynard, PharmD
Lead Editor
Pyrls

Joshua Davis Kinsey and Rachel Maynard have no relevant financial relationships to disclose. 

BONUS: With this episode, you also get exclusive, FREE access to beautifully designed clinical charts and practice resources from our friends at Pyrls, that you can use in your everyday practice. Click the links below to access these practical tools:

 
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify current guideline-recommended antiretroviral therapy (ART) regimens and their key components.
2. Describe important counseling points for pharmacists supporting patients on HIV treatment, including adherence, side effects, and drug interactions.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-245-H02-P
Initial release date: 7/21/2025
Expiration date: 7/21/2026
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm excited about our conversation today. As a reminder, we've launched a special pilot series in collaboration with our friends at PEARLS, a modern drug information resource and app. These crossover episodes, called Game Changing PEARLS, combine PEARLS' trusted, evidence-based clinical tools with CE Impact's expertise in pharmacy education and accreditation, bringing you timely, actionable content that supports both your practice and your professional development. It's a privilege to work alongside the PEARLS team and we're excited to continue this pilot series with today's episode focused on HIV treatment. Hiv treatment continues to evolve, offering simpler regimens, improved tolerability and life-changing outcomes for patients. In today's episode, we'll cover what pharmacists need to know about current antiretroviral therapy, key counseling points and how to support patients through every step of their treatment journey. And it's so great to have Rachel Maynard back as our guest for today's episode Rachel welcome.

Speaker 2:

Thank you so much for having me back.

Speaker 1:

Yeah, and as a reminder, rachel joined us for a previous episode on asthma, but for some of those listeners that may not have had a chance to listen to that, rachel, if you'll take just a minute or two to introduce yourself and tell us a little bit about your position at Pearls and anything else you want to share, Sure, yeah, Thanks, Josh.

Speaker 2:

So I am a clinical lead at Pearls. As you mentioned, we're a drug information resource and some of our most popular features are some of our charts and key counseling points at Clinical Pearls so the name is apt. But my prior background? I worked for over a decade in the drug information education space and before that I was a community pharmacist. I did a community pharmacy residency and then was a staff pharmacist and managed clinical programs for a region of a grocery store chain. So really I'm here and excited today, passionate about educating healthcare providers to optimize care for patients in the best way possible, using tools and resources to make their work efficient and effective. So very, very happy to be here and to be chatting about this very important topic.

Speaker 1:

Yeah, yeah, absolutely. And you know, like I said in the segue, this is this topic. It just I feel like it's one of the ones that is just ever changing, like new stuff all the time, different regimens and and which is great, it's just wonderful, but it's one of those that we really have to work hard at keeping up to date with. So thank you so much for joining us and and giving us some actionable insights for today. So, as I always like to do, start off the episode with just a foundational refresh to make sure everybody's on the same page. So, if you don't mind, let's just recap exactly what HIV is and, just a little maybe, some facts about it and so forth. So we'll start with that.

Speaker 2:

Sure. So yeah, hiv it stands for human immunodeficiency virus. It is a retrovirus that targets the immune system, and so some of the metrics you might hear around that are CD4 count, which is a type of white blood cell, and also viral load. So how much virus is essentially in the blood for patients to know how well their condition is being managed? But ultimately it can lead to if unmanaged, can lead to a weakening of the immune system, and the most advanced stage of an HIV infection would be AIDS, acquired immunodeficiency syndrome. So without treatment, the life expectancy for people with AIDS is actually about three years, and even less if they were to develop an opportunistic infection. So if you think about that, that life expectancy for for AIDS, versus where we are now in treating HIV and getting patients treated sooner and managing the condition, like you say, it's come a really long way in the 40 years or so since it was sort of at the height of the epidemic.

Speaker 1:

Yeah, absolutely, and you know, again reiterating that this is no longer not to be frank, but no longer a death sentence, right?

Speaker 2:

Absolutely.

Speaker 1:

Yeah, it's a manageable condition. Early diagnosis is key, also making sure that the right regimen and treatment is key. But yeah, totally manageable disease and patients can live a normal, healthy life.

Speaker 2:

Yeah, what we're seeing is that, you know, more guidelines are coming out. We have our guidelines focused on HIV treatment, but we're also seeing more guidelines focused on managing chronic comorbidities in people living with HIV, because their life expectancy is now as good as somebody who doesn't have HIV. So, yeah, more like cardiovascular management and guidelines tailored to patients with HIV, but focusing on these other comorbidities that they might be living with, just like any other patient who's living a long life would expect to have.

Speaker 1:

Exactly yeah, because back in the 80s, when it was at the forefront of everything, those patients weren't living long enough to develop diabetes or heart disease or things like that.

Speaker 1:

So, yeah, it's a great point. So one of the things that we're going to talk about, obviously, is the therapy and the different regimens, and so I mentioned earlier it's antiretroviral therapy, which we'll just refer to throughout as ART. We talked about that's a mouthful, so we're going to go ahead and just say that we're going to just refer to that as ART throughout the rest of the episode today. But let's talk just briefly about what are some of those regimens, and I'd also like to introduce undetectable, and I'd also like to introduce undetectable. That's something that you're going to hear in treatment and maybe exactly if you can explain what that means and what we're trying to reach with that yeah.

Speaker 2:

So antiretroviral therapy ART since that is a mouthful that is the idea of using multiple drugs to suppress HIV replication and that was really sort of, as you say, brought about in the early 90s and sort of revolutionized the treatment of HIV, the idea being that we have a multi-drug regimen that targets various points of the HIV life cycle to help manage the condition.

Speaker 2:

And so one of the key goals of therapy is not only to, you know, protect and preserve the immune system, but also, through that viral suppression, but also to help prevent transmission to people who don't have HIV. So, as you said, this undetectable and a really easy way to remember this, and what I think is getting a lot of press recently, is this U equals U, so U, the letter U equals U, so undetectable equals untransmittable, and the idea that this sustained viral suppression can help prevent sexual transmission of HIV. So, again, a really sort of revolutionizing opportunity for people to understand that taking HIV antiretroviral therapy, it doesn't mean just helping their own condition, but also helps prevent transmission to others, and that's a really, I think, powerful point for people to understand.

Speaker 1:

Absolutely, absolutely, and it's important for us, as pharmacists, to understand the terminology that's associated with it, and if our patients mention something like that, we need to be in the know as to what everything means.

Speaker 1:

So with that perfect introduction to what is the role of the pharmacist, so where are some of the things that some of the opportunities that we have? And we're going to dig into those deeper. But obviously we're the medication experts, right? So we are the ones that should know everything about the regimens, the medications, helping to select those. If we're working in a collaborative effort with other providers of our patients with HIV, we can obviously help with adherence support, we can help with counseling and all of those sorts of things and then managing any side effects. So, unfortunately, ARTs don't come with no side effects, Just like any other medications. There are a lot of side effects there, and one of the things that I really want to touch on later is you know, these medications are somewhat highly interactive with other meds and with other things. So we want to be sure that we as pharmacists are in the know about that as well. Anything to add there before we jump into each of those kind of individually and greater yeah, there's a lot to tackle.

Speaker 2:

So, yeah, let's let's break that up into bite sized chunks.

Speaker 1:

Perfect, perfect, okay. So one of the first things, as an opportunity for pharmacists, let's talk about the guidelines, the guideline based care, the pharmacotherapy that's out there, and the the importance of ensuring that our patients are on the right therapy, first line, so that we're not running out of options or that they're not reaching undetectable status quickly.

Speaker 2:

Yep. So the guidelines are from the US Department of Health and Human Services and the website is clinicalinfohivgov, so it's very easy to find. And again, there are guidelines specifically for antiretroviral therapy for adults and adolescents, as well as more tailored guidelines for perinatal care for pediatric patients for opportunistic infections. So there's a whole host of guidelines on the website, but very easy to digest and read through and they have executive summaries and very easy to sort of get the information you need quickly. So it's a good resource to be aware of and those are updated on a rolling basis as new evidence comes out. So the last time these guidelines were updated was last September and there was a pretty big shift in sort of this initial treatment for HIV because one of the previous regimens that was recommended as original initial treatment was sort of swapped out with a different regimen, and so I can chat a little bit about that if we're at a good place to do that, yeah, let's do it.

Speaker 2:

Okay, sure. So basically you can sort of think of the treatment of HIV as typically requiring two or three drugs in the regimen. So typically we'll see two nucleoside reverse transcriptase inhibitors, nrtis, plus a third drug from one of these other classes which might be an integrase transfer inhibitor, an integrase inhibitor I'll call it an NNRTI non-nucleoside reverse transcriptase inhibitor or a protease inhibitor with a pharmacokinetic booster. So I know that's a lot and I know. For me, learning about HIV in school and then like trying to remember it was always very overwhelming. But there are, like I said, lots of resources to help. The guidelines are great At Pearls. We also have a pharmacotherapy review chart, cheat sheet, which outlines the first line regimens for many patients with HIV and I know you show that here, josh.

Speaker 2:

So what we see now is that initial ART for most people living with HIV is, as you said, very streamlined and straightforward compared to what it was even a few years ago. So one of the first line options is a complete regimen. That's one tablet taken once daily with or without food, very straightforward. So it has three drugs. It has big Tegravir, tenofovir, alafenamide and emtricitabine. So again, an integrase inhibitor with two NRTIs. So it matches up with that sort of general combination we need to be thinking about, but it's a very simplified regimen for patients. So that's one option.

Speaker 2:

There are other three drug combos that again the chart shows and the guidelines have. But basically it means that for most people they can have a two pill regimen and much easier for two pill, you know, starting out at the most, and sometimes just one. So again, very, very streamlined. And the side effects you mentioned can be problematic. But for these initial therapies the toxicity and side effect concern is actually much, much less than it was with our older regimens. So again, that's another long way that I think we've we've come with HIV treatment is not only the simplicity but also helping to mitigate some of those side effects of some of the newer regimens.

Speaker 1:

And have a better quality of life for the patient as they're taking the medications.

Speaker 2:

Yeah, and to help improve adherence right, Because we know, adherence, as you said, is such an important part of HIV treatment. So if we can have meds that are better tolerated, that's obviously going to innately improve adherence, just by, yeah, the matter of having better tolerated meds, absolutely.

Speaker 1:

Yep, yeah, and this chart for those of you that are just listening, I am showing a chart right now from Pearls and it is their pharmacotherapy review HIV pharmacotherapy review chart and it's just it's I was telling Rachel early it's so good, it's so detailed, it has so much great information on here and it's just a really great resource for the pharmacy teams to ensure that patients are starting out on the right thing and if there is an opportunity for you know if they have to change therapy, this is a great resource to look at to see what are the other options for your patients. Rachel, is there anything else you wanted to share on this particular chart here?

Speaker 2:

No, I would just say again, I always felt like HIV treatment was very overwhelming and I think this just helps to exemplify the fact that it doesn't need to be. And for all of us as pharmacists, I think we can really just sort of remember some simple strategies, like the fact that you know it's two NRTIs, usually with one of these other classes, and there are these complete regimens available that have all three drugs in one pill. So we have again it's streamlined and simplified, hopefully from what many of us may have been taught in school.

Speaker 1:

Yeah, exactly, I mean, it was 20 years ago for me, when I was more than 20. Yeah, so it definitely is much more streamlined and I feel like much more manageable from that provider perspective, like it's easier for us as pharmacists to help manage this process. So you mentioned adherence support and I think that's huge. So let's talk about that. That's another opportunity. Obviously, as pharmacists, we're the medication experts, but we also you know that's one of our roles is making sure that patients understand the importance of staying adherent. So, if we can speak to that for just a couple minutes as well, yeah, yeah, absolutely.

Speaker 2:

And I think, just like with any adherence consideration in working with our patients, it's not a one size fits all approach and any concerns about adherence are going to be very patient, specific.

Speaker 2:

So finding out what might be a potential barrier for that patient or where a gap in understanding might be, and helping the patient get that buy-in for whatever is important to them.

Speaker 2:

So you know, if it is a concern about number of pills, number of daily doses, as I said, there are one pill, one daily dose, you know, with or without food, that can be very straightforward.

Speaker 2:

So hopefully that is less of a concern than it maybe was before. But also helping people understand the importance of taking the medicine in this condition versus other conditions they might be taking medicines for. It's a similar sort of thing where they might not have any symptoms or any visible effects from the condition, just like with heart disease, diabetes they might not have anything that they feel, but the importance of suppressing that viral load and maintaining that in order to not only improve their own health but also that U equals U right. So preventing transmission to others and especially with HIV treatment, the concern about resistance and so helping them understand if the regimen isn't taken as prescribed, then it might increase the risk of resistance and then that can lead to the treatment not working as well and then they might need a different regimen that maybe isn't as easy to take or isn't tolerated as well, and so, again, getting that understanding and buy-in early on, I think can just go a long way, but really helping them understand working with the patient.

Speaker 2:

As I say, if it's concerned about side effects, again, side effects are much more easily navigated than they might have been in the past. With any regimen. It's going to vary by regimen and there are still a lot of regimens, so it's going to vary but we can let them know that. You know, common side effects include things like fatigue, nausea, sleep problems, but those typically are mild and go away with time. I think, in terms of side effects, the point I would really want to bring home is that if they are having anything they feel is a side effect, just be sure to report it to me, like I would rather have you come to me and tell me that you're concerned, rather than having you try to adjust your regimen or stop the regimen because of those issues with resistance and then not having that viral load suppressed.

Speaker 2:

So yeah, just encouraging that open communication so patients feel comfortable coming to us with those concerns.

Speaker 1:

Absolutely, and that's something that we talk about all the time as pharmacists. That's our role is to to have that, that relationship with a patient, so that they do feel comfortable telling us everything you know. I think it's really important, too, to to point out that not only is this like a like a one one pill wonder, where you know all three are in one pill, but it's just once daily as well, like it's just it's one pill once daily, taking the same time each day, you know, and so I think that's really important too.

Speaker 1:

I think you think about, and even again, back when I was in school, I felt like the regimens weren't that simplified, like there was even, you know, multiple times a day, or two or three pills a day, or whatever, and so I, you know, just really focusing on this is simple, this is easy. And if you take it this way and continue to do it in this easy way, then it gets to stay that way, you know like it's when you're non-adherent. That's when we have more complex regimens.

Speaker 2:

That's when we have difficulties and whatever. So yeah, and I will say too, there is an injectable treatment option as well. And I will say too, there is an injectable treatment option as well. So, for people who are stable and have, you know, a very good viral suppression, there is an injectable option that, once it's initiated, it can be given every two months or so. So that is another option. If patients are stable and doing well, it may be a consideration for them. If they're having trouble with that daily dosing, that could be another injectable option to consider.

Speaker 1:

Yeah, that's a great call out Again. Just so many advancements in this space. You know the fact that there are injectable options now that are longer acting. So one of the other things that we'd be remiss if we didn't talk about is counseling and educating the patients on prevention of transmission even though you know we reached the undetectable.

Speaker 1:

It's not 100%, absolutely not possible. It is very, very high, but we want to be sure that we are educating our patients with HIV about, you know, their partners who might be at risk of transmission. So anything you want to add to that in that space?

Speaker 2:

Yeah, so, as you said, pre-exposure prophylaxis. So PrEP is, I think, a term that both you know, the public and healthcare professionals are getting more and more aware of. You know, helping prevent people from being at risk of getting HIV before they're exposed. So, like you say, if somebody living with HIV is being treated with antiretroviral therapy and has a partner who doesn't have HIV, if they were to use PrEP, that also would then substantially reduce their risk of getting HIV. And so there are oral medicines again that people can take on a daily basis to help prevent exposure.

Speaker 2:

But actually, pretty big news, just last week I don't know if you saw, but there was a new injectable option approved for PrEP. So lenacapivir is the name of the drug and it's the first option that's actually injected every six months for PrEP. So just twice a year patients can get an injection for PrEP and to help prevent exposure. There was an injectable option before that was given every two months. It's still available and there are still, like I say, oral medications that can be taken as well. But this is another again nice option to help simplify PrEP too. Yeah, and use that in tandem.

Speaker 1:

And I wonder you know if, is it good news down the line that there may be another long-acting injectable option to treat HIV that is more of a six-month or one year or something like that, which would just make the regimen that much simpler for patients. Just, like a long-acting thing it's interesting to think about and hopefully that is something that we can see coming down the pipe.

Speaker 2:

So I don't know is something that we can see coming down the pipe. So I don't know, yeah, if actually the the pearls chart that we have, that hiv medications chart that we have. So it has, um, like we said, it has all the complete regimens. It has the um individual drug classes so you can see which drugs are in each class. Um, it does note the the injectable options here as well. There we go, just waiting for that to pull up, and so, yeah, if you scroll down just a little bit, yeah, it shows here these lenacapavir options, so that Salenka is also approved for treatment and Yastigo sorry, is the brand names for these drugs that are for PrEP. So there's both an injectable option of that same drug for treatment as well. So, just again, another it's not a complete regimen, but it is a drug option that can be ejected, whereas if you look in the complete regimen category there's um again oral, but also that injectable that I mentioned. Um, that can be a treatment option too.

Speaker 2:

So just a good way to just sort of have these all side by side because, again, there are a lot of drugs, it's hard to keep them straight, but definitely lots of options available for patients too, which is great.

Speaker 1:

Yeah, yeah, I know this is another great chart. I love that. It's just so well organized, and even the icons here let you know whether it's an oral pill or an injectable, and so, yeah, just super great charts. So again, for those of you that are just listening, I'm showing the HIV medications chart, a resource from Pearls, so okay. So one other thing. I think, actually I think that may be all of the opportunities that we wanted to touch on for pharmacists. So let's move into some of those challenges that we see, some of those challenges that we may face as pharmacists with managing the care for our patients, and we've touched on these and we've talked about them. But just to kind of reiterate, so let's dig into the drug interactions first. So, unfortunately, some of these medications do have interactions with other medications and so forth. So let's talk a little bit about what that looks like and being sure that that's something that we, as pharmacists, are helping out with.

Speaker 2:

Yeah, and, as you say, it is something that it's a common concern with several of these different drug classes, and it's also a concern with products that people may take over the counter, which I think is the trickier part with that. You know that often people might not think about OTCs or vitamins or supplements as being necessarily a concern with interactions, and so they might know oh yeah, I need to be aware of interactions but might not think about OTCs and vitamins as an issue. So I think, again, that I would say is probably one of the most important points is not only making the person aware that interactions are something they should be talking about each time they start a new product, but also that it's not just prescriptions, it's also the stuff they can get over the counter without talking to anyone if they wanted to. So, yeah, the ones that I think of most often are those that can affect absorption, and so, with the integrase inhibitors again, which are often in several of these first line regimens, they can be, they can interact with divalent cations, so things like iron, calcium, aluminum, magnesium. So again, you can find those in antacids and vitamins and laxatives. So those can usually be managed by spacing apart, but how you space. It depends on the drug. So it is just important to have the person be aware of that and coming to you like, hey, if I'm having heartburn I want to take this antacid. Just check with me so that you know how to take it properly with your other meds.

Speaker 2:

Acid reducers more broadly, so not only antacids but also H2 blockers and PPIs Again, these over-the-counter meds that may interact are a concern with some other HIV medicines, like atazanivir and rapilverine. So just being aware of those and then those cytochrome P450 interactions too. So CYP enzymes can metabolize many drugs, including various classes of HIV meds. So protease inhibitors tend to be a concern with those. So, for example, with statins, that's something to be aware of. Some of these boosters, pharmacokinetic boosters like ritonavir and cabistostat I think a lot of us think of ritonavir as sort of like boosters, pharmacokinetic boosters like ritonavir and cabistostat. I think a lot of us think of ritonavir as sort of like a classic, also in the COVID antiviral right.

Speaker 2:

And so often something that we think about with interactions. So, yeah, definitely some key concerns to be aware of, but I think again, one of the points I wanna drill home with patients is the fact that it's not just prescription medicine. So it's not only important for me to be aware of what you're getting from other pharmacies, but also what you're taking over the counter.

Speaker 1:

Absolutely, and you know, rachel, I think that goes back to the point we made earlier where building that relationship with the patient, making sure that they feel comfortable talking to us about you know everything.

Speaker 1:

And it's important to also say, like you mentioned, tell me things that you're taking over the counter you know like. And if they're taking supplements and things like that, sometimes patients are hesitant to share that because you know it's not something that's you know like. Oh, I read this or I heard this on TV and I'm taking this, you know, as a supplement, and I know you may not agree with it and whatever. So I think it's really important for pharmacists to also be sure that we're in a nonjudgmental space and that we're not just saying like, oh, don't do that, don't ever do that, or whatever, because that could push the patient away from telling us more. So we want to be sure that we're always keeping the lines of communication open so that they feel comfortable telling us about it, because that's just really important, because if they start taking things and hiding it from us, then we don't know what they're doing and what they're doing.

Speaker 1:

We can't help manage. So, yeah, really important. So another challenge that we have obviously we touched on it is, you know, regardless of adherence, I mean, it's pretty clear if the patient is adherent, but there are times when failure, treatments fail and when resistance occurs, and so that is another challenge for us as well is recognizing when the regimen needs to change or what alternative needs to be had, and also being able to collaborate with other providers in that space to choose different regimens.

Speaker 2:

So, if you can kind of talk briefly about that and our role as pharmacists in that space too, yeah, yeah, and I think it goes back to this idea of you know they are checking in with us often on a regular basis and so making sure they are having regular monitoring with their other health providers if needed. The frequency of how often that happened varies depending on their status, but usually at least three to six months they should be having a check of their viral load and making sure you know if it is suppressed or not and helping them understand what that means Again, so they might be aware of the need for viral suppression. There are cases where you know sometimes there will be a little blip, which is where a patient you know they might go up to a detectable viral load and then go back down to an undetectable level without you know. There could be all kinds of reasons for that to happen, but that doesn't necessarily mean that they've failed or that they're you know. It doesn't mean that the treatment is failing either.

Speaker 2:

Sometimes that can happen. The blips are different than a virologic failure, so but seeing some of those results and understanding them also, I think, can go a long way in helping patients understand how that ties back in with adherence and maybe interactions are leading to some of those issues too or, like you say, it could be a concern with the resistance. So just helping them keep up with that, monitoring, understanding what those levels mean and taking action if needed. But again, it doesn't necessarily mean a change is needed unless they have a consistent viral load over 200, that's typically linked to resistance and then in that case identifying the cause and again, the cause is usually poor adherence is critical to then identify whether a new regimen is needed and, if so, if adherence is a concern, being sure to keep that definitely in mind and simplifying the regimen if possible.

Speaker 1:

Yeah. So, rachel, in our last couple of minutes I just want to be sure I think we'd be remiss if we didn't mention, you know, the stigma that sometimes is associated with an HIV status and also the fact you know making sure that we are navigating those sensitive conversations that were obviously ensuring confidentiality. But cultural competence is huge as well. You know. We know that certain communities LGBTQ communities specifically is more susceptible to HIV infection, and so just understanding that a lot of times there's conversations that will need to be had that that patient may not be out to their work or to their community or to their family or whatever, and so just really understanding the need for confidentiality and navigating those sensitive discussions. So if there's anything you want to add to that, I know that that's just a, that's a challenge, but it's also a great opportunity for pharmacists because you know we can navigate those situations very easily and that's something that we can do well.

Speaker 2:

Yeah, I think it goes back to that idea of open communication, creating a safe space.

Speaker 2:

So identifying if you need to go to a more private area, you know, if there's more sensitive conversation that needs to be had.

Speaker 2:

You know, using using terms like your medicine instead of your HIV medicine, things like that can be very small steps that can go a long way in helping to avoid stigma.

Speaker 2:

But, like you say, just, I think it's what we want to do with all of our patients, right, it's just making sure they feel comfortable and using our strategies like active listening, and avoid assuming you know what their priorities might be. Um, if they have concerns, acknowledging those and recognizing those and the supplement example you gave is a great example, because we don't we wouldn't want them to feel like we would be judging them for taking a supplement. So, you know, making sure that that safe space is there, both both in a, you know, communication perspective, but also from, you know, an interaction perspective and just chatting with them. So not only privacy from a, but also from an interaction perspective and just chatting with them. So not only privacy from hearing other people, being able to hear, but, yeah, just making them feel comfortable and supporting their decision-making too. So if they do or don't feel comfortable with one strategy or another, supporting them down that road.

Speaker 1:

Yeah, no, that's a great point. So I think we always run out of time, rachel, we have so much to talk about.

Speaker 1:

So I think just as kind of a wrap up, so many opportunities for pharmacists in this space to help with adherence and educating the patients and ensuring you know that we're watching out for any sort of interactions or managing side effects and just really keeping the lines of communication open with our patients who have HIV and you know the resources that we've shared so good that help with pharmacotherapy. They help identify the different medications and the opportunities that are there for regimens. What else do you want to add before we wrap up? Anything that you felt like you didn't get to talk about?

Speaker 2:

Well, I would just say, you know, something that was always in the back of my mind as a community pharmacist was about vaccination, so I'll just put in a plug for that as well.

Speaker 2:

Immunizations are always a top of mind for all of our patients, but for patients with HIV it's also a consideration, not only with what they may need, but also, you know, depending on how well the condition is being managed, if they may not be, but also, you know, depending on how well the condition is being managed, if they may not be eligible for some live vaccines, for example. So I'll just put in, I'll throw that in, as another you know, thing to be keeping in mind with these discussions. But yeah, I think one of the biggest things that I would take away from the discussion is that U equals U concept. I think that's. There's a lot of information on the CDC site regarding this and I think it's a new concept that some of us might not be as familiar with, but it is such an important way to help convey the importance of adherence and help patients sort of get empowered with what they can do to prevent transmission to others.

Speaker 1:

Yeah, that's great. And to improve their own quality of life.

Speaker 2:

Exactly.

Speaker 1:

Yeah, that's great. Okay, so, as I always do, I think you kind of did it just now, but what would you say? Is the game changer here. What would you say is the game changer? Is the game changer you know? Fully understanding and knowing about you equals you, or is you've already done that one, so I'm going to ask you for a different one.

Speaker 2:

Yeah, I think probably one of the most important considerations with HIV treatment is adherence, and so you know we talked about lots of different ways to improve adherence. Think about adherence including injectables, including streamlined regimens that are, you know, one pill easy to take, um, but uh, also thinking about the the person's particular barriers and any challenges they might have. So I would say adherence for so many reasons is important. And then also again with these interactions and the concern about interactions with over-the-counter products and vitamins and supplements. I would say that's just again reinforcing that point of good communication and encouraging the patient to come with you with any questions about what they might be taking over the counter.

Speaker 1:

Yep. So, as is the case with so many of our conversations on the podcast, the game changer is that pharmacists have a very impactful role in managing patients with HIV. So yeah, so many things that we are the experts at doing and can really improve the quality of life and outcomes for our patients with HIV. So thank you again, rachel. So good to have you again. We really appreciate you giving us your time again.

Speaker 2:

Thank you so much for having me. It was great to be here.

Speaker 1:

So, before we wrap up, here's a quick tip. Through our partnership with Pearls, you now have access to the clinical charts and practice tools that we talked about and that I shared during this episode. The resources are designed to enhance your workflow and support patient care. You'll find all the links and details in the show notes, so be sure to check those out. If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week.