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Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Management guidelines for HIV-related Co-morbidities
I attended the talk by Dr Janine Trevillyan titled: Management guidelines for HIV-related Co-morbidities result in increased screening but no change in Primary Prevention Implementation.
Janine described an audit conducted at Alfred Health, Melbourne comparing compliance with local recommendations/guidelines for screening and management of cardiovascular risk factors before and after release of the guidelines.
The audit showed that compliance rates for sticking to guidelines for statin use pre and post intervention were similar and there were no changes in patients receiving a statin pre and post intervention.
Although routine blood pressure monitoring increased from 65% pre intervention to 88% post intervention, there was no change in antihypertensive use and no observed improvement in systolic blood pressure post intervention.
One interesting finding of the audit was that renal function was borderline (eGFR 60-90mL/min) in 51% of patients. Janine mentioned that this will be something that will be followed up as the implications of these findings are unclear and it will be interesting to see where the renal function of these patients is at in a few years.
Overall, the audit found that implementation of recommendations/guidelines can increase screening rates for cardiovascular risk factors but this did not translate into improved implementation of primary prevention therapies. Janine mentioned that a change in the model of HIV care provision may be needed.
These findings are important to me as a pharmacist involved in the care of patients at an ambulatory HIV clinic. We have recently implemented a pharmacist review at annual health checks for patients taking combination antiretroviral therapy (cART) in my clinic. See poster number 12. Impact of a Pharmacist review during annual health checks in patients taking combination antiretroviral therapy.
A pharmacist review during annual health checks may help to identify patients not meeting the recommended cardiovascular risk factor targets, bring these to the attention of the doctor and assist with their management.