HIV clinical pharmacists--the US perspective

Clinical pharmacists have been involved in treating people with HIV and AIDS since the epidemic began. Their roles have evolved from inpatient infectious diseases training clinical pharmacists offering treatment regimens for the serious opportunistic infections seen in the hospital, to clinical pharmacists who received specialized training in the treatment of people with HIV in the ambulatory care setting. Their roles and benefits have been documented in the literature, but not to a large extent. Improvements in adherence and cost savings have been seen, but significant improvements in clinical outcomes (changes in viral load and CD4 cell counts) are quite complex and often difficult to identify in the small studies that have been published. This manuscript will review the published data on this topic, and provide examples of clinically trained pharmacists in the US who focus on the treatment of people with HIV infection. The pharmacists discussed here practice in a variety of settings (privately managed free-clinics and government managed clinics), take care of a variety of types of patients (children, adults, military veterans, lower socio-economic groups, etc.), and are employed by a variety of institutions (academic, pharmaceutical company, large healthcare systems and small healthcare systems). These pharmacists were chosen to be representative of the wide variety of individuals, positions and roles of clinical pharmacists involved in the treatment of HIV in the US.