Impact of HIV infection on pharmaceutical services at Walter Reed Army Medical Center

Services developed by the pharmacy department at Walter Reed Army Medical Center (WRAMC) relating to the treatment and study of patients infected with the human immunodeficiency virus (HIV) are described. The WRAMC pharmacy department closely monitored use of azidothymidine (renamed zidovudine) before and after its approval by FDA. It has also done pharmaceutical cost studies for HIV-infected patients by disease stage according to the Walter Reed Classification System. An Army pharmacist at the U.S. Army Centralized Allergen Extract Laboratory is involved with the development and distribution of delayed hypersensitivity skin tests used to determine the progression of the disease; the current test battery correlates with the CD4 T-lymphocyte count, low numbers of which indicate disease progression. The Walter Reed Retrovirus Research Group includes an Army pharmacist who not only is involved with the traditional distributive and clinical aspects of the position but also is involved in clinical pharmacy, pharmacoepidemiology, and social and behavioral research. This pharmacist is the principal investigator on protocols studying the relationship of various factors to the frequency and distribution of both beneficial and adverse pharmaceutical outcomes in this patient population. The pharmacy department at WRAMC has taken an active role in both the treatment of HIV-infected patients and HIV-associated research, as part of an aggressive overall Army effort to develop effective treatment and chemoprophylaxis or immunoprophylaxis for this disease.