HIV - Living longer and the PHC nurse’s role in care

By Joshua Borja, HIV Project Officer, ASHM, Alexander Dowell-Day, HIV Project Officer, ASHM, Melinda Hassall, Clinical Nurse Lead, ASHM 

Source: APNA Primary Times Summer 2022-23 (Volume 22, Issue 2)


New, highly effective forms of treatment have allowed people living with HIV (PLHIV) to live longer lives. This means that the care for those living longer with HIV is changing. As a primary health care (PHC) nurse, what can you do to ensure the best care for PLHIV? 

You may have heard that HIV is not a death sentence anymore, but what does this mean? There are still an estimated 30,000+ PLHIV in Australia1 who require HIV-related care. This article will give an overview of the changing needs of PLHIV and what PHC nurses can do to support them. 

There are now drug regimens that reduce the viral load of PLHIV to a level known as ‘undetectable’. PLHIV who have an undetectable viral load cannot transmit the virus to another person sexually.2 This is commonly referred to as Undetectable = Untransmittable or (U=U),3 and is presumed to also apply to occupational percutaneous transmission.

PHC nurses play an integral role in supporting PLHIV to manage their HIV and other health concerns Be understanding, non-judgemental and remain educated. 

These drug regimens, known as highly active antiretroviral therapy (HAART), come in many forms and are well tolerated by patients: from a one-pill-a-day regimen to long-acting injectables that require PLHIV to receive only 6 doses over a year.5 However, these medications are only effective when the patient adheres to their medication by taking it as prescribed.6 Nurses are well positioned to provide care and assistance to PLHIV regarding adherence.6 

HIV has become a manageable, chronic condition due to these advances in treatment, and many PLHIV are living longer and healthier lives.7 Consequently, the need to manage health concerns associated with chronic conditions is increasing among PLHIV, as the life expectancy of PLHIV also increases.   

PLHIV are at increased risk of some chronic diseases, including cardiovascular and kidney disease, and some cancers.8 Therefore, polypharmacy is a further concern for PLHIV. Polypharmacy can lead to drug–drug interactions as medications, including some statins, can cause adverse reactions, such as myopathy and liver damage.9 

PLHIV can also be impacted by HIV-associated neurocognitive disorder (HAND), regardless of reduced viral load.10 The onset of frailty is another important consideration, given it has been found to occur earlier and at a higher prevalence among PLHIV.

PHC nurses play an integral role in supporting PLHIV to manage their HIV and other health concerns by: 

  • Providing person-centred care free from stigma and discrimination  
  • Discussing challenges and concerns regarding medication adherence  
  • Identifying opportunities for a Domiciliary Medication Management Review (MBS Item 900)11 
  • Providing health education related to nutrition and physical activity 
  • Discussing how to manage early onset frailty screening for comorbidities  
  • Completing continuing professional development to keep up to date with current HIV treatment, management and care regimes (see the ASHM website for details) 
  • Developing an understanding of the early clinical signs of HAND.10 

With new and effective treatment options available, the future for those living with HIV who are engaged in care is bright. However, this means that the support required from PHC nurses has changed. Be understanding, non-judgemental and remain educated about the ever-changing landscape of HIV treatment and management so that PLHIV can lead long, healthy and meaningful lives. 

 

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) is Australasia’s peak professional body of workers in HIV, viral hepatitis, other bloodborne viruses and sexual and reproductive health. Our members include nurses, physicians, researchers, epidemiologists, social workers and allied health workers – united to eliminate harm from these diseases and to protect our diverse communities. 

 

References 

1. Australian Federation of AIDS Organisations (AFAO), ‘HIV in Australia’, AFAO website, 2022, accessed 6 October 2022. www.afao.org.au 

2. M Cohen, Y Chen, M McCauley et al., ‘Prevention of HIV-1 infection with early antiretroviral therapy’, N Engl J Med, 2011, 365(6):493–505. 

3. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), ‘U=U: ASHM guidance for healthcare professionals’, ASHM website, 2022, accessed 9 October 2022. www.ashm.org.au 

4. P Bryant, H Calabretto, D Herd et al., ‘PEP recommendations after occupational exposure’, PEP Guidelines website, 2022, accessed 9 October 2022. www.pep.guidelines.org.au 

5. Y Hughes, L Tomlins and T Usherwood, ‘Prescribing for patients taking antiretroviral therapy’, Aust Prescr, 2022, 45(3):80–87. 

6. C Lambert, B Galland, M Enriquez and N Reynolds, ‘A systematic review of nurse-led antiretroviral medication adherence intervention trials: how nurses have advanced the science’, J Assoc Nurses AIDS Care, 2021, 32(3):347–372. 

7. M Bloch, ‘Frailty in people living with HIV’, AIDS Res Ther, 2018, 15(1)19. 

8. J Heron, S Norman, J Yoo et al., ‘The prevalence and risk of non-infectious comorbidities in HIV-infected and non-HIV infected men attending general practice in Australia’, PLoS One, 2019, 14(10):e0223224. 

9. B Wiggins, D Lamprecht, R Page and J Saseen, ‘Recommendations for managing drug–drug interactions with statins and HIV medications’, Am J Cardiovasc Drugs, 2017, 17(5):375–389.  

10. D Cummins, ‘HIV-associated neurocognitive disorder’, HIV Management/ASHM website, 2022, accessed 9 October 2022. https://hivmanagement.ashm.org.au 

11. Australian Government Department of Health and Aged Care, ‘Item 900: Medicare Benefits Schedule’, MBS Online, 2022, accessed 10 October 2022. www9.health.gov.au 

The Australian Primary Health Care Nurses Association acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respects to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.


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