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This season of SNACK has been produced by Queensland Positive People as part of the COTA Queensland Consortium Home Care Workforce Support Program which received grant funding from the Australian Government.
Produced by Martin Franklin at East Coast Studio
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And welcome to another episode I’m your host for this season, Blair Martin. Today, I’m joined by associate professor Andy Redmond, who works in infectious diseases medicine and sexual health. He has a deep interest in care of patients living with HIV. Today’s episode focuses on providing a brief overview of HIV medications and treatments and how having a basic understanding of these can assist home care workers to provide high quality care for older people living with HIV. So welcome, Andy. How are you? Really good. Thanks, Blair. Great to be talking with you. Andy, before we kick start, I always like to check pronouns with people, the pronouns that they use. My pronouns are he, him, or they, them, either is fine. What pronouns do you use, Andy? I use he/him, Blair. Thank you very much for that.
So we’re going to have a look firstly at a quick overview of the most commonly used HIV medications. What are some of the most common HIV medications and treatments and their purposes that are used today? Most people living with HIV now in in Australia as a as a rich country are receiving their HIV medications just with, one tablet. We’ve got quite a few options available to us as prescribers whereby people can receive 2 or 3 or even 4 medications all packaged up within 1 tablet.
And by far and away, that’s what we do for most people. In the setting of someone who’s older, they might have had HIV for a long period of time, and perhaps they might be on an older regimen that has more tablets. But for the vast majority of people, where treatment is now very straightforward and, is easy to take and easy to administer. In an earlier episode of SNACK, we talked briefly about HIV medications and how they’ve changed the outcome for people who live with HIV. So how important is it for people living with HIV to adhere to their treatment regimen? It’s critically important because the HIV virus, even though our treatments have gotten a lot better, it remains incredibly tricky. And the virus is able if medications are discontinued or stopped, the virus is able to become resistant to those to the medications. And with our medications that are now packaged up with 3 or 4 medications in 1 tablet, they can hang around in the body for different lengths of time. And so the virus can be exposed in to different amounts of different drug. And, we really don’t want the virus to have that opportunity to become resistant to drugs. You mentioned there about resistance. Where are we at now, particularly with older people living with HIV? Because, in a way, we’re quite fortunate that people who were diagnosed at the very beginning of the pandemic in the eighties, perhaps in their teens, twenties, early thirties, are now living into their sixties seventies. What resistance is happening for them with HIV medication? Look, it is an amazing time. A lot of a lot those people, Blair, were really told that, that they were not going to live into their older age.
And I’ve heard many stories about people selling up their assets and and getting ready for a for a short life, and then and then turning around when more treatments became available and being prepared for a much longer life. It’s a wonderful challenge to have. And so some of those patients will have acquired resistance that is it is hiding away, if they got into a situation where they couldn’t get their medication. But mostly, for the vast majority of people, we are able to get the virus suppressed. And hopefully, they’re able to be on medication that makes that they’re not unwell with and that they can tolerate well. And then the resistance mutations that are hiding away are actually not a not a problem for them while they’re able to take their medication. Early nineties was when the first serious, I suppose, or successful medication became available to people who were living with HIV. In the last 20 years, for example, what further development has there been to make a lot more effective use of treatment regimens? There’s been a couple of really critical things have happened. One of them is that for the classes of drugs that were known about back in the nineties, we’ve produced better versions of those, versions that are less likely to cause side effects, versions that require fewer tablets, and versions that are easier to swallow. The second thing that’s happened is that there have been new classes of drugs developed, and so these have included new ways of how to stop the virus replicating, and that provided options for us where patients have acquired resistance. And the third thing that’s really happened is the is this co formulation of medications. And so that I talked about at the start where someone can be on 3 or 4 pills, 3 or 4 different drugs just with 1 pill.
And so and then really the fourth thing that’s happened, I guess, is that there’s now some new medication where people can potentially have a long acting injectable HIV medication. And so instead of taking a tablet or tablets daily, some patients are able to choose to have an to have injections once every 8 weeks. And, and some people love not having to take a tablet every day. So thinking now with home care staff, people coming in to offer care, particularly for people who are aging, assisting those people with adherence to the medication, and we have mentioned so many different and new different things. You’ve talked about injectables, long term ARVs, the one pill a day, and all of that. How can those home care staff assist? What is the way of getting across potential confusion for people who live with HIV? So I guess there’s a couple of ways of thinking about this, Blair. There’s does the home care worker and does the client do they have a good understanding of what the what all of the medications are for, including the ARVs? Do they need to have a talk about what’s the shared understanding? Is there one person who’s in charge, or is it a shared responsibility? And that’s really established by conversation. Maybe conversation with the older person or if they’re in an institutional setting, then conversation with, with their carers or friends. And so just work making sure that that everyone’s on the same page. I guess the next thing is just thinking about the mechanics of the medication. You know, has the has the client got access to the medication themselves? Do they essentially manage the medication themselves and the carer just needs to say, have you taken your medication today?
Or for people who’ve got who’ve maybe got poor memory or higher needs, you know, we might benefit from using a dose set box where you can see, oh, have I taken Tuesday’s pill? Yes. And if you have taken it, then the then the box will be empty for Tuesday. Or in the case of someone who’s got higher needs still, it might be that the carers are there administering the medication and saying, well, here’s your pill Here’s your pill for Tuesday. And so just really making sure that everybody understands what everyone else’s role is and, and that if there was if there was a risk that the that the client might say, yes, I’ve taken it, but they haven’t really taken it, that there’s a that there’s an ongoing process of checking in and just making sure that, that everyone’s that the understanding that was reached 6 months ago is still a is still the right understanding now. Looking at side effects, because I mentioned earlier, those people who were part of the original cohort taking those massive cocktails of drugs. And I’ve spoken to people who’ve said we often didn’t know what was in them. We didn’t know if we were in in placebo or what was being added to us and what that was going to mean for us long term and now here, we are living with those side effects. What are some of the side effects and how they’re going to be managed? Particularly, someone again going in home care, aged care for a person who lives with HIV, regular check-in, monitoring for side effects, and connecting to an established medication routine? There’s been a variety of of side effects that have been common over the duration of the HIV, epidemic.
And and those first drugs that were developed, the nukes or nucleoside reverse transcriptase inhibitors that that that you mentioned, Blair, that people were on at the start, and they caused this terrible mitochondrial damage where people wound up with real wasting of their peripheral fat and, nerve damage, and some people got, pancreatitis. And people have been left with, especially, nerve damage and fat wasting since the early nineties. When the Protease inhibitors came around, people not only got diarrhea, but they also they intended to put on a whole lot of weight, in particular, in their torsos. And so there are people with, you know, big abdominal girth and maybe a fat pad at the back of their neck from the protease inhibitors. And then with the class of medications that’s been most recently developed and used widely, the integrase inhibitors, people just tend to seem to be putting on a little bit of waste, and, and that can be a progressive challenge. And so being aware of, I guess, each of those each of those side effects, and looking out to see if they’re if they’re an ongoing challenge, They’re all the things that we would be looking for now. Severe side effects that may happen now for someone living with HIV and their carer being able to recognize that. So things like this is out of the ordinary, what is out of the ordinary, and when they need to seek guidance from a medical specialist or GP or someone else with deeper medical knowledge, when do those sort of things come into play? The highest risk time is when there are changes to medications and, or if there is a new medical problem occurring. And so, drug interactions are certainly always possible.
And when changes to medications occur, that’s when that’s when drug reactions are most likely to occur. The times then those are times when side effects might turn up. But we’re really seeing fewer and fewer serious side effects. I guess the thing to just be aware of is that HIV, even when it’s well treated, causes systemic inflammation. And so really, the things to look out for are the things that can happen to anybody, but we see people with HIV having more heart attacks than other people. We see people with HIV having more strokes than other people. And there are there’s, you know, increased rates of a variety of cancers that can occur. And these are not specific drug side effects, but in fact, they’re probably more likely to occur than a lot of the drug side effects because, essentially, the medications now are just very well tolerated. What would be some tips for reducing the potential impact of medication side effects? I mentioned inflammation earlier, and the integrase inhibitors that are really the backbone to treatment that most people are on now, they can they can be effective in suppressing most of the of the inflammation caused by the virus, but there’s some residual inflammation that goes on. And people could potentially mitigate that by having a really good sensible diet. And that’s not a diet that is peculiar to people with HIV. That’s really the diet that that all of us who want to live, you know, long and healthy lives should be on. And so that’s eating, not you know, having fresh fruit and vegetables, not eating too many carbohydrates, making sure that we’ve got a good intake of protein, especially plant based proteins such as such as legumes and then also having regular physical activity.
They’re really managing our weight, managing our well-being, with good diet and good exercise. Really, these are the these are the lifestyle changes. And stopping smoking and not drinking alcohol to excess. These are the things that are going to mitigate medication side effects and also just improve things generally. Andy, I noticed earlier we were talking about the probably the key to all of this to being a successful relationship between either home care worker, aged care worker, and someone living with HIV is open communication, actually being able to feel confident and comfortable in sharing information with each other. So mitigating these potential medication side effects, I’m sort of thinking of an aged care or support worker saying to someone, have you been for a walk today? We should go for a walk. We should be doing this. Yeah. How would you, as a clinician, suggest to someone that they keep be able to take that way of communication between someone who lives with HIV and all of these things that are going to help mitigate potential medication side effects. Working out how to have good clear communication that is nonjudgmental and that is open and accepting is, you know, is really what we’re all trying to do in life. And if we want people to share with us what’s really going on for them, then we totally need to be able to talk in a in a nonjudgmental way. And, and, you know, asking questions is a is a great way of doing it. Gosh. I I see you’re eating chips there. I’ve I you know, and I’ve been struggling with, with eating less healthy foods myself. Where are you at in terms of thinking about your diet? You know, just open questions, a bit of self-reflection, not too much judgment.
You know, this the the I think these are the ways forward. Something like good humour helps as well too. As you said, not being judgmental, but developing a good human exchange with the person that you’re caring for. Absolutely. It’s all about human interactions. Andy, before we finish today, I know there are a couple of things that perhaps, as a clinician, you’d like to share with people who are going in as home care workers or aged care workers for people living with HIV. What is probably one of the bigger things that you think they should take with them as they go into that environment? One of the key takeaways is just that there’s a beautiful outcome of HIV treatment now that we’ve really only become aware of, in the last 10 years or so. And that is that there is a beautiful dual benefit from HIV medication. And the dual benefit is that the person with h with HIV benefits from the medication, but the other side is that people around that person benefit from the HIV medication as well. And that is because when someone has a suppressed viral load, they are incapable of passing on HIV. So it’s never been a safer time really to be a home care worker providing care for people with HIV, because of that beautiful dual benefit. Andy, thank you so much for your time in sharing the perspective of someone who is so closely associated with the clinical side of a person living with HIV, medication, how that medication helps prolong and also engaging with a better quality of life. Thank you so much for joining us. That’s associate professor Andy Redmond, infectious diseases physician. Thank you so much for your time on this episode of Snack. Andy?
Thanks very much, Blair. It’s been great to talk with you. So Andy has shared with us some valuable insights into the commonly used HIV medications, emphasizing their significance in managing their condition effectively. We’ve learned that adherence to these medications is paramount as it not only improves the individual’s health, but also helps prevent development of drug resistance. We’ve discussed the landscape of HIV treatments is continually and constantly evolving. There are emerging therapies like long term ARVs and injectables offering new options for patients. These options expand and becomes essential for home care staff to be well informed and able to assist older individuals with HIV in adhering to their treatment regimens. It’s clear that with the right knowledge and support, home care workers can play a vital role in enhancing the quality of life for older people living with HIV. We hope that this episode has provided you with valuable insights to better serve this community.
Thank you for joining us on this episode of Snack. Until next time. Stay tuned, stay informed, and stay person centred in your care. QPP are a peer led community based organization based in Queensland who are committed to improving the lives of all people living with HIV.
Funding for this podcast has been provided by the Council on the Aging Queensland Home Care Workforce Support Consortium as part of the Home Care Workforce Support Program, which was funded through grant funding from the Australian government.
