AIDS : Prevention and Pharmacist's role

By - 04/07/2008

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Shail Akhter

Sohail Akhter

HIV/AIDS currently affects about 31 million people worldwide. Many infected people do not receive proper care because of a lack of resources or education about current treatment options.

Even where treatments are available, they are often not optimal because of poor adherence, adverse events or resistance. In developed countries, HIV/AIDS is quickly becoming a chronic disease requiring long term care. Disease management concepts are being adapted to this disease, but are not yet fully successful because of the lack of definitive guidelines and disjointed delivery of care. Also, alternative caregivers have not been actively recognized by traditional providers, resulting in even less continuity of care. A new community-based model for healthcare delivery for people with HIV/AIDS is required. A potential model uses the pharmacy, now termed a community care centre, as the focal point for care delivery. A new healthcare team, including a doctor/physician, pharmacist and nutritionist would coordinate treatment selection and delivery. The pharmacist would also act as a community resource for information on HIV/AIDS to help dispel myths and misinformation about the disease. They can be a provider of testing services and counseling, as well as preventative methods and information.

Introduction:

Acquired immune deficiency syndrome:

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the human immunodeficiency virus (HIV) in humans, and similar viruses in other species (SIV, FIV, etc.). The late stage of the condition leaves individuals susceptible to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to slow the virus' progression, there is no known cure. AIDS (Acquired Immune Deficiency Syndrome) was first reported in 1981 in homosexual man. AIDS is a retroviral disease caused by human immune deficiency virus (HIV). The disease is characterized by immunosuppression, secondary neoplasm and neurological manifestation. AIDS is invariably fatal since there is no cure .^{(3, 4, 5.)}

Human immunodeficiency virus (HIV) :

HIV is a retrovirus that can lead to acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). Previous names for the virus include human T-lymphotropic virus-III (HTLV-III), lymphadenopathy- associated virus (LAV), or AIDS-associated retrovirus (ARV). There are two type of HIV(HIV-1 and HIV-2) and both are infectious and causing agent of AIDS. Development of disease results from lack of control of HIV replication by the host immune system. a person acquires aids after the HIV infection has damaged the immune system to a point (less than 200 CD4+ lymphocytes per microlitre of blood) that a body can no longer protect itself from other infections and cancers. It is secondary disease that leads to death from AIDS. Infections that develops HIV has weakened the immune system are called opportunistic infections. Some of these diseases are respiratory infections (tuberculosis, and pneumocystis carnii pneumonia), toxoplasmosis, and Kaposi sarcoma. ^(3,17)

Structure of the human immunodeficiency virus,which is responsible for AIDS

fig: Structure of the human immunodeficiency virus, which is responsible for AIDS ⁽³⁰⁾

Transmission of HIV:

Transmission of aids essentially required body fluid (semen, vaginal secretions, blood, milk) containing the virus or virus infected cells. The distribution of risk factors for aids transmission are as follows. ^(28,30)

Homosexuality 60%

Heterosexuality 15%

Intravenous drug abusers 15%

Transmission of blood and blood products 6%

Others (shaving razors, used blades, organ 4%

and tissue transplant

Itshould, however be noted that HIV cannot be transmitted by:

Hand shaking, hugging, talking, eating the food with aids patient, sharing the work with them, sitting or sleeping with them, mosquito bite. Further, transmission of aids from an infected individual to a healthy personnel attending on him is extremely rare. ^{(16, 5)}

Natural Course of AIDS

Three distinct phases of HIV infections with the immune system with the infected body has been identified. These are early, acute, intermediate, chronic and crisis phase. ^(3,17)This is depicted in the given figure:

Graphic Representation of a typical course of HIV infection

Graphic Representation of a typical course of HIV infection ⁽¹⁷⁾

Diagnostic test:

Screening test: ELISA and RAPID TEST

These are used in initial phase of screening. These have to be followed by supplemental test to confirm the state of the patient. ^{(17, 16, 5)}

The supplemental test: WESTERN BLOT, IMMUNOFLUORESCENE TEST

These are meant to confirm the result obtained with screening test. The patient can be positive or negative depending on the result obtained. In case of intermediate result the test should be repeated after certain period of time. ^{(16, 17)}

Confirmatory test: VIRUS ISOLATION, P-24 ANTIGEN TEST, PCR, Abnormal T-lymphocytes count. ^{(5, 16, 17)}.

Global And Indian Hiv/Aids Statistics And Feature (2006-07)

A pandemic of aids continue to spread relentlessly throughout the world. According to the UN AIDS and WHO updates, estimates released at the end of 2007, 42.5 million people are living with HIV/AIDS. According to the data more than 95% of cases remain in developing countries. Beyond the death tool and human suffering, AIDS continue to roll back hard on developmental gains in many region of the world.

According to UN-AIDS updates 2007 total average population suffering from HIV/AIDS ⁽³⁴⁾

Total	42.5 million
Adults	32.2 million
woman	18.0 million
Children(under 15 year)	2.8 million
HIV prevalence	1%

In India, the number of HIV positive cases up to 2006 was 5.7 million. Between 5-7%adult are infected in at least in 10 urban areas, including Mumbai, Kolhapur, Pune, Hyderabad, Churachandrapura and Kohima. AIDS will soon beat T.B as the leading cause of premature death in Indian adults. The unsafe sex practice and abysmal health services help to spread HIV through infected blood and contaminated injection syringe and other medical equipment. Given all this it is no surprise that the number of Indian adult infected with HIV is now doubling every 18-24 months put bluntly, on an average 3500 Indians are contracting HIV everyday. ^{(32, 33)}

Surveillance of HIV/AIDS in India

The National AIDS control organization of India (NACO) is responsible for surveillance and control of HIV/AIDS in India . As on 31october 2006 updates on aids cases in India, information by sex ,presumed mode of transmission wise AIDS cases in India are shown here:

AIDS Cases In India By Sex^{(32, 34)}

Total	57,00000
Adult	56,00000
Woman	1,60000
Children	2,00000
HIV prevalence estimates	0.9%

Risk/Transmission Categories ^{(32, 34)}

Mode of transmission	Percentage
Sexual	84%
Perinatal transmission	2.10%
Blood and blood products	3.43%
Injectable drug users	3.57%
Others	6.89%

The specific role of pharmacist:

· A centre for exposing people to HIV/AIDS information through the display of Information Education and Communication (IEC) material as well as by keeping leaflet on the counter for the people to pickup for themselves.

· People have faith in pharmacist as he/she dispenses drugs for various ailments. This way we are targeting not just HIV/AIDS but also other infections, which often precipitate the onset of major illnesses. In such instance, documentation on any STD or HIV cases should also be done. People generally go to the pharmacist, describe the symptoms and ask for the appropriate drugs. Once noted the case could be forwarded to the appropriate agency for further follow up. It should be so planned that the person comes back to the drug store every 3/5 days. This will help in seeing the progress of the person and could also be an avenue for counseling regarding the infection. Education input at this point could help reduce the number of recurring cases, new infection and increase the condom use, preventing spread as well as population control.(^11,33)

· The pharmacist, besides giving information and clearing doubts of those people who seek clarification on disseminated information on a product related in some way to HIV/AIDS and its related issue, and also serve as a focal person for providing information on care of those infected as well as on how to take care of affected family.

· Information could be given when a drug related to STD is sold here a message for complete course of medication along with the treatment for spouse could be given. Further, the benefit of using a condom could be emphasizing for the prevention of STDs.

· Living in the community, the pharmacist could initiate a social support group for those infected, reducing stigma related to the infection. Further, he/she could also be a trainer for people in a community for home based care, which reduces the financial burden on the community.

· The pharmacist is in a position to emphasize the availability of balanced and cheap nutrition, as drugs by themselves cannot help a person to regain strength. It has been observed that people are unaware about the nutrition facts. Poster regarding the same too could be displayed for people to read and understand.⁽¹⁴⁾

· When a syringe or condom is sold information on the safe and better use of the new product could be disseminated to the customer along with the information to destroy the same, to avoid recycling.

· All these will help in developing a positive attitude towards the people infected as well as affected. It should not be misunderstood that the pharmacist has to do each and every activity stated above. In a day, may be one of the many may require his input and some day may be all or a few. He/she should judge the situation and then provide the necessary input.

To achieve the above objectives, it is necessary, rather essential, for all pharmacists to undergo a training programme, covering the above issues. It could be divided in to segment of HIV/AIDS transmission, prevention and care.

Role of community pharmacy :

Although in India , more than 5lakhs pharmacists/chemists/druggists, working in retail outlet are convinced that they have a role of play; they lack support or knowledge in existing pharmaceutical care to become actively involved. Furthermore, they remain to be seen as traders and less as care viewers and are seldom involved in national programme to share responsibilities with the other health professionals. The community pharmacists’ network has to play a key role in controlling aids epidemic in the country. At the same time, involving them in the programme is probably one of the most difficult activities. Considering the scenario of HIV/AIDS in India , and efforts put in by various organizations and professional bodies in the areas of HIV/AIDS, every additional effort will help. Community pharmacy is a potential area that can be deployed highly effectively as the community pharmacists are in close contact with the people.

Although in India , 500,000 pharmacists/ chemists/ druggist working in retail outlets are convinced that they have a role of play, they lack support or knowledge in extending pharmaceutical care to become actively involved. Furthermore, they remain to be seen traders and less as care givers and are seldom involved in National Programmes to share responsibilities with other health professionals. Considering the scenario of HIV/AIDS in India , and the efforts put in by various organizations and professional bodies in the area of HIV/AIDS, every additional effort will help. Community pharmacy is a potential area that can be deployed highly effectively as the community pharmacists are in close contact with the people .^(11,14,30)

Community pharmacists can be considered because

· There are more than half million retail pharmacies in the countrywide spread across the vast and remote areas of the country and are regularly accessed by the general public.

· These retail pharmacies are first-port-of-call for the community who often discuss their health problems. On an average - the number of people visiting a pharmacy is much more than other health care units.

· A pharmacy is the most popular location for buying condoms.

. Most pharmacists-seeking a relevant professional role in health care-would Enthusiastically play a pro-active role in prevention and awareness about AIDS and provide counseling if properly trained for the job.

· Retail pharmacists could reinvent themselves as health care providers.

Role of Hospital and Clinical Pharmacy :

The need for setting of a modem hospital pharmacy service in large government hospitals under the charge of qualified personnel has been highlighted in the recommendations of the recommendations of the National Human Rights Commissions in 1999. About 30% of the hospital budget is being spent on drugs and medicinal items. However, due importance and proper attention is not given to the setting up modern hospital pharmacies with trained hospital pharmacists. The pharmacy services in most hospitals with trained hospital pharmacist. The pharmacy services in most hospitals with the exception of a few here and there are still in a primitive stage.^(11,14) Besides the need for acquiring adequate knowledge pertaining to HIV/AIDS a hospital pharmacist should have additional training to be able to take part in the various activities like:

· Hospital pharmacists can play an instrumental role in prevention and treatment of HIV/AIDS and other STDs. There are definite areas such as generating awareness in the hospital staff about a proper handling of AIDS patients, handling biological fluids. Monitoring the therapy given to patients, drug interactions, etc. where Pharmacists play a key role.

· In collaboration with ministry of health and family welfare, a program can be designed, where hospital pharmacist is assigned the responsibility of distributing the pamphlets, posters, stickers etc. to the patients, at least to those attending the STD, obstetrics/gynecology clinics. Condoms can also be distributed through this channel.

· The patients and members of the public should also be made aware of the importance of safe disposal, through posters, informative leaflets, etc. to be displayed at strategic points.

· The pharmacist, who is an important member of the central sterile supply department (CSSD), should formulate proper guidelines, methods and documentation procedure for receiving non-sterile material, flow of material, etc. to avoid cross- contamination in the CSSD.

· In the hospital pharmacy, the pharmacist can double up as a pre and post-test counselor for HIV. He/she can also be a counselor for out-patient and in-patients, as well as source of information for visitors.

· The pharmacist can play his/her clinical role by being an important member of the team of physicians and consultants responsible for drug therapy, considering the knowledge of the pharmacist in monitoring drug therapy, pharmacokinetics, drug interactions, etc.

· Strategic places of the premises of the hospital can be used to educate the public about HIV/AIDS, and also announce that further information, answering of queries related to HIV/AIDS is available at the pharmacy, where pharmacists are available round the clock.

Counseling of HIV/AIDS patients:

Counseling has two main functions: the provision of social and psychological support to those affected by HIV and the prevention of HIV infection and its transmission to other people.

In dealing with HIV/AIDS patients or their families, pharmacists can adopt different strategies because they are dealing with issues concerning human beings.

Pre- test counseling

Pre-test counseling consists of making an individual, who has come for testing; understand a number of different points:

Simply stated facts about HIV/AIDS.
The need for the individual to get tested after discussion at length of the person’s background, profile, attitudes, behavior, and habits to assess his/her level of risk-related behavior.
Some details about what the test result.
Exploring the possible result of the test with the individual, so as to make it relatively easier to cope with the result, be it negative or positive.
Discussing things such as who to inform, to whom the person can turn to for support.
Discussing preventive strategies against infection to the individual and that he/she is in sexual contact with.

Post-test counseling

Post-test counseling may be dealt with in one of two ways, depending on the result of the test. If the result is negative, the process is fairly simple, focusing on following main points:

Revealing the results and emphasizing the need, if a retest after the window period.
Reiterating and re-emphasizing behaviour change in the individual and stressing the need for and methods of infection prevention.
Post-test counseling of a seropositive person has to be done with a high degree of compassion, understanding, and skill.
It may be noted that counseling, particularly post-test counseling is not a one time activity and has to be an ongoing effort.

When a person is detected HIV positive, counseling must also include:

Supporting the process of anticipatory grief.
Planning for continued involvement of the client in self-care.
Establishing or re-establishing a support network to provide physical and emotional care during the course of the disease.
Exploring ways of taking care of survivors.
Accepting fear of death and continuing to provide emotional support.

Drug Related Patient Counseling

A). General (for all antiretroviral drugs)

Inform the patients that the given medication is not a cure for HIV infection, that they may continue to acquire illnesses associated with AIDS, including opportunistic infections. Medicines may not reduce the incidence of frequency of such illnesses.

Tell the patients that the long-term effects of these drugs are unknown at this time. Advise them that the therapy has not been shown to reduce the risk of transmission of HIV to others through sexual contact (safe sex) or blood contamination.

Drug-specific patient information

Antiretroviral drugs may be grouped as under.

Nucleoside Reverse Transcriptse Inhibitor Analogues (Nrtis)

Zidovudine (azidothymidine, AZT, Compound S)

The major toxicity of Zidovudine is granulocytopenia or anemia that may require transfusion or dose modification including possible discontinuation. Frequency and severity of the toxicity are greater in patients with more advanced disease and in those who imitate therapy later in the course of their infection. If is extremely important to have blood counts followed closely while on therapy, especially patients with advanced symptomatic HIV disease. ^{(8, 21)}
Warm the patients about the use of other medications (eg. Ganciclovir, interferon) that may exacerbate the toxicity of zidovudine. ^{(4, 5, 9, 21)}
Advise the patients to contact their physician if they experience shortness of breath, muscle weakness, symptoms of hepatitis or pancreases. Or any other unexpected adverse reaction. Inform patents that nausea and vomiting may also occur. ⁽⁵⁾
Advice pregnant women considering use of the drug to prevent maternal-fetal transmission of HIV and that transmission may still occur in some cases despite therapy. Long term consequences of in utero and infant exposure are unknown. ^{(5, 21)}
HIV-infected women should not breastfeed. ^{(5, 21)}
Take the dose exactly as prescribed. Do not share the medication and do not exceed the recommended dose.

Lamivudine (3TC)

Advise patients of the importance of taking lamivudine exactly as it is prescribed.
Advise parents to monitor pediatric patients for symptoms of pancreatitis. ⁽²¹⁾

Stavudine (d4T)

Inform patients that the most common toxicity of stavudine is peripheral neuropathy. Symptoms include tingling, burning pain or numbness in the hands or feet. ^{(4, 16, 21)}
Counsel patients that this toxicity occurs with greater frequency in patients with a history of peripheral neuropathy. Advice them to report these symptoms to their physician and that dose changes may be necessary. ^{(16, 19, 21)}
They should also be cautioned about the use of other medications that may exacerbate peripheral neuropathy. ^{(16, 19, 21)}

It should not be combined with zidovudine. ^{(19, 20, 21)}

Zalcitabine (dideoxycytidine; ddC)

Since it is frequently difficult to determine whether symptoms are due to the drug or the underlying disease, encourage patients to report all changes in their condition to their physician. Use of Zalcitabine or other antiretroviral drug does not preclude the ongoing need to maintain practices designed to prevent transmission of HIV. ^{(5, 19, 21)}
Instruct patients that the major toxicity of zalcitabine is peripheral neuropathy. Pancreatitis and hepatic toxicity are other serious and potentially life-threatening toxicities. Advise patients of the early symptoms of these conditions and instruct them to promptly report these symptoms to their physician. ^{(16, 19, 21)}
Since development of peripheral neuropathy appears dose-related, advise patients to follow the prescribed dose.
Women of childbearing age should use effective contraception while on zalcitabine.
The drug should not be used concomitantly with Didanosine or Stavudine. Do not take simultaneously with aluminum/ magnesium containing antacids. ^{(19, 20)}

Didanosine (ddl)

· To be taken on an empty stomach, at least an hour prior to or 2 hours after a meal.

Avoid alcohol as it may exacerbate toxicity. ^{(16, 21)}

Non-Nucleoside Reverse Transcriptase Inhibitors (Nnrti)

Efavirenz

· To improve tolerability of nervous system side effects, bedtime dosing is recommended during the first 2-3 weeks of therapy and in those patients that continue to experience these symptoms. ^{(19, 21)}

· High fat meals should be avoided. ⁽¹⁹⁾

Delavirdine Mesylate

Instruct patients that the major toxicity of delavirdine is rash, and advise them to promptly notify their physician should a rash occur. ⁽²¹⁾
Any patients experiencing severe rash or rash accompanied by symptoms such as fever, blistering, oral lesions, conjunctivitis, swelling or muscle or joint aches should discontinue medication and consult a physician.
Inform patients to take delivering every day as prescribed. Patients should not alter the dose of delavirdine without consulting their physician. If a dose is missed, patients should take the next dose as soon as possible. However, if a dose is skipped, the patients should not double the next dose. ^{(5, 8)}
Patients with achlorhydria should take delavirdine with an acidic beverage (e.g., orange or cranberry juice). However the effect of an acidic beverage on the absorption of delavirdine in patients with achlorhydria has not been investigated.

Protease Inhibitors (Pls)

Indinavir Sulfate

Advise patients to remain under the care of a physician when using indinavir and not to modify or discontinue treatment without first consulting the physician. Therefore, if a dose is missed, patients should take the next dose at the regularly scheduled time and should not double this dose.
For optimal absorption, administer indinavir with water 1 hour before or 2 hours after a meal. Alternatively, administer with other liquids such as skimmed milk, juice, coffee, or tea, or with a light meal jelly, juice and coffee with skimmed milk and sugar, or corm flakes, skim milk and sugar. ^{(16, 19, 21)}
Ingestion of indinavir with a meal high in calories, fat and protein reduces the absorption of indinavir.

Saquinavir

It should be taken within 2 hours after full meal. When taken without food, concentrations of saquinqvir in the blood are substantially reduced and may result in no antiviral activity. Patients are properly adviced for storage of the capsule. ^{(11, 21)}

Nelfinavir Mesylate

For optimal absorption patients are advised to take with food or light snack. The most frequent adverse effect is diarrhea, which can usually be controlled with drug such as loperamide. ^{(5, 19, 21)}

Instruct patient taking oral contraceptives to use alternate or additional contraceptive measures. ^{(20, 21)}

Patients are advised to take nelfinavir every day as prescribed. Patients should not alter the dose or discontinue therapy without consulting their doctor. If a dose is missed, patient should take the dose as soon as possible and then return to their normal schedule. However, if a dose is skipped, the patient should not double the next dose. ^{(8, 11)}

Ritonavir

Take with meals if possible. Should be stored in the refrigerator as directed. ⁽⁸⁾

Amprenavir

Take with a meal or light snack. ⁽⁸⁾

Hydroxyl Urea

Physician are notified if fever, chills, sore throat, nausea, vomiting, loss of appetite, diarrhea, sores in the mouth and on the lips, unusual bleeding or bruising occur. Medication may cause drowsiness, constipation, redness of the face, skin rash, itching and loss of hair. Notify physician if these become pronounced. Extra fluid intake is recommended. Contraceptive measures are recommended during therapy. ^{(5, 16, 21)}

Current treatment guidelines:

Antiretroviral drug treatment guidelines have changed many times. Early recommendations attempted a "hit hard, hit early" approach. A more conservative approach followed, with a starting point somewhere between 350 and 500 CD4+ T cells/mm³. The current guidelines use new criteria to consider starting HAART, as described below. However, there remain a range of views on this subject and the decision of whether to commence treatment ultimately rests with the patient and their doctor. The current guidelines for antiretroviral therapy (ART) from the World Health Organization reflect the 2003 changes to the guidelines and recommend that in resource-limited settings (that is, developing nations), HIV-infected adults and adolescents should start ART when HIV infection has been confirmed and one of the following conditions is present ⁽³¹⁾ :

Clinically advanced HIV disease;
WHO Stage IV HIV disease, irrespective of the CD4 cell count;
WHO Stage III disease with consideration of using CD4 cell counts less than 350/µl to assist decision making;
WHO Stage I or II HIV disease with CD4 cell counts less than 200/µl.

The treatment guidelines in the USA are set by the United States Department of Health and Human Services (DHHS)⁽³²⁾ . The current guidelines for adults and adolescents were stated on October 6, 2005 :

All patients with history of an AIDS-defining illness or severe symptoms of HIV infection regardless of CD4+ T cell count receive ART.
Antiretroviral therapy is also recommended for asymptomatic patients with less than 200 CD4+ T cells/µl.
Asymptomatic patients with CD4+ T cell counts of 201–350 cells/µl should be offered treatment.
For asymptomatic patients with CD4+ T cell of greater than 350 cells/µl and plasma HIV RNA greater than 100,000 copies/ml, most experienced clinicians defer therapy but some clinicians may consider initiating treatment.
Therapy should be deferred for patients with CD4+ T cell counts of greater than 350 cells/µl and plasma HIV RNA less than 100,000 copies/mL.

The preferred initial regimens are :

efavirenz + zidovudine + lamivudine
efavirenz + tenofovir + emtricitabine
lopinavir boosted with ritonavir + zidovudine + lamivudine

Lopinavir boosted with ritonavir + tenofovir + emtricitabine

Limitations of antiretroviral drug therapy:

If an HIV infection becomes resistant to standard HAART, there are limited options. One option is to take larger combinations of antiretroviral drugs, an approach known as mega-HAART or salvage therapy. Salvage therapy often increases the drugs' side-effects and treatment costs. Another is to take only one or two antiretroviral drugs, specifically ones that induce HIV mutations that diminish the virulence of the infection. The most common resistance mutation to lamivudine (3TC) in particular appears to do this. Thus, 3TC can be somewhat effective even alone and when the virus is resistant to it. If an HIV infection becomes sufficiently resistant to antiretroviral-drugs, treatment becomes more complicated and prognosis may deteriorate. Treatment options continue to improve as additional new drugs enter clinical trials. However, the limited distribution of many such drugs denies their benefits to patients in the developing world. Drug holidays (or "structured treatment interruptions"), are intentional discontinuations of antiretroviral drug treatment. Studies of such interruptions attempt to increase the sensitivity of HIV to antiretroviral drugs. The interruptions attempt to change the selection pressure from the drug resistance back toward resistance to the human immune system, thus breeding a more drug-susceptible virus. HIV spends some of its life-cycle in a state where its DNA is entirely integrated into human DNA. Under certain conditions, drug-resistant strains of the virus can remain dormant in this state, since CD4 T-cells also are dormant when not aroused by invading organisms. The resistant strain can then reemerge when antiretroviral drugs are re-introduced. Intermittent therapy is an experimental approach designed to reduce exposure to antiretroviral drugs in an effort to mitigate side-effects. Intermittent therapy differs from treatment interruptions in that it involves using a much shorter cycle of switching on and off the antiviral drugs. Studies of such approaches include schedules of Week-on, week-off and Five-days-on, two-days-off which skips treatment on weekends. They also seek to determine what kinds of patients are best suited for this approach. However, initial data suggest that intermittent therapy is ineffective and results in drug resistance^.(23,24)

Conclusion:

The number of people living with HIV and death caused by AIDS is still on increase globally. National AIDS control organization (NACO) statistics reveal an increase in the number of AIDS cases in India . Though the developments in recent years are revealing some hope and optimism, the ground realities are that there is no vaccine still available. The antiretroviral therapy which is available is not under the reach of the common man because the recommended regime and clinical testing procedure are elaborate, time consuming, costly and difficulty associated with anti retroviral therapy such as adherence, drug interaction, long term side effects and accessibility for indefinite period of time with the caution that not a single dose should be skipped during the period of therapy. The pharmacist, being an important resource among health providers, has a great role and responsibility in this connection. He is competent educationally and is involved in teaching and researching the mechanism of pathology of the disease, developing new drugs for its treatment including vaccines, promoting the awareness about the disease and how it can be prevented and control through the mean of retailing and distribution as medical representative and as a patient counselor and community pharmacist. A proposal has been included in the national aids prevention and control plan for providing training to the pharmacist for prevention and control of HIV/AIDS. But the vision lies in developing cheaper ART and easily availability of condoms; development of safe vaccine (still under pipeline).such a potential contribution will extend the national importance of the pharmacist as the health provider.

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