Today’s plenary session included a talk provided by Dr Patrick Mallon titled ‘ Why should we switch for Toxicity?’. While this talk very much spoke to those who prescribe antiretroviral therapy it did highlight some key points that nurses seeing HIV patients should be aware of. Dr Mallon also did a great job in presenting the information in a way that all clinicians involved in HIV care not just the prescriber should have an awareness of the role of toxicity and tolerability when talking with our clients about their satisfaction with their regime and adherence. Key points that Dr Mallon discussed that apply to nurses providing HIV care included:
– The key differences between tolerability and toxicity: Tolerability is subjective as this is what our clients report. In contrast, toxicity is somewhat more difficult to assess as it is only detected though monitoring hence prescribing clinicians need to determine what toxicities they should be monitoring for.
He gave a great example here from a study that examined patients on a regime that included a placebo. Patients were on regimes, which either included Efavirenz, or a regime including a placebo. As patients didn’t know whether they were being given Efavirenz or not they were warned about the potential for nightmares. Interestingly 10% of the patients on the placebo reported nightmares, which highlighted the role of subjective toxicity.
– Treatment for life and what patients want: Research has shown patients want single tablet regimes and that their satisfaction plays an important role in their ability to tolerate adverse events (which would otherwise be considered toxicity). However, some patients may tolerate such events better due to their satisfaction with the regime.
– The drop versus switch debate: Prescribers need to ensure they take a holistic approach when considering what approach to take with those patients experiencing toxicities. Does the drop or switch outweigh the proposed benefits? The example given was in regards to a study where patients were switched regimes due to concerns about decreasing bone mineral density. This switch resulted in saving 3 years of bone mineral loss but in an era where patients are moving towards being on treatment for life is this actually a significant change? In addition does if such a change is to result in significant increases in costs or decreased patient satisfaction – does it outweigh the benefits?
As nurses we play a key role in assessing our clients adherence and satisfaction with their regimes. This talk highlighted some key points we need to consider when talking with our clients about their regime. At times we are an additional link between our clients and their prescribers hence having an awareness of such issues will assist us further in advocating for our clients.