Introduction

Great strides have been made in HIV management and outcomes in the last 30 years. With the introduction of combination antiretroviral therapy (ART), HIV infection rates have been decreasing, along with the morbidity and mortality rates associated with HIV infection. Unfortunately, despite numerous initiatives, such as “Getting to Zero” and “Undetectable=Untransmittable” (U=U), and the implementation of pre-exposure prophylaxis (PrEP), the incidence of HIV infections has remained high in certain risk groups such as young Black men who have sex with men [MSM] and in certain geographic areas, including the southern US.1,2 This highlights the challenges in HIV management that still exist, such as engagement and retention in care and achieving and maintaining virologic suppression across all patient populations, especially those that struggle with adherence to ART. Moreover, the prevalence of people living with HIV (PWH) is increasing because people are living longer with HIV.3 Therefore, health care providers (HCPs) have to consider the comorbidities that occur with normal aging, along with the comorbidities that occur as a result of living with HIV. HIV management is complex in and of itself and the presence of age-related comorbid conditions can increase the risk of adverse events (eg, drug-drug interactions [DDIs]), accenting the need for effective communication among subspecialists and carving out a distinct role for pharmacists on multidisciplinary teams.

Although ART has been the mainstay of HIV treatment for decades, it has continuously evolved to increase rates of virologic suppression and reduce morbidity and mortality through more-effective and -tolerable regimens (eg, fewer and smaller pills, fewer side effects). Among key recent advances are antiretroviral (ARV) therapies with high barriers to resistance that allow for same-day initiation of ART, long-acting injectable (LAI) formulations, and advances in pharmacologic options for heavily treatment-experienced (HTE) PWH. Rapid ART is an important strategy to engage patients in health care as early as the day of HIV diagnosis, to quickly achieve virologic suppression, therefore improving outcomes and reducing transmission. Research and development advances have added 2 LAI injectable options to the ARV armamentarium. These LAI ARVs combat some of the barriers to ART adherence (eg, pill burden), and 1 option provides a novel mechanism of action to overcome drug resistance in HTE PWH. However, to capitalize on the benefits afforded by these strategies and treatment options, it is necessary to employ a multidisciplinary team to meet the complex needs of the expanding and aging HIV population. With their breadth of knowledge and experience, pharmacists are an integral part of HIV care teams across all clinical settings. Therefore, the following educational content was designed to provide clinical and managed care pharmacists the information they need and the strategies they can employ to facilitate rapid initiation of ART, implementation of LAI ART, and optimization of complex ART regimens in HTE patients with HIV to improve outcomes.