Shout Out Health

ASK THE PHARMACIST: Confidentiality in the Pharmacy; What are Your Rights?

Q: "I was in to pick up my monthly prescriptions for HIV medications the other day. The clerk behind the counter told me my prescriptions for HIV medications had to be filled elsewhere now because it's a specialty medication. There were several people around, and she used the word "HIV" when addressing me. I don't like to disclose my status to strangers. I'm wondering if I should report this. Aren't there pharmacy rules on confidentiality? Also, have you also heard about insurance that does not cover HIV medications at a normal pharmacy?"

A: In short, it sounds like this information was exchanged near the cash register, and at the very least, this 'conversation' should have been taken to a more private area. Ideally, the pharmacy would
have contacted you by phone to review this insurance issue before you even came in. But unfortunately,
that's not the case, and this kind of scenario happens much more often than people think, and it's important to know how to handle it.

In hindsight, any member of the pharmacy staff should use extreme caution when discussing any PHI (protected health information) with a patient at the pharmacy. (PHI is any individually identifiable health information.) Because of the changes in the HIPAA (Health Insurance Portability and Accountability Act), the patient has very explicit rights when dealing with PHI. That said, the HIPAA laws are vague on information that is "overheard" by other individuals that may be standing around the patient area when information is being discussed. 

In a high traffic pharmacy, hundreds of patients cross the register daily. Some people will yell out in front of a waiting room full of strangers, “I want to pick up my Viagra and Xanax,” and not blink an eye.  Other people are much more discreet and don’t want this information known by others. 

ASK THE PHARMACIST: Is PrEP available for 'mixed' status couples?

Q: I'm HIV negative, but my boyfriend is positive. We're fully committed to each other, but navigating our sex life is a constant challenge. But I just read somewhere that there's medication that not only treats HIV, but can help greatly reduce risk of HIV infection for negative people. Am I a candidate for this medication and how do I get it? Thanks.

A: You are correct! Some recent studies have been published showing promising results with regards to antiretroviral medication helping to reduce the risk of contracting HIV. Truvada, a medication currently on the market indicated for the treatment of HIV, has demonstrated efficacy in its use in pre-exposure.

This is encouraging news for individuals such yourself that are in a "mixed" HIV status relationship. I have talked to several patients who share your concerns, and I especially hear this from HIV positive patients, who are very concerned about the possibility of passing the virus on to someone they have fallen in love with and are committed to spending their lives with.

So based on the results of the iPrEx Trial (Pre-exposure Prophylaxis Initiative) -- which you can read about in detail here -- there is reason to be encouraged. But that said, there is also reason for pause. I haven’t yet filled any prescriptions for this purpose and Truvada isn’t yet FDA indicated for this purpose.  However, clearly you would be an ideal candidate for pre-exposure therapy, being you are in a relationship with an HIV-positive person. Ultimately, this decision is up to the patient and the prescriber. I urge you to contact your medical provider and discuss your options regarding this preventive treatment. Good luck. -- Heath P. Dobson Jr., BS Pharm, RPh

ASK THE PHARMACIST: Can supplements help improve energy and muscle tone?

Q: I'm tired of taking so many supplements to enhance my energy and muscle tone (I'm HIV positive). Do you have any suggestions (maybe something like K-Pax?) to make it easier to understand my options?

A: Proper nutrition is a key component to maintaining a healthy lifestyle. But this fact is increasingly important for HIV positive patients. 
 
There are several nutritional supplements available that can provide a positive benefit in HIV patients.  Many of these are covered by your state’s AIDS Drug Assistance Program.  Ensure, Boost, Gulcerna, and other enteral supplements are commonly used to treat and prevent HIV malnutrition.  These supplements are available in a liquid form and consumed two to three times daily. Juven is another type of supplement used to prevent muscle wasting, increase energy and promote muscle growth. Juven is packed with glutamine, among other amino acids, which function to regenerate tissue, muscle, and promote healing.  Each packet is dissolved in water or juice and consumed twice daily.  K-Pax, which you mentioned in your question, is a multivitamin supplement on the market that claims to prevent muscle wasting, increase energy, and promote muscle growth.