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Ferris alumna helps HIV-positive patients adhere to their drug regimens
Above Jean Lee’s desk is a photo of an iceberg floating near Cape Spear, just outside St. John’s, Newfoundland. “They float down from the arctic in May or June when the waters start warming up,” says Lee (P’01), a St. John’s native. “Once in a while you’ll see a polar bear or seal stuck on an iceberg. When they get closer to land they’ll hop off. Sometimes you’ll find them in the city because they’re lost.”
Patients at Saint Mary’s McAuley Health Center, an HIV clinic in Grand Rapids, Mich., can feel equally lost when they first discover their positive status. As clinical pharmacist, Lee helps patients chart a path through the territory of complicated drug regimens after a physician decides with the patient that medications are required for their HIV care.
“If they’re going to be starting medications, I usually try to schedule a separate appointment,” says Lee. “I find that if I do it on the same day as their visit, their mind is still on their provider’s visit. I want them to be able to focus on what I have to say, because the information about their medications is very important.”
The Body (dot com)
Lee first learned about the medical needs of HIV-positive patients when she was a staff pharmacist at a hospital in Canada. At the time, she didn’t know much more about such care than the average layperson. That all changed while working on her Pharm.D. degree at Ferris. At the time, Lee thought she wanted to specialize in pediatric oncology. Then, during an infectious disease rotation at Kalamazoo’s Bronson Hospital, she had a number of HIV-positive patients on her rotation.
“There was a newly diagnosed woman, a hemophiliac having problems and someone who was in the ICU, so I saw the various stages,” recalls Lee. “It was just so fascinating in terms of how the virus intertwines with different systems within our bodies.”
Lee not only knows a lot more about the virus now, but was recently cited with an award for her care of patients by thebody.com, a Web site devoted to providing resources and information of those living with HIV/AIDS.
“I guess one of my patients nominated me; it was very flattering,” says Lee. “I think the award for pharmacy is a new category. There are more and more pharmacists being involved in HIV clinics around the country helping patients.”
Jean Lee received recognition from the Web site thebody.com for her work with HIV/AIDS patients.
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New Horizons
Since the Food and Drug Administration approved the use of Zidovudine (AZT) to treat HIV/AIDS in 1987, drug regimens have progressed to more complex three-drug combinations. These pharmacological “cocktails” help patients fight their particular strain of the virus.
“Twenty years ago we had AZT and that was it. Today, we have more options and more information about when to start treatment. For a newly diagnosed patient, you need to know that if a particular regimen doesn’t work, you still have these other options,” explains Lee. “In designing a regimen, it’s almost like playing chess.”
Through an “expanded-access” program, there are three new drugs that are available via study protocol, but not yet FDA approved to add to the mix of the chess game against HIV. As clinical research coordinator for the clinic, Lee is helping bring these new therapies to her patients.
One of the new drugs is active against drug-resistant strains of the virus. Two other drugs are new classes of therapy. The first is an integrase inhibitor, which targets one of the three enzymes HIV needs for viral replication; the other, a CCR5 inhibitor, blocks one of two receptors the virus uses to enter cells and replicate.
“These new classes of drugs provide options for our patients who are in what we call ‘deep salvage’ they’re resistant to the majority of approved drugs and don’t have many other options left,” says Lee, who has spent several months filling out the necessary paperwork for the program to be able to enroll patients into these trials.
Against Complacency
One possible down-side to improved drug therapy is that people at risk for infection or re-infection might feel that taking preventative measures are no longer as necessary as they once were. Lee notes that patients on new regimens are at risk of developing resistance if they are not adherent to their medication regimen. They are also at risk of being re-infected with another strain to which their current medications are not effective.
“My biggest concern is spread of resistant virus,” says Lee. “The way I explain it to patients is, if you don’t have enough drug in the body, the virus is going to look around and have a party! The virus is going to multiply because there’s not enough drug to suppress it. Once the virus starts multiplying especially in the presence of a drug mutations will develop. ”
In addition to guarding against infection or re-infection and maintaining strict adherence to a drug regimen, Lee, like virtually all care providers, stresses the importance of knowing your HIV status if you are at risk. This helps those infected stop the spread of the virus (especially resistant strains) and get early treatment, which for a pregnant woman can mean preventing the transmission of the virus to her baby.
“Hopefully one day we’ll get there,” Lee says, referring to the development of either a preventive or therapeutic vaccine, “but it’s going to be tough. For now, we need to continue doing those things we can already do.”
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