Steven Peskin, M.D., MBA, FACP, discusses considerations for payers when identifying patients at risk for drug-resistant HIV.
Steven Peskin, M.D., MBA, FACP: In looking at multidrug resistant HIV [human immunodeficiency virus], that is an area where, again, we are relying as a health plan on our clinical partners, great groups like ID [Infectious Disease] Care here in New Jersey, just to name one. The clinicians who treat persons with HIV tend to be specialized in the disease. Certainly this is true in larger cities and areas like New Jersey where you have a limited amount of rural medicine, except for perhaps a bit of Cumberland county and so forth. Otherwise, you’re in areas where there are subspecialists, those are most often persons trained in infectious diseases. And part of that training involves significant focus on HIV and the management of the various medications, side effects, complications. HIV is a chronic condition that can also involve heart disease, weight gain, hyperlipidemia, those kinds of things.
In other areas, there are general internists, like myself, who might take an interest in HIV and do an excellent job of treating those persons. There are family physicians as well, and pediatric infectious disease subspecialists with pediatric and adolescent patients with HIV. It tends to be a condition where there are very highly trained subspecialists, or specialists who aren’t subspecialists but have additional training, who have the comfort level and the acumen, and maintain the scholarship to manage HIV.
As far as thinking about multidrug resistance, this is an issue for sure. Again, from a health plan perspective, health plans not always but oftentimes have care managers or case managers working with persons with HIV. And if not, the clinicians will be very much on top of looking for signs of resistance, checking viral load periodically, that sort of thing.
Transcript edited for clarity.