Complete Story
Egrifta administration in a patient living with HIV
Due to the nature of human immunodeficiency virus (HIV) and side effects of antiretroviral treatments (ART) used to treat HIV, many patients experience what is known as lipohypertrophy, or excess visceral fat in the abdominal area. The exact mechanism of lipohypertrophy in patients living with HIV is unknown, and few treatments exist to assist patients in getting rid of this excess abdominal fat. One of the treatments that does exist is EGRIFTA SV® (tesamorelin for injection), an injectable growth hormone-releasing factor (GHRF) analog used for the reduction of excess abdominal fat in patients living with HIV. This drug is complicated, to say the least. It requires a special ordering mechanism, must be dispensed through a specialty pharmacy, has a prior authorization process, and has a complex administration mechanism - a nightmare for pharmacists and patients alike.
I had a patient come into the pharmacy to pick up his Egrifta prescription, not knowing what to expect. The medication kit comes in two large boxes - one with the actual vials of medication, and another with the injection supplies. I went to counsel the patient, also having no idea what to expect as this is not a commonly dispensed medication. I found the injection kit comes with 30 vials of sterile water, 30 vials of Egrifta, 90 needles, and 60 syringes! Each dose of Egrifta needs to be reconstituted with sterile water, which can be overwhelming for a patient who has never injected medication before.
I was honest with the patient, and told him I had never helped anyone with this particular medication - but I had definitely drawn up, reconstituted, and injected more than enough vaccines with the same process. We got to work and I made sure to explain every aspect of the medication, while having the patient model what I was doing so I knew this could be administered safely at home. Thirty minutes later, the first injection was complete with no issues and the patient was elated. They told me they felt confident in their abilities to inject themselves and promised to call if they needed anything else.
There is nothing better than helping a patient and getting to learn something new all at the same time.
Grace Havens, PharmD
PGY1 Community-Based Pharmacy Resident
The Ohio State University and Equitas Health
