Counseling on a Patient with HIV Infection. For the Improvement of the QOL.

Medication program should be designed by giving careful consideration to the QOL of each patient individually. We would like to report a case that showed marked improvement in the QOL, in which patient counseling played an important role.A 30-year-old male patient with acquired immunodeficiency syndrome was started on treatment with pentamidine/ganciclovir at admission. Either the daily injection (5 mg/kg daily) or 5 time injections weekly (6 mg/kg daily) is known as the standard prescription regimen of ganciclovir maintenance therapy for ambulant patients. However, with such a drug regimen the QOL of such patients becomes quite restricted due to the need to visit the hospital. In such cases the patient strongly desires to need to visit the hospital in order to maintain his normal social activities. To reduce the number of hospital visits, we discussed possible modifications in the protocol together with the patient. After being convinced that the patient fully understood the therapy regimen, we proposed a prescription on 12 mg/kg daily, and he only had to visit the hospital 2 days a week. For reducing the injection times, the most important points are the correspondence of the new prescription, the patient's understanding of the therapy, and patient compliance. We therefore explained the importance of the therapy involving the pharmacology, effectiveness, dosage, pharmacokinetics, and adverse effects of ganciclovir. After the patient understood our explanation, a prescription, consisting of twice/week injections, was tried. The effectiveness of the therapy seemed to be equivalent to that of frequent hospital attendance. The reduction in the required hospital attendance improved the QOL of the patient markedly. This case demonstrates the importance of patient counseling in order to achieve an optimal outcome and improve the patient's QOL.