In this real-world cohort, 49% of patients stopped boceprevir-based hepatitis C therapy early, with only 20% stopping due to treatment futility. Having more comorbidities was significantly associated with early discontinuation. Tolerability of boceprevir-based regimens may be substantially worse than reported in clinical trials, particularly for patients with comorbidities.

SOF/RBV treatment was associated with fewer side effects than BOC-based triple therapy, appearing to be a safer and more tolerable alternative for HCV GT-1 subjects. These results show that emerging IFN-free therapies may enhance patient adherence, allowing treatment of larger number of patients with improved efficacy.

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Infection with human immunodeficiency virus remains a global concern with a significant number of incident infections still reported worldwide. The use of prophylaxis prior to exposure to the virus to prevent infection has been a growing area of recent research. Results in nonhuman primates and clinical trials in high-risk patient populations using preexposure prophylaxis have shown promising results in terms of efficacy and safety, especially relating to oral preexposure prophylaxis. The potential use of oral antiretroviral agents traditionally used for human immunodeficiency virus treatment as prophylaxis raises interesting considerations, such as the best agents available for such a role, long-term safety in healthy individuals, and the potential development of resistance to these agents should infection occur. From a public health perspective, the cost-effectiveness of implementing this preventive strategy has not been fully defined at this point in time.

BackgroundHospitalists are critical partners in antimicrobial stewardship program (ASP) efforts to improve antimicrobial use, but limited data exists on the effectiveness of ASP-hospitalist collaboration. We performed a hospitalist-led quality improvement project with pharmacy collaboration to improve antimicrobial prescribing practices on general internal medicine teaching services at an urban academic medical center.MethodsWe conducted a 3-arm intervention study on internal medicine teaching services from September-December 2016. Three services received an educational (Ed) intervention consisting of an antibiotic rationale checklist, a templated progress note to promote trainee critical thinking about antibiotic management, and a pocket card with institutional guidelines. In addition, 1 team received twice weekly stewardship rounds with an infectious disease clinical pharmacist (Ed+ID-PharmDx2) while another team received 5x week stewardship rounds with a generalist clinical pharmacist (Ed+PharmDx5). The primary outcome was broad-spectrum antibiotic use calculated as days of therapy (DOT) per 1000 patient days compared with historical data from the corresponding months. Secondary outcomes included duration of inpatient therapy, antibiotic costs, length of stay, 30-day readmission, ICU transfer and in-hospital mortality.ResultsBroad-spectrum antibiotic use significantly decreased by 26% (415 vs. 306 DOT/1000 patient days) and 32% (425 vs. 287 DOT per 1000 patient days) on the Ed and Ed+PharmDx5 teams, respectively (P <0.01). Broad-spectrum use on the ED+ID-PharmDx2 team decreased by 9% but was not statistically significant. There was a significant improvement in median length of stay among patients receiving antibiotics for Ed only (-1.5 days; P < 0.001) and Ed+PharmDx5 (-1 day; P < 0.001) and no significant change in 30 day readmissions, ICU transfer and in-hospital mortality for any team. Direct antibiotic costs were reduced by $80,000 during the study period.ConclusionA hospitalist-led initiative to improve inpatient antimicrobial prescribing led to reductions in broad-spectrum antimicrobial use and reduced length of stay. ASPs should target hospitalists and pharmacists as partners in programmatic efforts to improve inpatient antimicrobial prescribing.Disclosures All authors: No reported disclosures.

Upon completion of this chapter, the reader should be able to to gain knowledge about new antiretroviral drugs in development, different strategies to restore the immune system and eliminate the latent HIV reservoir, and also discuss the role and current research of preventive and therapeutic vaccines....

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