BackgroundTreatment modifications within the first year are extremely important. The first HAART regimen should remain for years. The first regimen toxicity can have a negative impact on adherence and virological efficacy.PurposeTo establish the main reason for discontinuing antiretroviral treatment within the first year in an HIV cohort.Material and methodsProspective multicentre study. Treatment-naive adult HIV patients who started treatment between 2011 and 2013 were selected. Basic demographic characteristics (sex and age) and pharmacotherapeutic variables as initial HAART, discontinuation of HAART within the first year and its reasons based on Swiss HIV Cohort1 were collected. The main reasons for treatment modification were classified as treatment failure, intolerance and/or toxic effects, the patient’s choice, the physician’s decision, and other reasons.Results277 patients started HAART in this period, 82.4% men. The mean age was 40 ± 11. The most frequent HAART was emtricitabine/tenofovir/efavirenz (59.1%) followed by emtricitabine, tenofovir, atazanavir/ritonavir (13.6%), emtricitabine, tenofovir, darunavir/ritonavir (9.1%) and other combinations (18.2%). During the first year of HAART, 68 individuals modified their treatment. The reason for treatment discontinuation was: 64.7% intolerance or toxic effects, 16.2% the physician’s decision 10.3% treatment failure, 4.4% the patient’s decision and 4.4% other reasons. 44 patients modified their treatment because of drug intolerance and/or drug toxicity. CNS adverse events were the most frequent toxic effect (27.3%), followed by gastrointestinal tract intolerance and renal impairment (18.2%), rash (9.1%), biochemical alterations (6.8%) and others (18.2%).ConclusionThe number of patients stopping HAART in the first year is acceptable. It is necessary to properly assess starting HAART to reduce adverse reactions involving switching the treatment.ReferenceElzi L, Marzolini C, Furrer H, et al. Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008. Arch Intern Med 2010;170(1):57–65. doi:10.1001/archinternmed.2009.432No conflict of interest.
BackgroundThe addition of anti-HCV treatment to highly active antiretroviral treatment (HAART) in HIV/HCV co-infected patients leads to an increase in the treatment complexity which may result in reduced adherence.PurposeTo determine whether the number of patients adherent to HAART decreased after the addition of anti-HCV treatment to HAART.Material and methodsWe conducted a prospective two-centre observational study. HIV/HCV co-infected patients on HAART who started anti-HCV dual or triple therapy between January 2011 and December 2013 were included. Patients were excluded if they were virologically uncontrolled (>50 copies RNA VIH/mL) or their HAART had been modified in the six months before starting anti-HCV treatment. Variables collected were: demographics, anti-HCV treatment, weeks on anti-HCV treatment and adherence. Medicines adherence was assessed using electronic pharmacy repeat dispensing records. The threshold for optimal adherence was ≥95%. McNemar`s test was applied to compare adherence before and after the addition of anti-HCV treatment to HAART using SPSS-20.Results66 patients were included (86% male, mean age 47 ± 5). 53 (80%) patients were on dual therapy with peg-interferon and ribavirin, 11 (17%) patients were on triple anti-VHC treatment with telaprevir and 2 (3%) were treated with boceprevir. The median duration of the anti-HCV treatment was 45.6 (IQR: 20.4–49.1) weeks. 50 (76%) patients were considered adherent to HAART before starting anti-HCV treatment. After the addition of anti-HCV treatment, the number of adherent patients decreased to 45 (68%), p > 0.05. Subgroup analysis based on the anti-HCV treatment showed that patients adherent on anti-HCV dual therapy decreased from 42 (64%) to 37 (56%), p > 0.05. The number of adherent patients did not change in those on anti-HCV triple therapy.ConclusionThe introduction of anti-HCV dual therapy to HAART is associated with a tendency towards a decrease in the number of adherent patients.References and/or AcknowledgementsAIDS Behav 2013;17:94–103No conflict of interest.
BackgroundTreatment of immune thrombocytopenic purpura (ITP) is a controversial subject. The management varies widely, ranging from observation only, to aggressive management with corticosteroids, intravenous anti-RhD, intravenous immunoglobulin (IVIG), rituximab, splenectomy, etc.PurposeTo assess the effectiveness of treatment by administration of immunoglobulins (Ig) in patients diagnosed with idiopathic thrombocytopenic purpura (ITP).Material and methodsRetrospective descriptive study of about 5 years (January 2009–March 2014). All administrations of Ig in patients diagnosed with ITP in our study period.The variables analysed were: sex, age, dose Ig, number of administrations to each patient, pre-treatment with corticosteroids, effectiveness of treatment with Ig (being defined as platelet levels increasing to above 30–109/l, as indicated by the clinical guidelines for the use of Ig).Patients and clinical data were selected from the outpatient and inpatient records (Farmatools) and electronic patient clinical histories.ResultsA total of 23 patients were treated with PIT Ig in the study period. 6 patients were excluded because their clinical data had not been collected. 17 patients (two of whom were paediatric patients) of whom 41% were males were included. The mean age was 48 years.The mean dose administered per patient was 40.44 grams of Ig. Mean Ig administration per patient in the study period was two administrations per patient.Pre-treatment with corticosteroids as first-line treatment was performed in 88.23% of patients.Of the 34 administrations recorded, 61.76% were found to be effective according to the clinical guidelines for the use of Ig for the treatment of ITP.ConclusionIg treatment had a higher than 60% efficacy, so it is justified to use it in symptomatic treatment prior to corticosteroids in patients diagnosed with ITP.ReferenceIndian Pediatr 2013;50(6):611No conflict of interest.
BackgroundMedication regimen complexity index (MRCI) has been identified as a predictor of sustained virologic response in patients treated with peginterferon and ribavirin for chronic hepatitis C.PurposeTo determine the influence of the MRCI in the premature discontinuation of triple therapy treatment with boceprevir or telaprevir in hepatitis C virus-HIV (HCV/HIV) coinfected patients.Material and methodsWe conducted a multicentre and prospective study that included HCV/HIV coinfected patients treated with triple therapy with boceprevir or telaprevir in combination with peginterferon-alpha plus ribavirin between January and December 2013. Basal variables colleted were: age, gender, hepatits C treatment-naïve or previously treated, presence of cirrhosis, psiquiatric disorder. We evaluated the proportion of patients achieve extended rapid virologic response (RVRe), defined as HCV RNA negative between 4 and 12 weeks of treatment with telaprevir and between 8 and 24 weeks of treatment with boceprevir. The rate of premature therapy discontinuation with the PI and reasons were collected. To calculate the MRCI, we considered all prescribed drugs and used the tool developed by McDonald et al.1 To determine the independent predictors of therapy discontinuation, we performed a multivariate logistic regression analysis.Results55 patients of three different centres were included (86.4% were men and the mean age was 48 years (SD = 3.7)). 68.0% were non-naive. 90.7% had cirrhosis. 83.1% achieved RVRe. 18 patients (30.5%) prematurely discontinued the treatment. Reasons for treatment discontinuation included adverse events (50.0%), lack of efficacy (33.0%) and refusal to continue the medication (17.0%). The mean MRCI was significantly higher in patients who discontinued the therapy (31.11 vs. 26.16). In the multivariate analysis, the only predictor of premature discontinuation of the therapy was the MRCI (OR = 1.17, p = 0,009; 95% CI (1.04–1.53).ConclusionThe MRCI is an independent predictor of premature discontinuation of the triple therapy with boceprevir and telaprevir in HCV/HIV coinfected patients.References and/or Acknowledgements1 McDonald MV, Peng TR, Sridharan S, et al. Automating the medication regimen complexity index. J Am Med Inform Assoc 2013;20(3):499–505No conflict of interest.
BackgroundComorbid chronic conditions have increased among HIV-infected patients. Little work has studied adherence rates for long-term medicines (LTMs).PurposeTo assess adherence to other LTMs (non-antiretroviral therapy) among HIV-infected patients as well as to evaluate its relationship with clinical and therapeutic factors.Material and methodsA cross-sectional study was conducted from May to July 2014 in HIV-infected patients treated with ART and ≥1 LTM. The following variables were collected: sex, age, living situation, employment status, mode of transmission, T-CD4, viral load, CDC classification, type of ART and adherence to other LTM (non-antiretroviral treatment), using the 4-item Morisky Medication Adherence Scale. The chi-squared test was applied to examine the role of the different variables on adherence, using SPSS 20.0.Results126 patients were included (80.4% male, mean age 50.4 ± 8.3). Injection drug use was the main mode of transmission (61.9%). The median T-CD4 was 538.5 cells/mm3 (IQR: 341.1–778.2). Most of patients presented T-CD4 ≥ 500 cells/mm3 (56.3%) and undetectable viral load (74.6%). 63.5% of them had AIDS. ART was mainly (36.5%) two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) with one non-nucleoside reverse transcriptase inhibitor (NNRTI). The percentage of patients adherent to other LTMs (non-antiretroviral therapy) was 46.0%. The variable AIDS exhibited a statistically significant relationship with non-adherence (OR = 2.2; CI [1.1–4.7]; p = 0.041). The most common long-term medicines were sedatives and anxiolytics (42.9%), lipid-lowering drugs (35.7%), antihypertensives (33.3%), gastrointestinals (28.6%), antidepressants (15.1%), antidiabetics (12.7%), analgesics (11.1%), antiasthmatics (9.5%) and cardiovascular drugs (87.9%).Abstract CP-010 Table 1Variable: n (%)Non-Adherent (n = 68)Adherent (n = 58)p-ValueAge ≥ 50 years30 (44.1)26 (44.8)1.000Gender: female14 (20.6)12 (20.7)1.000Living alone18 (26.5)11 (19.0)0.399Employment status: employed16 (23.5)19 (32.8)0.399Mode of transmissionSexualInjection drug use21 (30.9)47 (69.1)27 (46.6)31 (63.4)0.097Detectable viral load (>20 copias/ml)18 (26.5)14 (24.1)0.839T-CD4 ≥ 500 Cells/mm3 38 (55.9)33 (56.9)1.000AIDS49 (72.1)31 (53.4)0.041Type of ART2NRTIs + NNRTI2NRTIs + IP/rOthers25 (36.8)20 (29.4)23 (33.8)21 (36.2)21 (36.2)16 (27.6)0.657ConclusionPatients showed a low level of adherence to other LTMs. This study allowed us to attempt to educate HIV-infected patients with suboptimal adherence.References and/or acknowledgementsCantudo-Cuenca MR, Jiménez-Galán R, Almeida-Gonzalez CV, et al. Concurrent use of comedications reduces adherence to antiretroviral therapy among HIV-infected patients. J Manag Care Pharm 2014;20(8):844–50No conflict of interest.
Background Pharmaceutical care consultations specialising in viral diseases seem to benefit the therapeutic objective. Purpose To analyse the frequency of changes in antiretroviral treatment regimens (ART) when the patient is able to consult a pharmacist specialising in viral diseases; to determine the causes and compare the results with available studies that do not include a consultation of this nature. Materials and methods Prospective observational study. The patients included were monoinfected HIV + and co-infected HIV/HCV patients who had been followed up in an outpatient consultation of a hospital and who had changed their ART for any reason between January 2010 and September 2013. The following variables were collected: age, sex, ART before and after the change and cause of change (adverse effects, simplification, interactions, virological failure and others). Adverse effects were classified as: gastrointestinal, renal, metabolic, hepatic, related to the central nervous system (CNS), cardiovascular and others. Data collection was done through the outpatient database and medical record reviews. Annual frequency of change and frequency depending on the cause were calculated. The data obtained were compared with those described in Davidson et al.’s study (Antiviral Research 2010, 86:227–9) concerning non-specialist consultations. Results A total of 538 ART regimens were changed, affecting 44% (n = 365) of patients. 79% were men with a mean age of 48 years. The annual rate of change was 18%. The main cause of change was adverse effects (45%) (mostly for gastrointestinal disorders (26%) and CNS disorders (21%)). This was followed by other causes (19%), simplicity (19%), virological failure (12%) and interactions (5%). Conclusions The reasons for discontinuation of ART agree in order but not in magnitude with those indicated in the existing bibliography. Fewer changes due to adverse effects were found and more changes in the hope of treatment optimisation when a specialised consultation was possible. This was due to better pharmaceutical care and better communication between doctor and pharmacist. No conflict of interest.
BackgroundAtypical antipsychotics need a prescription check (visa), that is, a prior official authorisation of prescriptions, so as monitor patient safety.PurposeTo describe the prescription of quetiapine in a health area and compare the indications for prescribing with the indications approved on the visa summaries from the perspective of patient safety.Material and methodsWe conducted a descriptive observational study of the prescription of quetiapine between 15th September and 15th October 2014 in a visa unit of a health area, formed by a hospital and a primary care district.We recorded the following variables: gender, age, medical service, indication and acceptance or rejection. Quetiapine indications allowed by the visa are: (1) schizophrenia, (2) depressive episodes associated with bipolar disorder, (3) moderate to severe manic episodes in bipolar disorder, (4) prevention of recurrence of manic or depressive episodes in patients with bipolar disorder who previously responded to quetiapine treatment, (5) add-on ongoing treatment in patients with major depressive disorder who have had sub-optimal response to treatment with other antidepressants, (6) persistent aggressiveness among elderly people with moderate to severe dementia, who have contraindication or have not responded to other treatment (benzodiazepines, haloperidol, risperidone).ResultsWe assessed 31 prescriptions for quetiapine (58.1% male, mean age 65 ± 19.4 years). The medical services were primary care (41.9%), mental health (32.3%) and neurology (6.5%). The main indication for quetiapine was “persistent aggressiveness with moderate to severe dementia” (32.3%), “followed by depressive episodes associated with bipolar disorder” (22.6%), “schizophrenia” (19.4%) and “moderate to severe manic episodes in bipolar disorder” (19.4%). Four prescriptions (12.9%) were not correct according to the visa, so they were rejected.ConclusionDiscrepancies between the drug’s visa recommendations and real use of quetiapine commonly occur, which means added risk for the patients. The visa unit is essential to promote the safer use of atypical antipsychotics.ReferenceRev Español Econ Salud 2006;5:276–85No conflict of interest.
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