No abstract

Dolutegravir (DTG) is the third HIV integrase inhibitor (INI) available for prescription in Belfast since July 2014. It has shown high virological efficacy in both treatment-naïve and -experienced patients. We carried out a retrospective case chart analysis of HIV-1-positive adults commenced on DTG between July 2014 and September 2015. Patients were identified from records as either treatment-naïve or antiretroviral therapy (ART) experienced. Outcomes included: (1) virological response (HIV-1 RNA viral load at 0, 4, 8 and 12 weeks), (2) immunological response (CD4+ cell count at 0, 4, 8 and 12 weeks) and (3) tolerability (side effects and discontinuation). The main exclusion criteria were patients transferring care already established on DTG from other treatment centres or inadequate follow-up information (defined as attendance at <50% of clinical and serological follow-up visits). One hundred and fifty-seven commenced DTG out of 823 patients on ART; 106 (68%) were switched to DTG from another regimen, and 51 (32%) were ART-naïve. One naïve and 14 treatment-experienced patients were excluded from the analysis due to failure to attend clinical follow-up. Analysis of HIV-1 RNA viral load (HIV-1 VL) was divided into three groups: 50 new starters, 68 suppressed at switch and 24 not suppressed at switch. New starters: Baseline median HIV-1 RNA VL 71,259 copies/mL (19,536-196,413); 73% were virally undetectable (HIV-1 RNA VL <70 copies/mL) by week 4. Switching patients: Of those with an HIV-1 RNA undetectable viral load prior to switching, two were detectable with a mean viral load of 443,730 copies/mL after four weeks. Of the 24 patients detectable at switch (median HIV-1 VL 2212 [311-43,467]), 10 were detectable after four weeks. For those with a recordable viraemia, the median HIV-1 VL reduced to 376 (220-1181). At week 12, four patients were detectable with a median VL of 12,390 (567-52,285). Overall, 56 (35%) reported side effects; 40 (25%) reported either difficulty with low mood, anxiety or sleep disturbance. Sixteen (10%) discontinued DTG, with 13 (8%) due to intolerable side effects. DTG is a useful drug in naïve or switch patients. It has the potential to effectively suppress the viral load within the first four weeks of treatment and thus reduces infectiousness. Within the cohort, DTG was generally well tolerated but side effects such as low mood, anxiety and sleep disturbance were high, with 8% of patients discontinuing treatment.

IntroductionIn 2014 the pharmacy team completed an interaction screen of all HIV patients on a boosted antiretroviral (ARV) regimen using then recently launched NIECR. We concluded that there was a need for primary and secondary care teams to screen and manage drug-drug interactions (DDI). 56 patients in 2014 required urgent clinical intervention.MethodsIn 2014 we reported on patients taking a boosted ARV regimen for DDI; we continued this work for all patients and this year we reviewed our interaction screening database, to assess the following: Interaction screen documented, Number of patients issued medication by their GP, Percentage of interactions identified.Results1093 unique patient records, 887 (81.2%) have a recorded H&C number and interaction screen. 468/887 patients (53%) are prescribed medication by their GP with no or no significant interactions. 235/887 patients (27%) are prescribed medication by their GP where an interaction is identified by the MDT and managed. 122/887 patients (14%) do not obtain any medication from their GP. 9/887 patients (1%) have opted out of NIECR. No patients required an immediate clinical intervention.DiscussionThe number of patients prescribed medications by their GP has increased from 45% in our 2014 report compared with 79.3% in this review. There was a significant improvement in the latest review of interactions and no patients were identified with serious interactions. A medicines reconciliation and interaction screen before initiating/switching treatment and prior to a clinic review has enabled our cohort to avoid clinically significant DDI.