ObjectivesTo identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases.MethodsWe conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication.ResultsOut of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001).ConclusionOne-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.
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.
Background Anti-HCV treatment may add significant complexity to antiretroviral treatment (ART). The complexity of the medicines regimen could be a risk factor for non-adherence or increasing incidence of blips. Purpose To determine if the addition of anti-HCV treatment to antiretroviral treatment increases the complexity of the treatment, therefore modifying medicines adherence and incidence of blips. Materials and methods We conducted a retrospective observational study. HIV/HCV co-infected patients treated with interferon alfa-2a plus ribavirin for at least 12 weeks between 01/2008–06/2012 were included. We excluded patients with HIV viral load >50 copies RNA/mL in the six months prior to the introduction of anti-HCV treatment. The following variables were collected: sex, age, weeks on anti-HCV treatment and incidence of blips. Additionally, adherence (≥95%) and complexity index were collected before and after the addition of anti-HCV treatment. Blips were defined as a detectable HIV-RNA level (>50 copies/mL but no more than 1000 copies/mL) occurring between 2 negative assays. Complexity index was calculated based on a score (Martin et al , 2007) which considers number of pills taken per day, dosing schedule, dosage form and any specific instructions related to drug use. Quantitative and dichotomous variables were compared using the t-test for related samples and McNemar’s test respectively (confidence interval (CI) 95%). Data analysis was carried out using SPSS 20.0. Results 36 patients were included (75% male, mean age 47 ± 5). The mean duration on anti-HCV treatment was 41 ± 18 weeks. The mean value of the complexity index before and after the addition of anti-HCV treatment to ART was 5.3 ± 1.9 and 11.4 ± 1.6 respectively (p < 0.001, CI:-6,68;-5,56). 4 out of 36 (11.1%) patients experienced viral blips (p > 0.005). After the introduction of the anti-HCV treatment, the number of non-adherent patients showed a non-significant increase from 11% to 22%. Conclusions The addition of anti-HCV treatment to ART correlates with a significant increase in the complexity index, leading to higher non-adherence and blips rates. No 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.
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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.