BACKGROUND: The use of highly active antiretroviral therapy has significantly reduced morbidity and mortality, thus increasing life expectancy of human immunodeficiency virus (HIV)-infected individuals, transforming HIV into a chronic disease. Accordingly, there has been an increase in the number of comorbidities concomitantly present in these individuals and also an increased use of comedications, which may negatively impact antiretroviral therapy adherence. These factors can affect adherence to antiretroviral therapy. The role of the HIV clinical pharmacist is essential to achieve therapeutic objectives and enhance adherence.
BackgroundThere has been an increase in the number of chronic conditions concomitantly present in HIV-infected individuals and correspondingly, in comedication. Beliefs play a crucial role in medicines adherence.PurposeTo investigate the relationship between beliefs (necessity and concerns) of HIV-infected patients about comedication and their adherence.Material and methodsWe conducted a cross-sectional study between May–July 2014, that included HIV-infected patients treated with antiretroviral treatment (ART) and ≥1 additional drugs for other chronic diseases.The variables analysed in the study were demographics (sex, age), mode of transmission, CD4+, HIV plasma viral load, beliefs about comedication and adherence to treatment for chronic conditions.The Beliefs about Medicines Questionnaires (BMQ) was used to assess patients’ beliefs about drugs for additional diseases. The BMQ-Specific has two scales (necessity and concern) with five questions each that uses a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = uncertain, 4 = agree, 5 = strongly agree). A total score per scale was calculated. Self-reported comedication adherence was measured using the 4-item Morisky Medication Adherence Scale (MMAS). MMAS scores were dichotomised into adherent/non-adherent.Internal consistency within BMQ scales was measured with Cronbach’s α and their association with adherence was assessed with t-Student tests, using SPSS 20.0.ResultsWe included 126 patients (80.4% male, mean age 50.4 ± 8.3). Injected drug use was the main mode of transmission. 43.7% of patients presented CD4+ ≤ 500 cells/mm3 and 25.4%, detectable viral load. The mean number of additional medicines was 2.9 ± 2.0.The percentage of non-adherent patients was 54.0%. Belief in necessity was positively related to self-reported adherence. No relationship between adherence and concern was found. Internal consistency for BMQ-Specific was high (Cronbach’s alfa = 0.724) which indicates high intercorrelation between items.Abstract CP-025 Table 1BMQ-Specific scale> Cronbach´s alfa Non-Adherent (Mean±SD)Adherent (Mean±SD) p-value Necessity0.79417.3 ± 5.618.8 ± 4.40.188Concern 0.785 14.6 ± 5.7 12.1 ± 6.1 0.019ConclusionGreater conviction that comedication is necessary was associated with higher self-reported adherence in HIV infected-patients, suggesting that it could be important to focus on the necessity of this treatment to improve adherence.References And/or AcknowledgementsPlos One 2013;8(12):e80633No conflict of interest.
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.
drugs involved according to the anatomical therapeutic chemical (ATC) classification, type of PI and acceptance rate. PIs were classified into seven groups: dosage adjustment, pharmacokinetic monitoring, stopping treatment, switching to equivalent therapeutic drug or pharmaceutical form, information about drug administration, duplicity and other (eg, date and time of administration). Results A total of 430 patients were admitted to the ICU during the study period. We performed 115 PIs in 66 patients (1 intervention/3 patients admitted): 13.9% were related to dosage adjustment, 24.4% to pharmacokinetic monitoring, 12.2% to stopping treatment, 2.6% to switching to an equivalent therapeutic drug or pharmaceutical form, 16.5% to drug administration information, 18.3% to drug duplicity and 12.2% other. Regarding ATC classification, 42.6% of PIs were related to group J, 13.9% to group B, 12.2% to group H, 6.1% to groups N and C, 4.4% to groups A and R, and 10.5% to group V. The acceptance rate was 94.5%. Conclusion and relevance The clinical pharmacist integration into the ICU enhanced pharmacotherapy optimisation of critical patients, especially through pharmacokinetic monitoring and interventions related to anti-infective drugs. The acceptance rate was >90%, which indicated a considerable concern by the ICU team.
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.
Background The number of HIV infected patients with other comorbidities is growing due to increased life expectancy. So many patients have very complex therapeutic regimens that could interfere with adherence. Purpose To determine the effect of the complexity of the drug regimen on the adherence to antiretroviral treatment (ART) and lipid-lowering treatment (LLT). Materials and methods We conducted a single-centre, retrospective study. We included HIV infected patients with ART and treatment for dyslipidaemia between January–June 2013. The dependent variable was the adherence (ART and LLT) and the independent variables were: sex, age, route of HIV transmission, HCV coinfection, alcohol consumption or illegal drug abuse, psychiatric disease and complexity of the drug regimen. Adherence was determined through pharmacy dispensing records. Patients were considered adherent when they took ≥90% of prescribed ART and LLT in the last 3 months. Drug regimen complexity was determined through the tool “medication regimen complexity index” (MRCI) developed by McDonald et al1. To determine the variables associated with adherence, we performed a univariate logistic regression analysis. Results We included 55 patients in the study (82% men, mean age 55 years). Sexual was the main route of HIV transmission (40%). 52.7% were co-infected with HCV, and 15% of patients used alcohol or illegal drugs. Atorvastatin was the LLT most frequently prescribed. 82% of patients were adherent to ART, but only 69% presented undetectable HIV-RNA. On the other hand, 51% of patients were adherent to LLT. MRCI was not a predictive factor for non-adherence. Alcohol consumption or illegal drug abuse was the only variable that showed statistically significant relationships with the non-adherence to ART (p = 0.013). Adherence to ART in this group of patients was 40% vs. 90.9% in the other group (not consuming alcohol or illegal drugs). Conclusions In this study the complexity of the drug regimen was not a predictive factor for adherence in HIV infected patients. Alcohol consumption or illegal drug abuse could lead to a lack of adherence. Hospital pharmacists play a key role in adherence to ART and this study showed a high adherence to ART. However, at present many patients have other prescription drugs for other comorbidities. In this study the adherence to LLT is low. Therefore, hospital pharmacists should try to ensure adherence to all the medicines and not only to ART. Reference McDonald MV, Peng TR, Sridharan S, Foust JB, Kogan P, Pezzin LE, Feldman PH. Automating the medication regimen complexity index. J Am Med Inform Assoc 2013. 1;20:499-505. No 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.
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