Análisis de las causas y factores predictivos de discontinuación del tratamiento con tenofovir en pacientes VIH pretratados

Morillo-Verdugo, Ramón; Navarro, Mercedes; Martin, Lindsay A; Muñoz, Ángeles; Roldán, Úrsula Baños; Criado, Silvia Artacho

doi:10.1016/s1130-6343(07)75374-6

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…Researchers demonstrated that patients with HIV under pharmaceutical care have significantly improved CD4+ counts, decreased HIV viral load, and fewer toxic effects related to ARV drugs 39. Toxicity reduction improves patient quality of life and treatment adherence 40–42. A cohort study in 2,234 patients showed that those patients who had pharmacy team involvement in their care adhered more to ARV therapy than those who did not have pharmacy team involvement 43.…”

Section: Discussionmentioning

confidence: 99%

Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection

Molino¹,

Carnevale²,

Rodrigues³

et al. 2014

TCRM

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BackgroundSubstantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection.MethodsIn this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia–University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load.ResultsAfter pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1–6.2) to 4.2 (95% CI =3.3–5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm3 [95% CI =175.8–345.6] to 312.0 cells/mm3 [95% CI =23.5–40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load.ConclusionThis study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

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Section: Discussionmentioning

confidence: 99%

Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection

Molino¹,

Carnevale²,

Rodrigues³

et al. 2014

TCRM

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“…The exact reason for this finding was unclear and will require further research. However, a study that investigated causes for discontinuing treatment amongst patients on TDF, reported that about 23.8% of patients on TDF in that study population discontinued therapy due mainly to adverse reaction [29]. Another study in South Africa reported that patients with preexisting mild to moderate renal dysfunction were at greatest risk of death [30].…”

Section: Discussionmentioning

confidence: 99%

The Pattern of Attrition from an Antiretroviral Treatment Program in Nigeria

Odafe¹,

Torpey²,

Khamofu³

et al. 2012

PLoS ONE

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ObjectiveTo evaluate the rate and factors associated with attrition of patients receiving ART in tertiary and secondary hospitals in Nigeria.Methods and FindingsWe reviewed patient level data collected between 2007 and 2010 from 11 hospitals across Nigeria. Kaplan-Meier product-limit and Cox regression were used to determine probability of retention in care and risk factors for attrition respectively. Of 6,408 patients in the cohort, 3,839 (59.9%) were females, median age of study population was 33years (IQR: 27–40) and 4,415 (69%) were from secondary health facilities. The NRTI backbone was Stavudine (D4T) in 3708 (57.9%) and Zidovudine (ZDV) in 2613 (40.8%) of patients. Patients lost to follow up accounted for 62.7% of all attrition followed by treatment stops (25.3%) and deaths (12.0%). Attrition was 14.1 (N = 624) and 15.1% (N = 300) in secondary and tertiary hospitals respectively (p = 0.169) in the first 12 months on follow up. During the 13 to 24 months follow up period, attrition was 10.7% (N = 407) and 19.6% (N = 332) in secondary and tertiary facilities respectively (p<0.001). Median time to lost to follow up was 11.1 (IQR: 6.1 to 18.5) months in secondary compared with 13.6 (IQR: 9.9 to 17.0) months in tertiary sites (p = 0.002). At 24 months follow up, male gender [AHR 1.18, 95% CI: 1.01–1.37, P = 0.038]; WHO clinical stage III [AHR 1.30, 95%CI: 1.03–1.66, P = 0.03] and clinical stage IV [AHR 1.90, 95%CI: 1.20–3.02, p = 0.007] and care in a tertiary hospital [AHR 2.21, 95% CI: 1.83–2.67, p<0.001], were associated with attrition.ConclusionAttrition could potentially be reduced by decentralizing patients on ART after the first 12 months on therapy to lower level facilities, earlier initiation on treatment and strengthening adherence counseling amongst males.

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“…Su incidencia puede variar entre el 1% y el 30% de acuerdo con la metodología empleada para su detección y evaluación. Los problemas de seguridad y costo de estas cuando son graves tienen un peso considerable en los sistemas de salud, pues se dice que son responsables de más de 770.000 lesiones y muertes anuales a nivel mundial, y que ocasionan hasta 56 millones de dólares de gasto por hospital -dependiendo del tamaño del mismo 3,7,8 .…”

Section: Introductionunclassified

Reacciones adversas evitables graves por antivirales. Sistema Cubano de Farmacovigilancia, 2008-2017

Pérez¹,

Milián²

2018

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Objetivo: Caracterizar las reacciones adversas graves evitables por antivirales presentes en el Sistema Cubano de Farmacovigilancia durante los años 2008 al 2017. Material y métodos: Investigación cuantitativa, observacional y descriptiva; enmarcada dentro de los estudios de farmacovigilancia, con un diseño de serie de casos. El universo conformado por las notificaciones de reacciones adversas graves evitables provocadas estos fármacos. Se utilizaron variables como: reacción adversa identificada, grupo de edad, sexo, fármaco antiviral, frecuencia y causas de evitabilidad.. Resultados: Las reacciones adversas evitables graves a los antivirales se comportaron a ritmo irregular que muestra tendencia al incremento. Predominaron en hombres (77.8%) y en adultos (94.4%). Zidovudina (44.4%) y nevirapina (38.9%) muestraron la mayor cantidad de reportes, relacionados con la aparición de anemia y síndrome de Stevens Johnson. Los médicos reportaron el 72.2% de los casos. Las reacciones encontradas se describen como frecuentes. Las interacciones medicamentosas (61.1%) fue la principal causa de evitabilidad. Conclusiones: La caracterización de las reacciones adversas graves evitables a los antivirales permitió identificar que las mismas fueron frecuentes, producidas por antirretrovirales y presentadas hombres adultos; siendo la anemia y síndrome de Stevens Johnson las más frecuentes. Las causas de evitabilidad identificadas con mayor frecuencia responden a errores de la prescripción.

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Análisis de las causas y factores predictivos de discontinuación del tratamiento con tenofovir en pacientes VIH pretratados

Abstract: Almost a quarter of the patients discontinued treatment with tenofovir during the study. The main cause for this was adverse effects. No association was found between any abnormal basal analytical parameter and a greater probability of discontinuing treatment.

Cited by 11 publications

References 23 publications

Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection

Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection

The Pattern of Attrition from an Antiretroviral Treatment Program in Nigeria

Reacciones adversas evitables graves por antivirales. Sistema Cubano de Farmacovigilancia, 2008-2017

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