Drug utilization study of HIV positive patients registered with antiretroviral therapy centre of a tertiary care hospital

Abstract

Objective: To determine the drug utilization pattern among HIV (Human Immunodeficiency Virus) outpatients in antiretroviral therapy (ART) centre of a tertiary care hospital. Method: We conducted a prospective, longitudinal follow up study of one year duration. Collected data was analyzed using descriptive statistics. Results: A total of 1491 prescriptions were collected from 250 HIV positive patients. Majority of the drugs were prescribed in oral dosage form. The average number of drugs per encounter was 4.26 and the average drug cost per encounter was INR 850.52. In majority of encounters (52.9%) first line HAART regimen was prescribed. The most common regimen prescribed among the first line HAART was the combination of Zidovudine, Lamivudine and Nevirapine (26.76%). The medication class most commonly prescribed were antiretroviral agents (39%). Antimicrobial agents were the second most common class of drugs prescribed (29.6%) with cotrimoxazole being the most common. The third most commonly prescribed drug class was vitamins (18.72%). There were total of 36 substitutions within the first line regimens with substitution of zidovudine by stavudine being the most common. In our study the optimal level of adherence as suggested by the national guidelines was achieved in 87.77% of encounters. Conclusion: Overall our results suggest that the prescribing pattern to be in accordance with national guidelines but there still remains a scope for improvement by using viral load as a biomarker instead of CD4 count. Also we would suggest a periodical external quality assessment of counsellors of all ART centres for further enhancement of adherence level.

Current trends in highly active anti-retroviral therapy in an anti-retroviral therapy centre attached to a remote government medical college of Maharashtra, India: a retrospective study

“…In the present study, zidovudine+lamivudine+nevirapine (ZLN) (86.75%) were the most commonly prescribed HAART combination followed by tenofovir+lamivudine+ effavirenz (TLE) (36.42%) and stavudine+lamivudine+nevirapine (SLN) (34.44%). Similar results were found in Jiyo C et al and Oreagba A. et al 16,1 The most common regimen prescribed among the first line HAART was the combination of zidovudine+lamivudine+nevirapine (26.76%) followed by stavudine+lamivudine+nevirapine (10.53%). The above findings is in accordance with our national guidelines for antiretroviral therapy which recommends ZLN as the first choice and SLN as second choice among all first line HAART regimens.…”

“…Understanding HIV-TB co-infection is of great significance because of increasing prevalence, rapid progression of HIV disease in TB patients and challenges in treatment due to drug interactions and immune reconstitution syndrome. 16 …”

“…Study results are in concordance with the previous studies by Dabla V et al and Jiyo C et al tuberculosis was found to be the most common opportunistic infection. 21,16 Majority of studies from India found pulmonary tuberculosis to be the most common opportunistic infection among people with HIV infection. Understanding HIV-TB co-infection is of great significance because of increasing prevalence, rapid progression of HIV disease in TB patients and challenges in treatment due to drug interactions and immune reconstitution syndrome.…”

A study of utilization pattern of drugs in HIV positive patients at antiretroviral therapy centre of a tertiary care teaching hospital

“…The finding is in consonance with other studies. 6,12 Majority of patients (84.31%) were on non PI based regime. This finding is in accordance with other studies.…”

“…This finding is in accordance with other studies. 6,9 As per the ART guideline 2013 by NACO, PI-based regime is to be used as second line regime. 5 PI-based regimes can pose challenges, such as a more complex dosing schedules, drug interactions, toxicities and increase in cost.…”