HIV pharmaceutical care in primary healthcare: Improvement in CD4 count and reduction in drug-related problems

Abstract

Highly active antiretroviral therapy (HAART) is complex and many factors contribute to a patient's response to initial therapy including adherence, drug effectiveness, and tolerance. Close HAART follow-up is needed, particularly when there are concurrent therapies such as prophylactic antibiotics and medications for the treatment of comorbidities. To assess the effectiveness of pharmacist intervention in reducing drug related problems in HIV/AIDS outpatients (intervention group) and in improving clinical parameters in the intervention group compared to the control group. We conducted a prospective controlled intervention study with patients paired by gender and initial T CD4+ lymphocyte (CD4) count. HIV-infected patients of a public outpatient service were enrolled for the study by consecutive and convenience sampling. Patients selected for the study were divided into a control group and an intervention group. Both groups were followed for one year; however, only the intervention group received pharmaceutical care. The primary outcome was the drug related problem (DRP) analysis for the intervention group. Secondary outcomes were CD4 count and viral load evaluation for both groups. There was a total of 143 patients enrolled in this study, with 53 (37.06%) patients in the control group and 90 (62.94%) patients in the intervention group. A total of 202 pharmacist interventions with 193 pharmacist-patient and 9 pharmacist-physician interventions were proposed. After one year of pharmaceutical care, a reduction of 38.43% between the initial and final DRP was found ( = 0.0001). The most common DRPs found were related to medication safety. The intervention group showed a mean increase of 84% for the CD4 count in comparison with that observed in the control group. The viral load was not significantly different between the final and initial mean values for both groups. Pharmacist appointments enabled identification, prevention, and solving of drug related problems, especially those related to drug safety. Also, pharmacist interventions improved adherence and increased HAART effectiveness as suggested by the higher elevation in the CD4 count seen in the intervention group in comparison with the control group.

Profile of sociodemographics, sources of infection, antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre, Indonesia

“…This is in compliance with the Indonesian Government's guideline for HIV/AIDS treatment. The guideline stated that antiretroviral treatment should consist of three types of drugs, all of which must be absorbed and be in therapeutic doses in the blood; this is known as highly active antiretroviral therapy [3]. While seven patients in this study only got two antiretrovirals, this warrants further considerations.…”

“…The effectiveness of antiretroviral treatment could be seen from the CD4 counts (>500 cells/mm 3 ), VL (<500 copies/mL) and clinical conditions (i.e. the clinical stages established by WHO) [1], [3], [4], [19], [20], [21], [22], [23], [], [24]. In terms of CD4 counts, the WHO classified CD4 counts of 350-499 cells/mm 3 as mild immunodeficiency, 200-349 cells/mm 3 as moderate immunodeficiency and <200 cells/mm 3 or <15% as severe immunodeficiency [].…”

“…The impact of HIV/AIDS infection causes high morbidity and mortality rates at a productive age so that it has an economic and social impact [2]. Although antiretrovirals cannot cure HIV, they can suppress HIV replication and enhance the immune response [3]. Reducing viral load (VL) and increasing cluster of differentiation 4 (CD4) has been evidenced to improve the quality of life of HIV/AIDS patients.…”

Clinical Pharmacists in Chronic Care

“…Pharmacists' involvement in the care of HIV-positive patients has been associated with improved patient outcomes, including enhanced, reduced pill burden and dosing frequency, greater increases in CD4 cell counts, higher rates of viral suppression, and decreases in medication errors [349]. Pharmacist involvement ensured identification, prevention, and solving of DRPs [351], increased CD4+ T-lymphocyte counts [352], reduced cost associated with medicine, doctor/hospital appointments, laboratory tests, and hospitalizations [353], reduced pill burden and dosing frequency [354] and greater adherence to and persistence with ART adherence (early studies indicated 95% adherence was needed for viral suppression) [355]. In a US Department of Veterans Affairs Medical Center adherence study, the results demonstrated a 10% increase in adherence associated with a viral load decrease [356].…”

Impact of HIV and chronic kidney disease comorbidities on hepatitis C treatment choices, drug–drug interactions and hepatitis C cure

“…However, in clinical practice, special considerations are required when prescribing DAAs for HCV/HIV co-infected patients due to concomitant medications and a potential increased risk of drug-drug interactions [21,22]. Similarly, in HCV/CKD comorbidity, owing to accelerated development of hepatic complications and complex drug regimens, personalized patient care is critical [18,23,24]. It is thought that a multidisciplinary team (MDT) approach inclusive of a prospective assessment of potential drug-drug interactions (DDIs) (prior to commencing HCV therapy), improves clinical outcomes and cure rates [25,26].…”