Role of a clinical pharmacist as part of a multidisciplinary care team in the treatment of HCV in patients living with HIV/HCV coinfection

Olea, Antonio; Grochowski, Janet R.; Luetkemeyer, Anne F; Robb, Valerie; Saberi, Parya

doi:10.2147/iprp.s169282

Cited by 22 publications

(20 citation statements)

References 25 publications

(16 reference statements)

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“…High SVR rates in our study population align with other real-world studies of DAA therapy. [11, 12, 28, 29] The difference in SVR rates between our two cohorts was driven by a higher rate of loss to follow up in the HCV monoinfected cohort. Given the higher rate of negative social determinants in HIV/HCV coinfected patients, the lower rate of loss to follow-up was somewhat surprising.…”

Section: Discussionmentioning

confidence: 93%

“…The rate and reason for ART change within our cohort was similar to Olea et al (23% n = 31/135). [12] Of those with an ART change, the most common was adjusting from TDF to tenofovir alafenamide (TAF)-based regimens. As more HIV/HCV coinfected patients are treated with TAF-based therapies prior to consideration of HCV treatment, the need to modify ART specifically for HCV treatment may decrease.…”

Section: Discussionmentioning

confidence: 99%

“…ART adjustment often involves coordinated care among multiple providers, including physicians, pharmacists, and social workers. [12] This can impact patients’ ability to initiate HCV treatment in a timely manner, which can be further compounded by arduous medication insurance approval processes. [13]…”

Section: Introductionmentioning

confidence: 99%

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Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter?

et al. 2019

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IntroductionSustained virologic response (SVR) rates in patients with hepatitis C virus (HCV) monoinfection and human immunodeficiency virus (HIV)/HCV coinfection treated with direct acting antiviral (DAA) therapy are similar in clinical trials. The objective of this study was to examine differences in patient characteristics, drug-drug interactions, and treatment pathways between these groups in a real-world clinical setting.MethodsWe performed an ambispective review of patients prescribed DAA therapy between September 2015 and April 2018 at a tertiary academic center. The primary endpoint was time from a decision to treat to treatment initiation. Secondary endpoints included patient characteristics; frequency and type of DAA medication interactions; frequency, type, and timing of antiretroviral therapy (ART) changes; and treatment outcomes.ResultsThree hundred and twelve patients were included. Almost half (43%) were HIV/HCV coinfected. Patients with HIV/HCV coinfection were more likely to be African American (p<0.001), have a diagnosed psychiatric disorder (p<0.001) and have a higher pill burden (p = 0.014). Patients with HIV/HCV coinfection were more likely to report an alcohol abuse history (p<0.001), injection drug use history (p<0.024), or active use of illicit substances (p = 0.019). In a multivariable regression model assessing the primary endpoint, time to treatment initiation was increased in patients requiring a change in ART therapy (OR = 9.2, p < 0.001) or a non-ART medication adjustment (OR = 2.4, p = 0.003), and in patients with Medicaid (OR = 6.7, p < 0.001). After controlling for all these factors, HIV/HCV coinfection still significantly impacted time to treatment initiation (OR = 1.7, p = 0.020). The groups had similar rates of drug interaction frequency, treatment completion, observed SVR, and side effects.ConclusionsPatients with HIV/HCV coinfection are more likely to have a variety of factors that add complexities to HCV treatment. In addition to these challenges, patients with HIV/HCV coinfection experience a longer time to treatment initiation while patients with HCV monoinfection were more frequently lost to care. Care delivery models may incorporate this data to improve patient engagement, access, and outcomes.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter?

et al. 2019

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“…10 Sebagai contoh, farmasi klinik yang tergabung dalam tim multidisiplin pada pasien HIV/Hepatitis C bisa berperan dalam delapan hal yaitu saat awal pengobatan, konseling kepatuhan, konseling dan skrining interaksi obat, efek samping, hasil pengobatan dan resiko infeksi, asesmen efek samping dan hal lain termasuk pengambilan obat dan manajemen komorbiditas. 24 Dalam melakukan pelayanan kefarmasian, apoteker perlu didukung sarana dan prasarana. Sarana yang dapat membantu meningkatkan kepatuhan ART pada anak antara lain "pil dispenser" yang berguna untuk memudahkan minum obat.…”

Section: Pembahasanunclassified

Gambaran Peran Apoteker sebagai Konselor dalam Pengobatan HIV-AIDS pada Ibu dan Anak

Handayani

Yuniar

Susyanty

et al. 2018

mpk

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Ministry of Health estimates there are 9,000 pregnant women HIV positive who give birth every year in Indonesia. HIV-positive pregnant women must get Anti Retroviral treatment with a minimum level adherence to the use of anti-retroviral drugs of 90 - 95% drug to get a response to suppresing the virus by 85% . Physiological changes during pregnancy and breastfeeding can affects the drug kinetics in pregnant and lactating women. In children, non-compliance can be caused by saturation, limited drug preparation for children, side effects and other diseases that accompany it. In this article, we will analyze the extent to which pharmacists act as counselors for HIV-AIDS treatment for mothers and children. Data were taken from 2 qualitative studies, namely Implementation Study of Prevention of mother-to-child transmission (PMTCT) Program at HIV-AIDS Referral Hospital in West Java Province in 2014 and Study on Access of HIV-AIDS and Opportunistic Infection Treatment for Children in Ten Districts of Indonesia in 2015. Data collection was carried out by in-depth interviews with pharmacists and doctors who handled pregnant women and children with HIV-AIDS. Data were analyzed using triangulation and content analysis method. The results showed that pharmacists had not been involved as drug counselors and support from the management of the hospitals did not yet exist, so the pharmacist could not yet as a counselor as a form of pharmaceutical services according to standards set by the government Therefore, the role of pharmacist as counselor needs to be improved, because the success of the treatment is highly dependent on the successful collaboration of doctors, nurses, and pharmacists. In order for the pharmacists play a role, it is necessary to get training on HIV-AIDS treatment. In addition, the government needs to advocate for hospital management to facilitate the pharmacist’s counseling as form of counselor. Abstrak Kementerian Kesehatan memperkirakan terdapat 9.000 ibu hamil HIV positif yang melahirkan di Indonesia setiap tahun. Ibu hamil dengan HIV positif harus mendapatkan pengobatan anti retroviral dengan minimal tingkat kepatuhan penggunaan obat Anti Retroviral sebesar 90 - 95% untuk mendapatkan respon penekanan jumlah virus sebesar 85%. Perubahan fisiologi selama kehamilan dan menyusui dapat berpengaruh terhadap kinetika obat pada ibu hamil dan menyusui. Pada anak, ketidakpatuhan dapat disebabkan karena jenuh, sediaan obat untuk anak yang terbatas, efek samping, dan penyakit lain yang menyertai. Pada artikel ini dianalisis sejauh mana apoteker berperan sebagai konselor pengobatan HIVAIDS pada ibu dan anak. Data diambil dari dua penelitian kualitatif yaitu penelitian Studi Implementasi Layanan Pencegahan Penularan HIV dari Ibu ke Anak (PPIA) pada Rumah Sakit Rujukan HIV-AIDS di Provinsi Jawa Barat Tahun 2014 dan Penelitian Akses Pengobatan HIV/AIDS dan Infeksi Oportunistik pada Anak di Sepuluh Kabupaten/Kota di Indonesia Tahun 2015. Pengumpulan data dilakukan dengan wawancara mendalam dengan apoteker dan dokter yang menangani ibu hamil dan anak dengan HIVAIDS. Analisis data dengan tri angulasi dan analisis konten. Hasil penelitian menyimpulkan bahwa apoteker belum dilibatkan sebagai konselor obat dan dukungan dari pihak manajemen RS belum ada, sehingga apoteker belum dapat berperan sebagai konselor sebagai salah satu bentuk pelayanan kefarmasian sesuai standar yang telah ditetapkan pemerintah. Oleh karena itu peran apoteker sebagai konselor perlu ditingkatkan karena keberhasilan pengobatan sangat tergantung keberhasilan kolaborasi dokter, perawat,dan apoteker. Agar apoteker dapat lebih berperan maka perlu mendapatkan pelatihan tentang pengobatan HIV-AIDS. Selain itu pemerintah perlu melakukan advokasi kepada manajemen RS untuk memfasilitasi apoteker melakukan konseling sebagai bentuk konselor.

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“…On the other hand, as of December 2014, an estimated 36.9 millions of individuals were living with HIV, 2 millions were newly infected, and 1.6 million died (Boulle et al, 2014;Hoseinpour et al, 2015). Infection with HCV has been reported in one quarter of HIV-positive individuals in the United States and more than of 9% of drug abuser HIV patients in Iran (Olea et al, 2018;Amiri et al, 2016). Infection with HIV influences the outcome of HCV therapy and worsens HCV progression to cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Impact of interplay between autophagy and interferon-alpha in HCV and HCV/HIV infection

Lajevardi¹,

Bamdad²,

Choobin³

et al. 2019

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Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are among the most dangerous pathogens globally. Infection with HCV has been reported in a high percentage of HIV patients. Viruses are obligate intracellular pathogens and their survival is associated with their capability to subvert antiviral defenses of cells and to improve cellular processes required for their replication. The aim of this study was to compare the expression rate of the key gene for autophagy process, Beclin-1, as a cellular response to viral infections, and its effect on interferon alpha (IFN-α) expression in both HCV and HCV/HIV patient groups. In this study, a total number of 40 samples of peripheral blood mononuclear cells (PBMCs) including 20 HCV and 20 HCV/HIV patients before treatment were evaluated. The HCV viral load in both groups was evaluated by semi quantitative real-time PCR. The level of Beclin-1 and IFN-α gene expression was examined in all samples by semi quantitative real-time PCR assay. The median viral load was 8.3×10 5 copies/ml in HCV group and 2.1×10 6 copies/ml in HCV/HIV patients. While the expression level of Beclin-1 gene in HCV group was significantly higher, the level of IFN-α expression was lower compared to the HCV/HIV group (P <0.03). Furthermore, an inverse correlation was observed between Beclin-1 and IFN-α level of gene expression in coinfected patients (P <0.05). According to the results of this study, the positive or negative correlation between IFN-α and Beclin-1 gene expression along with other genetic and physiological host factors can be considered as important agents involved in HCV and HIV pathogenesis, and a probable reason for progression toward to cirrhosis in co-infected individuals.

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Role of a clinical pharmacist as part of a multidisciplinary care team in the treatment of HCV in patients living with HIV/HCV coinfection

Cited by 22 publications

References 25 publications

Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter?

Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter?

Gambaran Peran Apoteker sebagai Konselor dalam Pengobatan HIV-AIDS pada Ibu dan Anak

Impact of interplay between autophagy and interferon-alpha in HCV and HCV/HIV infection

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