C Codina

Relationship between adherence level, type of the antiretroviral regimen, and plasma HIV type 1 RNA viral load: a prospective cohort study.

The relationship between adherence, antiretroviral regimen, and viral load (VL) suppression was assessed through a 1 year prospective follow-up study among 1142 HIV-infected patient. Patients on antiretroviral therapy who attended to the pharmacy during a 6-month period were considered eligible. Those included in the final analysis were patients who had been taking the same antiretroviral therapy for > or =6 months since their inclusion. The cohort included patients taking first line therapy (n = 243) and antiretroviral-experienced patients (n = 899). Naive patients who were included had to have reached undetectable VL at enrollment. Antiretroviral-experienced patients with detectable VL determinations in the previous 6 months were excluded. Adherence was measured by means of announced pill counts and dispensation pharmacy records. Of patients, 58% were taking NNRTI, 31.4% boosted PI, and 10.6% unboosted PI-based regimens. Overall, the relative risk of virologic failure was 9.0 (95% CI 4.0-20.1) in patients with adherence 80-89.9%, 45.6 (95% CI 19.9-104.5) with adherence 70-79.9%, and 77.3 (95% CI 34.2-174.9) with adherence <70%, compared with adherence of > or =90%. The risk of virologic failure in patients with adherence <90% taking unboosted PI was 2.5 times higher than the group taking boosted PI (95% CI 1.2-5.3). There were no statistical differences in patients taking boosted PI and those who were taking NNRTI. Less than 95% of adherence is associated with high virologic success. For patients taking NNRTI- or boosted PI-based regimens with adherence rates of 80%, the failure rate is <10%. These data do not affect the goal of achieving the highest level of adherence possible.

Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral en el año 2004

El cumplimiento incorrecto del tratamiento antirretroviral (TAR) constituye el factor principal de fracaso terapeutico. Los factores que han demostrado estar relacionados con la adherencia de forma mas relevante incluyen la complejidad del tratamiento, los efectos secundarios, los problemas psicologicos, la adiccion activa a drogas y/o alcohol, la falta de soporte sociofamiliar y las actitudes y creencias del paciente acerca del tratamiento. La monitorizacion del cumplimiento debe formar parte de la atencion habitual del paciente con infeccion por el virus de la inmunodeficiencia humana (VIH), deben utilizarse metodos factibles, adaptados a la realidad del hospital y lo mas universalmente aplicables. Puede considerarse un minimo aceptable la asociacion de un cuestionario validado y el registro de dispensacion del servicio de farmacia. Todo paciente que inicie o cambie el tipo de TAR debe realizar un programa de educacion sanitaria sobre el tratamiento, a cargo de profesionales sanitarios con experiencia y conocimiento del manejo de pacientes con infeccion por VIH. Debe procurarse la maxima disponibilidad del equipo asistencial (medicos, farmaceuticos y profesionales de enfermeria) para resolver las dudas y problemas que se presenten a lo largo del tratamiento. En los pacientes en los que no se alcancen niveles de cumplimiento adecuados, se deben intentar estrategias de intervencion, basadas en aspectos psicoeducativos y de asesoramiento personal, con capacidad para adaptar el esquema del TAR a los habitos de vida del paciente y proporcionando estrategias de resolucion de problemas. En determinadas situaciones sera necesario resolver la comorbilidad, por lo tanto el enfoque debe ser pluridisciplinar. Son aconsejables pautas mas sencillas en cuanto a numero de comprimidos y a dosis diarias.

Evaluation of antiretroviral‐related errors and interventions by the clinical pharmacist in hospitalized HIV‐infected patients

The aim of the study was to identify antiretroviral‐related errors in the prescribing of medication to HIV‐infected inpatients and to ascertain the degree of acceptance of the pharmacists interventions.

Comparación de tres métodos de cálculo de adherencia en pacientes con tratamiento antirretroviral

Introduccion El calculo de la adherencia al tratamiento antirretroviral constituye un dato de gran utilidad en el seguimiento de los pacientes con infeccion por virus de la inmunodeficiencia humana (VIH). Se han propuesto varios metodos para calcular la adherencia, pero cada uno de ellos presenta ciertas dificultades de aplicacion. Pacientes y metodos Se han evaluado, de forma prospectiva, tres metodos para el calculo de la adherencia: el recuento de la medicacion sobrante (RMS), la entrevista estructurada (EN) y el registro de dispensacion de medicacion desde el servicio de farmacia (DM). Se ha considerado el RMS como metodo patron y se ha evaluado la sensibilidad y la especificidad de los otros dos metodos con respecto a este. Resultados Los tres metodos se han podido aplicar a 69 casos. De estos, el porcentaje de pacientes que ha tomado el 95% o mas de las dosis prescritas ha sido del 72,5% (RMS), el 85,5% (EN) y el 81,2% (DM). Si se considera el RMS como el metodo patron, la concordancia con DM ha sido del 75,1% y con EN del 73,2%. La sensibilidad de DM y EN ha sido del 52,6 y 42,1%, respectivamente. Los pacientes con una adherencia _ 90% (RMS) presentaron una probabilidad de alcanzar una buena respuesta virologica 1,29 veces mayor (intervalo de confianza [IC] del 95%: 1,04-1,62; p _ 0,0138). Conclusion Aunque la concordancia entre los metodos es aceptable, DM y EN sobrestiman la adherencia respecto a RMS. Debido a que no se dispone de un metodo ideal para medir la adherencia es importante combinar varios metodos para realizar una medicion lo mas aproximada posible a los datos reales.

DI-011 Pharmacist’s role on adherence and literacy in a cancer outpatient setting

Background Oral anticancer agents (OAAs) require self-administration by patients at home, increasing the risk of non-adherence and consequently, costs and decreasing overall patient survival. Purpose To assess the impact of a comprehensive pharmaceutical care service on oncology outpatients’ adherence. Secondary objectives were to analyse influencing factors and to compare different adherence tests. Material and methods A comprehensive care program was developed in 2012. Pharmacist interviews and literacy reinforcement took place at the beginning of the treatment, after one and six months. A pre-post study was conducted. Patients starting treatment with OAAs in 2011 formed the control group and the ones who started in 2013, the intervention group. Demographics, tumour, OAA, current drug treatment, adherence evaluated by dispensing records and by Morisky-Green and Haynes-Sackett test data were collected at every visit. A patient was considered adherent when reaching 90% adherence. Results 115 patients formed the control group and 134 the intervention group (158 men and 91 women; mean age of 66.9). The most common diagnosis was lung cancer (26%). On average, patients were taking 5 drugs concurrently. The adherence rate in the first month was 94.7% in the control group and 95.7% in the intervention group (p > 0.05); after 6 months on treatment, it was 87.7% in the control group and 95.0% in the intervention group (p = 0.025). Moreover, the percentage of adherent patients increased in the intervention group after 6 months of treatment by 20% (60.5% vs. 80.8%, p = 0.001). In the intervention group, self-reported measurements depicted higher adherence rates that did not correlate with the record of prescriptions issued. Age and gender did not affect adherence. In contrast, differences were observed between OAAs (p = 0.008): sunitinib and pazopanib had the lowest rate of adherence (88.0%) in the first month and sorafenib (82.8%) in the 6th month. Conclusion A comprehensive pharmaceutical care program improves adherence, resulting in a 20% increase in adherent patients after 6 months of treatment. Differences in adherence were observed between OAAs. References and/or acknowledgements No conflict of interest.

Analysis of the duration of and reasons for changing the first combination of antiretroviral therapy

Abstract Objective To determine the duration of and reasons behind changing the various combinations of drugs used for the initiation of antiretroviral treatment in naiive patients. Methods A retrospective observational study that included all patients with HIV infection who started antiretroviral therapy in a high-tech university reference hospital during the period from 1 January 2003 and 31 December 2005. Patients were followed until 31 December 2008. To estimate the cumulative probability of discontinuation the Kaplan- Meier method was used. Results A total of 441 patients were included. The average duration of the first treatment was 384 (interquartile interval 84–1290) days. The regimen based on non-nucleoside reverse transcriptase inhibitors and those that included as nucleosides abacavir or tenofovir in combination with lamivudine or emtricitabine showed a significantly longer duration than the rest. The main reasons for termination were the side effects, although in a lesser percentage than that obtained in previous studies. No associations were found between the rest of the characteristics of the patients or of the treatment and the risk of termination. Discussion Although the duration of the first antiretroviral treatment remains short, currently fewer changes are made due to side effects and due to loss to follow-up. The reasons may be better tolerance and less complexity. However, more studies are needed to determine the benefits of one regimen or another, and to be able to generalise the results.