Eric M. Maiese

The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: A systematic review and meta-analysis

Abstract Poor adherence to antiretroviral therapies (ARTs) in human immunodeficiency virus (HIV)-infected patients increases the risk of incomplete viral suppression, development of viral resistance, progression to acquired immune deficiency syndrome and death. This study assesses the impact of specific treatment-related adverse events (AEs) on adherence to ART in the adult HIV patient population. A systematic review of studies involving adult HIV-infected patients aged ≥ 16 years that reported an odds ratio (OR) for factors affecting adherence to ART was conducted through a search of the EMBASE® and Medline® databases. Database searches were complemented with a search of titles in the bibliographies of review papers. Studies conducted in populations limited to a particular demographic characteristic or behavioural risk were excluded. To qualify for inclusion into a meta-analysis, treatment-related AEs had to be defined similarly across studies. Also, multiple ORs from the same study were included where study sub-groups were distinct. Random effects models were used to pool ORs. In total, 19 studies and 18 ART-related AEs were included in meta-analyses. Adherence to ART was significantly lower in patients with non-specific AEs than in patients who did not experience AEs [OR = 0.623; 95% confidence interval (CI): 0.465–0.834]. Patients with specific AEs such as fatigue (OR = 0.631; 95% CI: 0.433–0.918), confusion (OR = 0.349; 95% CI: 0.184–0.661), taste disturbances (OR = 0.485; 95% CI: 0.303–0.775) and nausea (OR = 0.574; 95% CI: 0.427–0.772) were significantly less likely to adhere to ART compared to patients without these AEs. Knowledge of specific treatment-related AEs may allow for targeted management of these events and a careful consideration of well-tolerated treatment regimens to improve ART adherence and clinical outcomes.

Impact of asthma controller medications on medical and economic resource utilization in adult asthma patients

Abstract Objective: To compare asthma-related resource utilization, adherence and costs among adults prescribed asthma controller regimens. Research design and methods: Medical and pharmacy claims from a US managed-care claims database were used to identify adults (18–56 years) initiating asthma controller therapy. Patients had 2 years continuous enrollment and ≥1 medical claims for asthma (ICD9: 493.xx) (January 2004 – March 2009). Asthma exacerbations, short-acting β-agonist (SABA) fills, adherence (MPR ≥0.80) and asthma-related costs were assessed for 1 year after the initial asthma controller medication claim. Separate logistic and negative binomial regression models for monotherapy and combination therapy were developed to examine the impact of controller therapy on outcomes. Results: A total of 28 074 patients [inhaled corticosteroids (ICS) (26.3%), leukotriene modifiers (LM) (23.2%), ICS + long acting β-agonist (LABA) (48.5%), ICS + LM (2%)] were included. LM patients had lower odds of ≥6 SABA fills (ORadj = 0.83, 95% CI: 0.73–0.96) and lower rates of asthma exacerbations (RRadj = 0.82, 0.75–0.89) vs. ICS patients. Odds of ≥6 SABA fills were similar for ICS + LM vs. ICS + LABA (ORadj = 1.3, 0.96–1.76); the rate of asthma exacerbations was greater for ICS + LM compared with ICS + LABA (ORadj = 1.4, 1.2–1.6). The proportion adherent was greatest for LM (14.9%) and ICS + LABA (4.1%). LM patients had higher unadjusted pharmacy costs, but lower medical costs compared to ICS patients. For combination therapy, ICS + LM had higher unadjusted mean medical and pharmacy costs vs. ICS + LABA. Higher adjusted mean total costs in the post-index period were observed for LM vs. ICS patients (

Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality

837 vs. 684) and for ICS + LM vs. ICS + LABA patients (

Economic Burden of HIV Antiretroviral Therapy Adverse Events in the United States

1223 vs. 873). Conclusions: LM monotherapy was associated with lower medical costs but higher total costs resulting from greater treatment adherence. Conversely, higher costs for ICS + LM resulted from greater exacerbations compared to ICS + LABA despite similar adherence. Higher total costs with LM were due to drug costs. Precise utilization of the medications filled by patients could not be determined.

Quality of life of HIV-infected patients who switch antiretroviral medication due to side effects or other reasons

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23-67 years, and living with HIV 4-20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ARTs impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices.

Increasing Pharmaceutical Copayments: Impact on Asthma Medication Utilization and Outcomes

Objective: To estimate health care costs associated with medical events identified as antiretroviral therapy (ART)-attributable adverse events (AEs). Methods: During September 2006 to June 2012, adults with ≥1 HIV International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code (042/V08), ≥1 claim for ART prescription (March 2007-June 2011; index date), and continuous health plan enrollment for ≥6 months pre- and ≥12 months postindex were included (IMS’ PharMetrics Plus Health Plan Claims Database). Patients with events of interest/ART claim during preindex period or with pregnancy/hepatitis C virus diagnosis/hepatitis B virus/cancer/tuberculosis during the study period were excluded. Postindex medical events were defined as first diagnosis code of event with ART claim ≤60 days prior to start of the event. Results: Differences in median total all-cause health care costs observed for diabetes/insulin resistance management (US

Hospital budget impact of sugammadex (Bridionâ®) for Reversal of Neuromuscular Blockade

14 547 median all-cause health care costs during time periods identified as diabetes/insulin resistance medical events versus US

Comparison Of Two Agents For The Reversal Of Neuromuscular Blockade: A Discrete Event Simulation Model Of Operating Room Efficiency In Canada

11 237 without diabetes/insulin resistance events; P = .0021), lipid disorders (US

Cost-Effectiveness Analysis of Raltegravir in Hiv-Infected Treatment Naive Patients in Greece

12 825 versus US

Cost-Effectiveness of Sugammadex for Routine Reversal of Neuromuscular Blockade, with Extubation at a TOF Ratio of 0.9, in Anaesthetised Patients Undergoing Elective Surgery in England and Wales

10 033; P = .0004), and renal disorders (US