Pharmacists Reduce HIV Drug Interactions

Thanks to the introduction of antiretroviral therapy (ART), HIV-infected individuals are living longer than ever before, with average life expectancy growing from a relatively young 56 years in 2002 to 71 today.

But this advancement means those with HIV are living long enough to experience aging’s comorbidities. They are also at higher risk for medication errors in the hospital, as ART is associated with greater polypharmacy and drug-drug interactions.

Inadvertent medication errors can increase viral resistance by decreasing ART levels, or increase risk of toxicity by elevating concentrations. Because of this, pharmacists are critical for preventing drug-drug interactions and other medical errors in HIV-infected hospital patients, concludes a study published in the Journal of the International Association of Providers of AIDS Care.

A team of pharmacy researchers conducted a retrospective chart review of HIV-infected patients at a single tertiary-care facility following expansion of the institution’s antiretroviral stewardship program to include a clinical pharmacist.

The investigators looked for a clinically significant difference in drug-drug interactions (CSDDIs) before and after antiretroviral stewardship program expansion, using the findings of a prior internal study as the comparative cohort.

Pharmacists monitored HIV-infected patients daily throughout their hospitalization.

Expansion of the antiretroviral stewardship program led to a significant reduction in the incidence of CSDDIs between ART and concomitant medications. In fact, only 2 CSDDIs were missed throughout the study, reducing the rate of missed CSDDIs by 52%.

Statins and acid-suppressive therapy were the worst offenders for CSDDIs in patients taking ART. Protease inhibitors were also associated with the majority of CSDDIs.

Aside from improving ART-related CSDDI incidence, clinical pharmacists made 80 other interventions that included zidovudine dosing adjustments during labor, renal dose adjustments, opportunistic infection prophylaxis, and recommendations to modify or discontinue therapy.

The authors concluded that clinical pharmacists are an essential addition to the antiretroviral stewardship team to ensure medication safety.

They noted that the study location has an in-house clinical pharmacotherapist-on-call service available around the clock that may not be replicated at every hospital.