Antiretroviral Therapy – Nucleoside/Nucleotide and Non-Nucleoside Reverse Transcriptase Inhibitors

Abstract Background Of 8 formulary HIV medications at our institution, 3 are no longer first line treatments. Agents unavailable on formulary are administered from a patient’s own supply. We examined the impact of availability of antiretroviral therapy (ART) on time to appropriate therapy among HIV positive inpatients. Methods Adult inpatients who received ART from 11/2015 – 10/2016 were included in this single-center review. Data were evaluated by encounter; individuals with multiple admissions were counted per admit. Descriptive statistics were used to evaluate the time from admission to ART order and administration. We noted discrepancies between ordered and home ART regimen, and any administration of partial therapy. Patients not taking ART prior to admission or without documentation of a home ART regimen were excluded from the outcomes analysis. A cost analysis was conducted to describe the financial impact of any recommended formulary changes. Results 36 patients with 55 inpatient encounters were evaluated; 46 (84%) had a documented home ART regimen. Mean age was 47.8 years, 67% were male, 36% met criteria for AIDS by CD4 cell count. Creatinine clearance was < 60 ml/minute in 33% of subjects, 25% were admitted for an infectious issue. Median length of stay was 5 days. Half (49%) were taking nucleoside reverse transcriptase inhibitors, 22% integrase inhibitors, 19% protease inhibitors, 3% non-nucleoside reverse transcriptase inhibitors. In the 7 encounters (15%) with all ART on formulary, 100% received their full ART regimens as inpatients vs. 69% of those with partial or no ART on formulary. Median time to therapy doubled in patients who had partial or no home ART on formulary: 25 hours (median of 1 missed dose) vs.. 12 hours (median of 0 missed doses). Anticipated annual cost of formulary revisions, including addition of 4 agents, was $6016.37. Conclusion Having a complete ART regimen on formulary substantially increased likelihood of complete ART administration without delay. Adding an NRTI alternative to tenofovir was needed due to high rates of renal dysfunction; adding agents with higher barriers to resistance, dolutegravir and darunavir, were important as genotypes and viral loads are not always known at admit. Expanding the ART formulary provides a significant improvement in quality of care at a reasonable cost. Disclosures All authors: No reported disclosures.

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Neuropsychiatric adverse effects of HIV antiviral medication

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1230 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S697-S698

Author(s):

S. Nascimento ◽

M. Mendes ◽

C. Solana ◽

M. Croca ◽

J. Reis

Keyword(s):

Antiretroviral Therapy ◽

Adverse Effects ◽

Reverse Transcriptase ◽

Opportunistic Infections ◽

Antiretroviral Drugs ◽

Reverse Transcriptase Inhibitors ◽

Nucleoside Reverse Transcriptase Inhibitors ◽

Neuropsychiatric Complications ◽

Competing Interest ◽

Neuropsychiatric Adverse Effects

IntroductionHIV (human immunodeficiency virus) infection is related to several neuropsychiatric complications, such as dementia, encephalopathy, psychosis, as well as, opportunistic infections of the central nervous system (CNS). The discovery of antiretroviral therapy (ART) has limited these conditions and extended the life span of infected patients into a chronic illness, but it is also associated with neuropsychiatric adverse effects.ObjectivesTo review the literature on the most common neuropsychiatric complications of the ART, since it can be difficult to distinguish drugs toxicity, the effects of the virus, immune system and psycho-social events.MethodsThe authors have conducted an online search in PubMed with the terms: “Psychiatry”, “HIV”, “adverse effects” and “antiretroviral drugs” from 2011 until 2016. From the outcome were collected, analyzed and summarized the articles considered to be relevant.ResultsThe antiretroviral therapy (ART) are associated with a numerous adverse effects on the central and peripheral nervous systems, as well as, metabolic, gastrointestinal, cardiac, and other toxicities. The neuropsychiatric effects are common and highly variable, including depression, cognitive impairment and sleep disturbance. The nucleoside reverse transcriptase inhibitors and the non-nucleoside reverse transcriptase inhibitors are one of the two classes of antiviral drugs most frequently associated with neuropsychiatric complications.ConclusionsThe occurrence of new-onset conditions related to ART makes it difficult to determine the association between psychiatric disorders and ART adverse effects, and given the fact that patients commit to lifelong therapy, as well as, they can diminish quality of life; it makes these assessment important in treating these conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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