scholarly journals 1306. Evaluation and Predictors of Antiretroviral (ART)-Related Medication Errors in Hospitalized People Living with HIV (PWLH)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S471-S471
Author(s):  
Daniel B Chastain ◽  
Amber Ladak ◽  
Jessica Curtis ◽  
Emily Tang ◽  
Henry N Young
Keyword(s):  
Medication Errors ◽  
Undetectable Viral Load ◽  
International Classification Of Diseases ◽  
Primary Objective ◽  
Transitions Of Care ◽  
People Living With Hiv ◽  
Development Of Resistance ◽  
Classification Of Diseases ◽  
Clinically Significant ◽  
Living With Hiv

Abstract Background As HIV has become a chronic condition, management of the disease and preventing resistance is paramount to improving patient outcomes. Medication errors can lead to suboptimal therapy and potential development of resistance. The purpose of this study was to identify the rate of antiretroviral (ART)-related medication errors in hospitalized people living with HIV (PWLH). Methods This was a multi-center, retrospective cohort study of patients diagnosed with HIV and/or AIDS based on International Classification of Diseases codes. Patients were included if they were at least 18 years old and hospitalized between March 2016 and March 2018. Patients were excluded if they were pregnant and only received intravenous zidovudine during their hospitalization. Of the patients eligible for inclusion, 400 were randomly selected and included in this study. The primary objective was to determine the rate of inpatient ART-related medication errors. Secondary objectives included the type of errors and rate of error resolution prior to discharge. Results A total of 203 ART-related medication errors occurred during the study period (mean 0.9 ± 1.2 errors per patient). Incorrect schedule was the most common type of error followed by incorrect or incomplete regimen. More errors occurred in male patients (P = 0.01), those known to be infected with HIV on admission (P < 0.05), and in patients with an undetectable viral load (P = 0.01). Approximately 30% of ART-related medication errors were resolved prior to discharge, of which pharmacists were responsible for 25%. Incorrect schedule, incorrect or incomplete regimen, and clinically significant drug-drug interaction (DDI) were the most common medication errors that persisted at discharge. Among resolved errors, resolution of clinically significantly DDI or incorrect/incomplete ART were the most common interventions. Conclusion ART-related medication errors continue to occur in hospitalized PLWH and frequently persist at discharge. Interventions should be developed to reduce rates of ART-related medication errors on admission. Antimicrobial stewardship programs serve as an ideal platform to incorporate ART stewardship into routine activities to help minimize errors while inpatient and during transitions of care. Disclosures All authors: No reported disclosures.

scholarly journals 1022. Impact of Hospitalization on Antiretroviral Therapy for People Living with HIV

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S541-S541
Author(s):  
Amber Ladak ◽  
Henry N Young ◽  
Emily Tang ◽  
Jessica Curtis ◽  
Daniel B Chastain
Keyword(s):  
Antiretroviral Therapy ◽  
Primary Objective ◽  
Transitions Of Care ◽  
Specific Factor ◽  
People Living With Hiv ◽  
Hiv Rna ◽  
Patient Status ◽  
Persons Living With Hiv ◽  
Regimen Modification ◽  
Living With Hiv

Abstract Background Persons living with HIV (PLWH) are frequently hospitalized for reasons often unrelated to HIV. Transitioning of antiretroviral therapy (ART) while inpatient may not always be an immediate priority due to lack of knowledge, formulary restrictions, and patient status. This could lead to medication errors and gaps in therapy, which can persist at discharge, and could lead to viral rebound and disease progression. The purpose of this study was to identify effects of hospitalization on ART for PLWH. Methods This was an IRB approved, multi-center, retrospective cohort study of patients with HIV and/or AIDS based on ICD codes. Patients were included if they were at least 18 years old, receiving outpatient ART prior to admission, and hospitalized between March 2016 and March 2018. Patients were excluded if they were pregnant and only received intravenous zidovudine during their hospitalization. The primary objective was to determine the rate of ART restarted during hospitalization. Secondary objectives included rate at which inpatient ART was modified compared to outpatient regimen, and risk factors associated with regimen modification. Results Of 400 patients screened, 295 (74%) patients were on an outpatient ART regimen and were included in the study. Approximately half, 51%, were on a single tablet regimen (STR) outpatient. This population was majority male (59%) and of black race (87%). Median age was 49 years. Median CD4 count was 160 cells/mm3, while median HIV RNA for those with detectable viral load was 57,095 copies/mL. 236 of 295 patients (80%) received ART during their inpatient stay. However, 70 (30%) of these patients received a regimen that differed from their outpatient ART regimen. 69% of regimens were modified for reasons other than to optimize therapy. Patient sex, place of admission, and receipt of a STR or multi-tablet regimen (MTR) as an outpatient did not significantly impact rate of regimen modification. Conclusion Ensuring appropriate transition of ART during hospitalization remains an area in need of improvement. No one specific factor was associated with whether outpatient ART was appropriately and accurately restarted during hospitalization. Thus, there are many opportunities to improve transitions of care and antiretroviral stewardship. Disclosures All Authors: No reported disclosures

Abstract P152: Impact Of New Hypertension Guidelines On The Prevalence And Control Of Hypertension In A Clinical Hiv Cohort

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Vishnu Priya Mallipeddi ◽  
Matthew Levy ◽  
Anne Monroe ◽  
Letumile Moeng ◽  
Lindsey Powers Happ ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
International Classification Of Diseases ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
New Guidelines ◽  
Living With Hiv ◽  
And Control

Introduction: People living with HIV (PLWH) with hypertension (HTN) have a higher risk of cardiovascular events and all-cause mortality compared with PLWH with normal blood pressure (BP) and HIV-uninfected adults with HTN. The prevalence and control of HTN among PLWH have not been widely studied since the release of newer 2017 ACC/AHA guidelines (new guidelines). To address this research gap, we evaluated and compared the prevalence and control of HTN using both 2003 JNC 7 (old guidelines) and new guidelines in a large clinical cohort of PLWH. Methods: We identified 3206 PLWH with HTN from the DC Cohort study in Washington, D.C, from 01/2018 to 06/2019. We defined HTN using International Classification of Diseases (ICD) -9/-10 diagnosis codes for HTN or ≥ 2 BP measurements obtained at least one month apart (>139/89 mm Hg per old or >129/79 mm Hg per new guidelines). We defined HTN control based on recent BP (≤139/≤89 mm Hg per old or ≤129/≤79 mm Hg per new guidelines). We identified socio-demographics, cardiovascular risk factors and co-morbidities associated with HTN control (per new guidelines) using multivariable logistic regression (adjusted Odds Ratio; 95% CI). Results: The prevalence of HTN was 50.9% per old versus 62.2% per new guidelines. Of the 3,206 PLWH with HTN based on 2017 ACC/AHA guidelines, 887 (27.7%) had a recent BP ≤129/≤79 mm Hg, 1,196 (37.3%) had a BP between 130-139/80-89 mm Hg and 1,123 (35.0%) had a BP ≥140/≥90mm Hg. After adjusting for socio-demographics, cardiovascular risk factor and co-morbidities, factors associated with HTN control included age 60-69 (vs. <40) years (1.42; 1.03-1.98), Hispanic (vs. non-Hispanic Black) race/ethnicity (1.49;1.04-2.15), receipt of HIV care at a hospital-based (vs. community-based) clinic (1.21; 1.00-1.47), being unemployed (1.42; 1.11-1.83), and diabetes (1.35; 1.13-1.63). Conclusion: In a large urban cohort of PLWH, nearly two-thirds had HTN and less than one-third of those met new guideline criteria. Older PLWH were more likely to have their HTN controlled compared to the younger PLWH. Our data suggests that more aggressive HTN control is warranted among PLWH, with attention to younger patients.

scholarly journals Ventricular Ectopy and Arrhythmia Characteristics for Persons Living with HIV and Uninfected Controls

2019 ◽  
Vol 18 ◽  
pp. 232595821985212
Author(s):  
Alexander Meyer ◽  
Sanjay Dandamudi ◽  
Chad Achenbach ◽  
Donald Lloyd-Jones ◽  
Matthew Feinstein
Keyword(s):  
Cardiovascular Disease ◽  
Chart Review ◽  
International Classification Of Diseases ◽  
Elevated Risk ◽  
Ventricular Ectopy ◽  
Persons Living With Hiv ◽  
Significant Difference ◽  
Classification Of Diseases ◽  
Living With Hiv

Background: Persons with HIV have elevated risk for cardiovascular disease, but little is known about the risk of ventricular ectopy and ventricular tachycardia (VE/VT) for HIV-infected (HIV+) persons. Methods: We evaluated the presence and anatomic origin of VE/VT for HIV+ persons and controls by screening a cohort using International Classification of Diseases codes and adjudicating positive screens by chart review. We sought to evaluate (1) presence of VE/VT and (2) likely anatomic origin of the VE/VT based on electrocardiogram. Results: There was no significant difference in the prevalence of VE/VT for HIV+ or uninfected persons. Among HIV+ persons, worse HIV control was associated with significantly greater odds of VE/VT. Exploratory analyses suggested that HIV+ persons may have a greater likelihood of VE/VT originating from the left ventricle. Conclusion: Although worse HIV control was associated with higher odds of VE/VT among persons with HIV, odds of VE/VT were not higher for persons with HIV than uninfected persons.

Anatomically Associated Venous Thromboembolism in Patients With Peripherally Inserted Central Catheters

2017 ◽  
Vol 22 (4) ◽  
pp. 182-187
Author(s):  
Travis Kimple ◽  
Niaman Nazir ◽  
Chad M. Cannon
Keyword(s):  
Venous Thromboembolism ◽  
International Classification Of Diseases ◽  
Tertiary Hospital ◽  
Peripherally Inserted Central Catheters ◽  
Vein Thrombosis ◽  
Icd9 Code ◽  
Classification Of Diseases ◽  
Clinically Significant ◽  
Deep Vein ◽  
Central Catheters

Abstract Background: Peripherally inserted central catheters (PICCs) are ubiquitous in modern hospitals, but are associated with venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and/or pulmonary embolism (PE). We retrospectively examined this association in hospitalized patients, highlighting anatomically associated VTEs (those with DVT in the PICC extremity). Methods: Charts with an International Classification of Diseases, Ninth Revision (ICD9) code for VTE were collected from a discharge database of PICC-managed patients at a tertiary hospital. A sample (52.3%) of the VTE charts was manually reviewed to verify PICC-associated VTE (unverified charts were excluded), and determine such data as the extremity in which each DVT was diagnosed (using ultrasound reports). VTE rates were calculated using an uncorrected method (from charts with VTE ICD9 code) and a corrected method (from charts with manually verified PICC-associated VTE). Results: Our uncorrected VTE rate was 3.9% (P &lt; .0001), whereas the corrected rate was 1.5%. Among 125 charts with manually verified PICC-associated VTE, 69 (60.5%) out of 114 patients with a DVT had their DVT occur in the PICC extremity, yielding an anatomically associated VTE rate of 0.84%. The most common reason for a chart being excluded (60.2%) was a VTE occurring before PICC placement. Conclusions: We found clinically significant rates of PICC-associated VTE. The majority of patients' DVT occurred in the same extremity as their PICC, lending further evidence that PICCs are an independent risk factor for VTE and require judicious use. There was also a discrepancy in VTE rate derived from ICD codes alone vs. manual chart review.

scholarly journals Thrombocytopenia according to Antiretroviral Drug Combinations, Viremia and CD4 Lymphocytes among HIV-Infected Patients in Cameroon A Snapshot from the City of Yaoundé

2019 ◽  
Author(s):  
Alex Durand NKA ◽  
Samuel Martin Sosso ◽  
Joseph Fokam ◽  
Bouba Yagai ◽  
Georges Teto ◽  
...  
Keyword(s):  
Viral Load ◽  
Blood Platelets ◽  
Undetectable Viral Load ◽  
Drug Combinations ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Viral Loads ◽  
Reference Centre ◽  
Antiretroviral Drug ◽  
Living With Hiv

Abstract Background Thrombocytopenia is an abnormal decrease in blood platelets, which can affect the prognosis of people living with HIV (PLHIV). In order to limit the occurrence of this haematological disorder, we evaluated the frequency of thrombocytopenia according to antiretroviral drug combinations, viremia and the immune status of PLHIV. Methods A cross-sectional and analytical study was conducted from June-November 2016 among 310 PLHIV at the “Chantal BIYA” International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon. Thrombocytopenia was assessed by blood count on Mindray BC 3000 plus, then categorized as mild (50,000-149,999 platelets/μL), moderate (20,000-49,999) and severe <20,000; HIV-1 viremia was measured by Abbott m2000RT and CD4 by BD Facs Calibur; treatment history was retrieved from medical records. Data were analysed using Graph Pad Prism.6, with p<0.05 considered statistically significant. Results Median age was 40 [IQR: 33-49] years with, and 60.9% of participants being female. Up to 79.0% (245) were receiving antiretroviral therapy (ART); 54.5% had CD4 counts <500 cells/mm3 and 25.4% had viremia >3log10 RNA/ml. Overall rate of thrombocytopenia was 19.0% (59/310), with 17.4% (54/310) mild, 1.6% (5/310) moderate and 0.0% severe. Following ART-exposure, rate of thrombocytopenia was 64.6% (42/65) versus 6.9% (17/245) in naïve versus treated patients respectively, p<0.0001. Following ART regimens, rate of thrombocytopenia was 64.7% (11/17) versus 35.3% (6/17) among AZT-containing versus AZT-sparing regimens, p=0.02. Following viral load ranges, rate of thrombocytopenia was 15.8% (20/130) in those with undetectable viral load, 11.0% (12/101) with viral loads 1.60-3.0 log10 RNA/ml and 34.1% (27/79) with viral loads >3 log10 RNA/ml (p=0.03; r=-0.12). As concerns CD4-count, rate of thrombocytopenia was 16.2% (42/259) in those with ≥200 CD4/mm3 versus 33.3% (17/51) with <200 CD4/mm3 (p=0.0003; r=0.21). After adjusting for age, sex, ART, viral load and CD4, only ART exposure was significantly associated with decreased risk of thrombopenia (p<0.0001). Conclusions Thrombocytopenia occurs generally at mild-level among PLHIV in Cameroon, especially among ART-naïve, AZT-treated, high viremia and severe immune-compromised patients. Interestingly, ART coverage appears as an independent factor in preventing the occurrence of thrombocytopenia, especially for AZT-sparing treatment combinations in countries with similar features like Cameroon.

scholarly journals Skin and Soft Tissue Infection in People Living With Human Immunodeficiency Virus in a Large, Urban, Public Healthcare System in Houston, Texas, 2009–2014

2019 ◽  
Vol 70 (9) ◽  
pp. 1985-1992
Author(s):  
Vagish Hemmige ◽  
Cesar A Arias ◽  
Siavash Pasalar ◽  
Thomas P Giordano
Keyword(s):  
Human Immunodeficiency Virus ◽  
Soft Tissue ◽  
High Viral Load ◽  
International Classification Of Diseases ◽  
Public Healthcare ◽  
Susceptibility Data ◽  
Immunodeficiency Virus ◽  
Classification Of Diseases ◽  
Hiv Primary Care ◽  
Living With Hiv

Abstract Background Skin and soft tissue infections (SSTIs) disproportionately impact patients with human immunodeficiency virus (HIV). Recent declines in the incidence of SSTIs have been noted in the non-HIV population. We sought to study the epidemiology and microbiology of SSTIs in a population of 8597 patients followed for HIV primary care in a large, urban county system from January 2009 to December 2014. Methods SSTIs were identified from the electronic medical record by use of International Classification of Diseases-9 billing codes. Charts were reviewed to confirm each patient’s diagnosis of acute SSTI and abstract culture and susceptibility data. We calculated the yearly SSTI incidences using Poisson regression with clustering by patient. Results There were 2202 SSTIs identified. Of 503 (22.8%) cultured SSTIs, 332 (66.0%) recovered Staphylococcus aureus as a pathogen, of which 287/332 (86.4%) featured S. aureus as the sole isolated organism. Among the S. aureus isolates that exhibited antibiotic susceptibilities, 231/331 (69.8%) were methicillin resistant, and the proportion did not change by year. The observed incidence of SSTI was 78.0 per 1000 person-years (95% confidence interval 72.9–83.4) and declined from 96.0 infections per 1000 person-years in 2009 to 56.5 infections per 1000 person-years in 2014 (P &lt; .001). Other significant predictors of SSTI incidences in both univariate as well as multivariate analyses included a low CD4 count, high viral load, and not being a Spanish-speaking Hispanic. Conclusions SSTIs remain a significant problem in the outpatients living with HIV, although rates of SSTIs appear to have declined by approximately 40% between 2009 and 2014.

scholarly journals Evaluation of a Combined HIV and Geriatrics Clinic for Older People Living with HIV: The Silver Clinic in Brighton, UK

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 81 ◽  
Author(s):  
Tom Levett ◽  
Katie Alford ◽  
Jonathan Roberts ◽  
Zoe Adler ◽  
Juliet Wright ◽  
...  
Keyword(s):  
Older People ◽  
Demographic Data ◽  
Undetectable Viral Load ◽  
Service Evaluation ◽  
Geriatric Syndrome ◽  
People Living With Hiv ◽  
Geriatric Syndromes ◽  
Geriatric Service ◽  
Patient Demographic Data ◽  
Living With Hiv

As life expectancy in people living with HIV (PLWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses, but few services exist for the assessment and management of these individuals. Here, we provide an initial description of a geriatric service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen in the clinic between 2016 and 2019. We present patient demographic data, assessment outcomes, diagnoses given, and interventions delivered to those seen in the clinic. The average age of attendees was 67. Primary reasons for referral to the clinic included management of complex comorbidities, polypharmacy, and suspected geriatric syndrome (falls, frailty, poor mobility, or cognitive decline). The median (range) number of comorbidities and comedications (non-antiretrovirals) was 7 (2–19) and 9 (1–15), respectively. All attendees had an undetectable viral load. Geriatric syndromes were observed in 26 (50%) patients reviewed in the clinic, with frailty and mental health disease being the most common syndromes. Interventions offered to patients included combination antiretroviral therapy modification, further health investigations, signposting to rehabilitation or social care services, and in-clinic advice. High levels of acceptability among patients and healthcare professionals were reported. The evaluation suggests that specialist geriatric HIV services might play a role in the management of older people with HIV with geriatric syndromes.

scholarly journals Prevalence and factors associated with severe depressive symptoms in older West African people living with HIV

2020 ◽  
Author(s):  
Charlotte Bernard ◽  
Hélène Font ◽  
Zélica Diallo ◽  
Richard Ahonon ◽  
Judicaël Malick Tine ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
West Africa ◽  
Successful Aging ◽  
Negative Impact ◽  
Depression Scale ◽  
Undetectable Viral Load ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Factors Associated ◽  
Living With Hiv

Abstract Background: Depression is one of the most common psychiatric disorders in people living with HIV (PLHIV). Depression has a negative impact on both mental and physical health and is mainly associated with suboptimal HIV treatment outcomes. To encourage successful aging and the achievement of the 3x90 objectives in older PLHIV, the psychological domain must not be neglected. In this context and as data are scarce in West Africa, this study aimed to evaluate the prevalence and the factors associated with severe depressive symptoms in older PLHIV living in West Africa. Methods: Data from PLHIV aged ≥50 years and on ART since ≥6 months were collected in three clinics (two in Côte d’Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. The severity of depressive symptoms was measured using the Center for Epidemiological Studies Depression scale (CES-D), and associated factors were identified using logistic regressions.Results: The median age of the 334 PLHIV included in the study was 56.7 (53.5-61.1), 57.8% were female, and 87.1% had an undetectable viral load. The prevalence of severe depressive symptoms was 17.9% [95% Confidence Interval (95%CI): 13.8 - 22.0]. PLHIV with severe depressive symptoms were more likely to be unemployed (adjusted Odd Ratio (aOR)=2.8; 95%CI: 1.4-5.7), and to be current or former tobacco smokers (aOR=2.6; 95% CI: 1.3-5.4) but were less likely to be overweight or obese (aOR=0.4; 95%CI: 0.2-0.8).Conclusions: The prevalence of severe depressive symptoms is high among older PLHIV living in West Africa. Unemployed PLHIV and tobacco smokers should be seen as vulnerable and in need of additional support. Further studies are needed to describe in more details the reality of the aging experience for PLHIV living in SSA. The integration of screening and management of depression in the standard of care of PLHIV is crucial.

Hoarding disorder

2020 ◽  
pp. 1023-1030
Author(s):  
Lorena Fernández de la Cruz ◽  
David Mataix-Cols
Keyword(s):  
Mental Disorder ◽  
International Classification Of Diseases ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Hoarding Disorder ◽  
Perceived Need ◽  
Cognitive Behavioural ◽  
Classification Of Diseases ◽  
Clinically Significant

Hoarding disorder (HD) is a mental disorder that was newly included in the obsessive–compulsive and related disorders chapter of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is also planned for inclusion in the International Classification of Diseases, eleventh revision (ICD-11). Individuals meeting the diagnostic criteria for HD experience persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. This results in the accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use, causing clinically significant distress or impairment. These symptoms must not be attributable to another medical or mental disorder. A majority of people diagnosed with HD excessively acquire items that they do not need or for which no space is available. Currently, the intervention with the strongest evidence base for HD is cognitive behavioural therapy tailored to the hoarding difficulties.

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