scholarly journals Immunological and Clinical Impact of DAA-Mediated HCV Eradication in a Cohort of HIV/HCV Coinfected Patients: Monocentric Italian Experience

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2336
Author(s):  
Andrea Marino ◽  
Gabriella Zafarana ◽  
Manuela Ceccarelli ◽  
Federica Cosentino ◽  
Vittoria Moscatt ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Drug Interactions ◽  
Clinical Impact ◽  
Pill Burden ◽  
Hcv Treatment ◽  
Hiv Patients ◽  
Italian Experience ◽  
Before And After

HCV treatment became available for all infected patients regardless of their comorbidities, especially for HIV coinfected subjects, leading to an improvement in both clinical and immunological conditions. We retrospectively analyzed a cohort of HIV/HCV coinfected patients treated with DAA therapies; data regarding epidemiological, viral-immunological, and hepatic parameters before and after DAA administration have been collected. Drug-drug interactions between DAA and both antiretroviral therapy and non-ART-drugs were also evaluated; the study showed the efficacy of DAA schedules in HCV eradication also for HIV/HCV patients with multiple comorbidities and assuming many different drugs. Principal issues are still represented by drug interactions, pill burden, and patients’ compliance. These concerns have to be taken into account, especially in HIV patients for whom the immunological state and ART interactions should always be considered.

scholarly journals The Incidence and Severity of Drug Interactions Before and After Antiretroviral Therapy Simplification in Treatment-Experienced Patients With HIV Infection

2019 ◽  
Vol 54 (1) ◽  
pp. 36-42
Author(s):  
Nicholas V. Hastain ◽  
Aleena Santana ◽  
Jason J. Schafer
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Drug Interactions ◽  
Patient Adherence ◽  
Potential Interaction ◽  
Rank Test ◽  
Signed Rank ◽  
Before And After ◽  
Signed Rank Test

Background: Current guidelines advocate for antiretroviral therapy (ART) simplification in patients on complicated regimens. Simplifying ART improves patient adherence and quality of life, but changes in drug interactions (DIs) are uncertain. Objective: This study assessed changes in DIs following ART simplification in patients with HIV. Methods: This was an observational, retrospective cohort study of patients attending an urban HIV clinic. Patients were included if they had ART simplification (a decreased number of daily tablets) and ≥1 concomitant medication (CM). Total DI scores were generated for each patient pre–ART simplification and post–ART simplification using an online DI database. Each ART-CM pair labeled as “do not co-administer” was given a score of 2, “potential interaction” a score of 1, or “no interaction” a score of 0. Differences in total DI scores following simplification were analyzed with a Wilcoxon Signed-Rank test. Predictors of DI score reductions were examined with linear regression. Results: A total of 99 patients were included. Their median age was 54 years, and 79% were male. The median durations of HIV infection and ART were 16 and 10 years, respectively. Patients were receiving an average of 4.5 CMs. Median interaction scores presimplification and postsimplification were 3 (interquartile range [IQR], 1-6) and 1 (IQR, 0-2) respectively ( P < 0.001). Predictors of score reductions were the patient’s number of CMs, discontinuing a protease inhibitor, and switching to a dolutegravir-based regimen. Conclusion and Relevance: ART simplification decreased the incidence of DIs in this analysis of patients with advanced age who had ART experience and polypharmacy.

scholarly journals Incidence and severity of drug interactions before and after switching antiretroviral therapy to bictegravir/emtricitabine/tenofovir alafenamide in treatment-experienced patients

2020 ◽  
Author(s):  
Jason J Schafer ◽  
Neha S Pandit ◽  
Agnes Cha ◽  
Emily Huesgen ◽  
Melissa Badowski ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Drug Interactions ◽  
Potential Interaction ◽  
People Living With Hiv ◽  
Interaction Database ◽  
Before And After ◽  
Tenofovir Alafenamide ◽  
The University ◽  
Living With Hiv ◽  
Paired T Test

Abstract Background Switching antiretroviral therapy (ART) in people living with HIV (PLWH) can influence their risk for drug-drug interactions (DDIs). The purpose of this study was to assess changes in the incidence and severity of DDIs among PLWH who switched their ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Methods This was a multicenter retrospective cohort study of PLWH on ART and at least one concomitant medication (CM) who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV Drug Interaction Database, two DDI analyses were performed for each patient. The first assessed patients’ pre-switch ART regimens with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a score of zero (no or potential weak interaction), one (potential interaction), or two (contraindicated interaction). A paired t-test analyzed changes in total DDI scores following ART switches and linear regression examined factors contributing to DDI score reductions. Results Among 411 patients, 236 (57%) had at least one DDI present at baseline. On average, baseline DDI scores were 1.4 (SD 1.8) and decreased by 1-point (95% CI -1.1,-0.8) after patients switched to BIC/FTC/TAF (p &lt; 0.0001). After adjusting for demographics, baseline ART and CM categories, switching to BIC/FTC/TAF led to significant DDI score reductions in patients receiving CMs for cardiovascular disease, neurologic/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions and conditions requiring hormonal therapy. Conclusion Treatment-experienced PLWH eligible to switch their ART, may experience significant declines in their number and severity of DDIs if switched to BIC/FTC/TAF.

Function of Serum Adenosine Deaminase as an Indicator of Immune Status in HIV Patients treated with Combination Antiretroviral Therapy

2021 ◽  
Vol 16 (7) ◽  
pp. 79-83
Author(s):  
Shashikant Nikam ◽  
Sneha Allannavar ◽  
Padmaja Nikam ◽  
Giridhar Patil
Keyword(s):  
T Cell ◽  
Antiretroviral Therapy ◽  
Adenosine Deaminase ◽  
Immune Status ◽  
Colorimetric Method ◽  
Elevated Serum ◽  
Combination Antiretroviral Therapy ◽  
Hiv Patients ◽  
Adenosine Deaminase Activity ◽  
Before And After

Acquired immunodeficiency syndrome (AIDS) is one of the greatest public health and social problems threatening the human race. The trend of annual AIDS deaths is showing a steady decline since the implementation of the free Anti-Retroviral Therapy (ART) program in India (2004). HIV infection is characterized by replication of virus by abnormal non specific immune activation and persistent inflammation. Adenosine deaminase (ADA) has a cytokine-like co-stimulatory role in T cell proliferation which is independent of catalytic activity. Therefore, we decided to study the role of ADA as an indicator of immune status in HIV patients treated with combination antiretroviral therapy (cART). Adenosine deaminase activity (ADA) in HIV patients was estimated before and after 3 months interval of antiretroviral therapy (ART) up to 9 months. The study included 150 HIV positive patients between age group of 20-50 years from ICTC (Integrated Counseling and Testing Centre) and ART centre. Venous blood samples were collected in plain bulb to estimate serum ADA activity before and after 3 months interval upto 9 months of ART. Serum ADA activity was estimated using colorimetric method of Giusti and Galanti. Activity of serum ADA was significantly raised before and after 3 months interval of ART with decrease in CD4 cell count. After 6 months, increased ADA activity started declining and comes to near normal after 9 months of ART (p<0.001). Elevated serum adenosine deaminase activity in HIV patients is an indicator of T-cell activation. Serum ADA activity along with other markers can be used as a prognostic marker to monitor response to antiretroviral therapy and immunocompetence in HIV patients.

scholarly journals Influential Factors of Successful Hepatitis C Treatment in Elderly Patients

2019 ◽  
Vol 10 (3) ◽  
pp. 14
Author(s):  
Jennifer Andres ◽  
Mandee Noval ◽  
Christine Mauriello ◽  
Derek Peiffer ◽  
Huaqing Zhao
Keyword(s):  
Hepatitis C ◽  
Elderly Patients ◽  
Drug Interactions ◽  
Elderly Population ◽  
Treatment Success ◽  
The Elderly ◽  
Pill Burden ◽  
Hcv Treatment ◽  
Increased Risk ◽  
The Impact

Background: Chronic Hepatitis C virus (HCV) is an infection associated with an increased risk of cirrhosis, hepatocellular carcinoma (HCC), and morbidity and mortality. Treating HCV poses challenges in the elderly population due to the lack of evidence and complexity of patients. Objective: This study aims to evaluate factors that influence HCV treatment success in elderly patients, especially those over age of 70, such as pill burden and comorbidities, in addition to drug interactions and adverse effects. Methods: This was a retrospective chart review of patients treated at our urban academic institution from 2014-2016. Results: Sixty-two patients over the age of 70 were included in this study. The sustained virologic response rate 12 weeks after the completion of treatment (SVR12) was 79%. In a multi-variate analysis, cirrhosis, age closer to 70, and longer duration of treatment were statistically significantly more likely to lead to treatment failure. Though not statistically significant, other factors that may negatively influence achievement of SVR12 were cognitive impairment, cardiovascular disease, multi-tablet HCV regimen, time to initiation of HCV treatment > 90 days, and prior treatment experience. Pill burden of other prescribed medications did not impact SVR12. Adverse events and drug interactions were common in the population. Conclusions: Overall SVR12 rate in the elderly population was lower than that reported in the literature. Factors associated with lower treatment success, especially cirrhosis, should be considered when treating an elderly population. Further data is needed on the impact of other factors on SVR12 attainment in an elderly patient population.   Article Type: Original Research

scholarly journals 1044. The Incidence and Severity of Drug interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment Experienced Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S551-S552
Author(s):  
Jason J Schafer ◽  
Neha S Pandit ◽  
Agnes Cha ◽  
Emily Huesgen ◽  
Melissa E Badowski ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Linear Regression ◽  
Drug Interactions ◽  
Regression Model ◽  
Panel Member ◽  
Potential Interaction ◽  
Research Support ◽  
Review Panel ◽  
Before And After ◽  
Tenofovir Alafenamide

Abstract Background Switching antiretroviral therapy (ART) in virally suppressed people with HIV (PWH) can simplify treatment, improve tolerability, and limit long-term toxicity. It can also influence the presence of drug interactions (DIs) in a positive or negative manner among patients receiving concomitant medications (CMs). The extent to which switching ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) influences DIs in treatment-experienced PWH is unclear. The purpose of this study was to assess changes in the incidence and severity of DIs after switching to BIC/FTC/TAF. Methods This was a multicenter retrospective cohort study of PWH on ART and at least one prescription CM who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV drug interaction checker, two DI analyses were performed for each patient. The first assessed patients’ pre-switch ART regimen with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a numerical score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). Total DI scores for each patient, both before and after switching to BIC/FTC/TAF, were then calculated. A paired t-test analyzed changes in DI scores following ART switches and a linear regression model examined factors contributing to DI score reductions. Results A total of 411 patients were included in the analysis (Table 1) of which 236 (57%) had at least one DI present at baseline. On average, patients had a baseline DI score of 1.4 (SD 1.8) and experienced a 1 point reduction (95% CI -1.1,-0.8) after switching to BIC/FTC/TAF (p &lt; 0.0001). After adjusting for demographic variables as well as baseline ART and CM categories in the regression model, switching to BIC/FTC/TAF led to significant DI score reductions in patients receiving CMs for the following conditions: cardiovascular disease, neurologic and psychiatric disorders, chronic pain, inflammation, gastrointestinal and urologic conditions and conditions requiring hormonal therapy (Table 2). Table 1. Descriptive Summary of Baseline Characteristics, n =411. Table 2. Linear Regression for the Difference of DI scores (post – pre), n =376. Conclusion Switching ART to BIC/FTC/TAF can reduce the incidence of DIs among treatment-experienced PWH who are receiving CMs for a broad range of comorbid conditions. Disclosures Jason J. Schafer, PharmD, MPH, Gilead (Research Grant or Support)Merck (Grant/Research Support, Advisor or Review Panel member)ViiV (Advisor or Review Panel member) Elizabeth Sherman, PharmD, Gilead (Grant/Research Support) Jennifer Cocohoba, PharmD, AAHIVP, BCPS, Viiv (Grant/Research Support)

scholarly journals Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Sue Jordan ◽  
Marie Gabe ◽  
Louise Newson ◽  
Sherrill Snelgrove ◽  
Gerwyn Panes ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Drug Reaction ◽  
Intervention Study ◽  
Clinical Impact ◽  
Care Homes ◽  
Service Users ◽  
Care Plans ◽  
Medication Monitoring ◽  
People With Dementia ◽  
Before And After

Objectives. People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring.Design. Feasibility “before-and-after” intervention study.Setting. Three care homes in Wales.Participants. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine.Intervention. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines.Outcome Measures. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants’ records before and after introduction of the profile, and one month later.Results. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20–25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation.Conclusions. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

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