Antiretroviral Stewardship in a Pediatric HIV Clinic: Development, Implementation, and Improved Clinical Outcomes

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Hsu, Alice J. ; Neptune, Asha ; Adams, Constants ; Hutton, Nancy ; Agwu, Allison L.
• Description:
  Background
  
  Antiretroviral (ARV) management in pediatrics is a challenging process in which multiple barriers to optimal therapy can lead to poor clinical outcomes. In a pediatric HIV clinic, we implemented a systematic ARV stewardship program to evaluate ARV regimens and make recommendations for optimization when indicated.
  
  Methods
  
  A comprehensive assessment tool was used to screen for issues related to genotypic resistance, virologic/immunologic response, drug-drug interactions, side effects, and potential for regimen simplification. The ARV stewardship team (AST) made recommendations to the HIV clinic provider, and followed patients prospectively to assess clinical outcomes at 6 and 12 months.
  
  Results
  
  The most common interventions made by the AST included regimen optimization in patients on suboptimal regimens based on resistance mutations (35.4%), switching to safer ARVs (33.3%), and averting significant drug-drug interactions (10.4%). In patients anticipated to have a change in viral load (VL) as a result of the AST recommendations, we identified a significant benefit in virologic outcomes at 6 and 12 months when recommendations were implemented within 6 months of ARV review. Patients who had recommendations implemented within 6 months had a 7-fold higher probability of achieving a 0.7 log10 reduction in VL by 6 months, and this benefit remained significant after controlling for adherence [adjusted OR 6.8 (95% CI 1.03-44.9, p <0.05)].
  
  Conclusions
  
  A systematic ARV stewardship program implemented at a pediatric HIV clinic significantly improved clinical outcomes. ARV stewardship programs can be considered a core strategy for continuous quality improvement in the management of HIV-infected children and adolescents.
  
  
• Subjects:
  Adolescent Anti-HIV Agents Child Drug Utilization Female HIV Infections Hospitals, Pediatric Humans Male Prospective Studies Treatment Outcome Young Adult

  More +
• Keywords:
  Antiretroviral Stewardship Human Immunodeficiency Virus Pediatrics Quality Improvement
• Source:
  Pediatr Infect Dis J. 35(6):642-648
• Pubmed ID:
  26906161
• Pubmed Central ID:
  PMC4865405
• Document Type:
  Journal Article
• Funding:
  K23 AI084549/AI/NIAID NIH HHSUnited States/ ; U50 MN000025/MN/OMHHE CDC HHSUnited States/
• Volume:
  35
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:bb239503f3e63d031471fbd5da7287bbeb71184371e2c48d5441b8c0016defe7
• Download URL:
  https://stacks.cdc.gov/view/cdc/39454/cdc_39454_DS1.pdf
• File Type:
  [PDF - 1.24 MB ]