i
Antiretroviral Stewardship in a Pediatric HIV Clinic: Development, Implementation, and Improved Clinical Outcomes
-
June 2016
Source: Pediatr Infect Dis J. 35(6):642-648 -
Alternative Title:Pediatr Infect Dis J
-
Personal Author:
-
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:
-
Pubmed ID:26906161
-
Pubmed Central ID:PMC4865405
-
Document Type:
-
Collection(s):
-
Main Document Checksum:
-
Download URL:
-
File Type:
Details:
Supporting Files
More +