ABSTRACT
BACKGROUND: Hepatitis C virus (HCV) is the most common blood-borne pathogen in the U.S., and Delaware has one of the highest sero-prevalence rates in the country. As a cause of significant morbidity and mortality, it is a public health priority to identify and link individuals with HCV to care.â¯The demand of patients with HCV far exceeds the current availability of providers in Delaware that offer HCV management.â¯. OBJECTIVE: To propose a framework for enabling non-specialist providers within Westside Family Healthcare to manage patients with HCV. METHODS: As a recipient of a Harrington Value Institute Community Partnership grant, the HIV Community Program of Christiana Care Health System (CCHS) started working together with the NE Wilmington pilot site of Westside in July 2018 to: 1) provide HCV education to Westside, 2) implement an HCV care model at Westside, and 3) conduct programmatic evaluation of this framework's effectiveness. Our goal is to improve Westside rates of HCV knowledge amongst patients and staff, as well as to improveâ¯the HCV care continuum, starting with universal HCV screening. RESULTS AND CONCLUSIONS: Results from the first year of collaboration will be available in August 2019.⯠Implementation of this partnership will enable future expansion and continuation of HCV management amongst Westside sites.
ABSTRACT
OBJECTIVE: A long-term medication adherence project was designed and implemented in an urban HIV clinic to address antiretroviral medication adherence. DESIGN AND METHODS: We conducted a prospective study of patients on long-term antiretroviral therapy. Referred patients were on antiretroviral agents at least six months and had two consecutive detectable viral loads. A standarized form was utilized to assess medication adherence, including patient report, practitioner assessed barriers, and pharmacy refill history. Individualized interventions were developed to accommodate patient needs. RESULTS: Seventy-eight patients met inclusion criteria for a total of 81 cases per study protocol. The majority of cases had an identifiable cause related to missed and/or mistimed doses. Following adherence interventions, 51 of the 81 cases (63%) experienced a successful outcome. In addition, 16 of the 27 cases (59%) without an identifiable cause became undetectable following intervention. CONCLUSIONS: This novel approach demonstrates that a proactive method for addressing barriers to long-term medication adherence yields improved patient understanding and preservation of treatment regimens.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Medication Adherence , Adult , Female , HIV Infections/virology , Humans , Male , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Middle Aged , Prospective Studies , Viral LoadABSTRACT
Poor correlation has been reported between the Roche Cobas AmpliPrep/Cobas (TaqMan) HIV-1 TaqMan assay and the Roche Cobas Amplicor HIV-1 Monitor version 1.5 Amplicor assay. We report 8 patients who experienced unexplained detectable viremia, despite exemplary medication adherence, following a change in viral quantification assay from Amplicor to TaqMan in January 2008. All patients were found to have undetectable HIV RNA by branched DNA (bDNA) assay.
Subject(s)
HIV Infections/virology , HIV-1/isolation & purification , Polymerase Chain Reaction/methods , Taq Polymerase , Viral Load/physiology , Viremia/virology , Adult , Anti-Retroviral Agents/pharmacology , Anti-Retroviral Agents/therapeutic use , Branched DNA Signal Amplification Assay , Female , HIV Infections/drug therapy , HIV-1/drug effects , HIV-1/physiology , Humans , Male , Middle Aged , RNA, Viral/blood , Reagent Kits, Diagnostic , Sensitivity and Specificity , Viremia/drug therapyABSTRACT
Transmitted antiretroviral drug resistance has been an ongoing consideration even in patients who are treatment naive. The authors retrospectively selected all eligible patients from a US-based urban HIV clinic who had a genotypic resistance assay performed prior to the initiation of antiretroviral therapy. Clinically significant resistance was detected in 8% of assays, and was comparable when stratified by duration of time from diagnosis to genotypic resistance assay.
Subject(s)
Drug Resistance, Viral/genetics , HIV Infections/drug therapy , HIV Infections/virology , HIV Reverse Transcriptase/genetics , HIV-1/genetics , Anti-Retroviral Agents/therapeutic use , CD4 Lymphocyte Count , Cohort Studies , Delaware , Drug Resistance, Viral/drug effects , Female , Genotype , HIV-1/drug effects , Humans , Male , Mutation , RNA, Viral , Retrospective Studies , Urban PopulationABSTRACT
Of the recently approved antiretroviral protease inhibitors, atazanavir has become a popular medication for the treatment of HIV infection. The advantages of an atazanavir-based regimen include a favorable side effect profile, low impact on lipids, low pill burden, and daily dosing. These have made it a favorable choice for antiretroviral treatment. As more experience is gained with newer antiretroviral medications, additional side effects become apparent. Recent reports have highlighted occurrences of nephrolithiasis in patients using atazanavir-based regimens. The authors present a case of a patient who experienced nephrolithiasis while taking combination antiretroviral therapy that included atazanavir.
Subject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Nephrolithiasis/chemically induced , Oligopeptides/adverse effects , Pyridines/adverse effects , Adult , Atazanavir Sulfate , Female , HIV Infections/complications , Humans , Nephrolithiasis/complicationsABSTRACT
Nephrolithiasis is a known complication of the use of sulfadiazine in the treatment of cerebral toxoplasmosis. Radiographic diagnosis of this complication has historically been challenging. Between March 1999 and June 2002, 11 patients were treated for cerebral toxoplasmosis with sulfadiazine-containing therapy. Four of these patients (36.4%) developed nephrolithiasis during this period. Case patients had received sulfadiazine for a median of 35.5 days prior to nephrolithiasis. All cases were diagnosed by spiral CT scans. Although studies are needed to evaluate the sensitivity and specificity of this modality, spiral CT may aid in the diagnosis of sulfadiazine-induced nephrolithiasis.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Sulfadiazine/adverse effects , Toxoplasmosis, Cerebral/drug therapy , Ureteral Calculi/chemically induced , Ureteral Calculi/diagnostic imaging , Adult , Humans , Male , Tomography, X-Ray ComputedABSTRACT
Tenofovir is a nucleotide reverse transcriptase inhibitor for treatment of human immunodeficiency virus (HIV) infection. Several cases of renal failure associated with tenofovir therapy recently have been reported. A 54-year-old man with HIV experienced decreasing renal function and Fanconi's syndrome secondary to tenofovir therapy. His condition gradually improved after discontinuation of the drug. The available medical literature for reported cases of tenofovir-related nephrotoxicity indicates that this complication is apparently rare. However, our case report and literature review underscore the importance of monitoring renal function when treating patients with any nucleotide reverse transcriptase inhibitor.
Subject(s)
Acute Kidney Injury/chemically induced , Adenine/analogs & derivatives , Adenine/adverse effects , Organophosphonates , Organophosphorus Compounds/adverse effects , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/drug therapy , Acute Kidney Injury/complications , Acute Kidney Injury/diagnosis , Adenine/therapeutic use , Anti-HIV Agents/therapeutic use , Clinical Chemistry Tests/methods , Fanconi Syndrome/chemically induced , Fanconi Syndrome/complications , Fanconi Syndrome/diagnosis , Female , Humans , Male , Middle Aged , Organophosphorus Compounds/therapeutic use , Reverse Transcriptase Inhibitors/adverse effects , Reverse Transcriptase Inhibitors/therapeutic use , Stavudine/therapeutic use , Tenofovir , Time Factors , Treatment OutcomeSubject(s)
Anti-Bacterial Agents , Drug Therapy, Combination/therapeutic use , Naphthoquinones/therapeutic use , Pneumonia, Pneumocystis/prevention & control , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , AIDS-Related Opportunistic Infections/prevention & control , Atovaquone , Clinical Protocols , Dapsone/administration & dosage , Dapsone/economics , Dapsone/therapeutic use , Drug Therapy, Combination/administration & dosage , Drug Therapy, Combination/economics , HIV Infections/complications , Hospital Administration , Humans , Naphthoquinones/administration & dosage , Naphthoquinones/economics , Pneumonia, Pneumocystis/etiology , Pneumonia, Pneumocystis/mortality , Retreatment , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination/economicsABSTRACT
Opportunistic infections during primary infection with human immunodeficiency virus (HIV) are rare, with the exception of oral and esophageal candidiasis. HIV-associated nephropathy (HIVAN) and Pneumocystis carinii pneumonia (PCP) typically occur during advanced HIV infection. We report two patients who developed HIVAN and a presumptive diagnosis of PCP, respectively, during primary HIV infection. Serologic testing demonstrated HIV seroconversion. Clinicians need to have a high index of suspicion when evaluating patients even when risk behaviors are not readily apparent.
