Antiretroviral prescribing errors in hospitalized patients.

OBJECTIVE: To quantify error type and frequency and to identify factors associated with antiretroviral prescribing errors in hospitalized HIV-infected patients. DESIGN: Systematic evaluation of all medication prescribing errors involving antiretroviral medications between January 1, 1996, and October 31, 1998. Each error was concurrently evaluated for the potential to result in adverse patient consequences. Each error was retrospectively evaluated by three pharmacists and assigned a "likely related factor." SETTING: A 631-bed tertiary care teaching hospital. PARTICIPANTS: All physicians prescribing antiretroviral medications during the study period and all staff pharmacists involved in the routine review of medication orders. MAIN OUTCOME MEASURES: Type and frequency of prescribing errors involving antiretrovirat medications and frequency of association of likely related factors to errors. RESULTS: A total of 108 clinically significant prescribing errors involving antiretrovirals were detected during the 34-month study period. The most common errors were overdosing and underdosing. Overall, errors occurred in 5.8% of admitted patients prescribed antiretroviral medications. The rate of error increased from 2% of admissions in 1996 to 12% of admissions in 1998. The most common likely related factors associated with errors were confusion/lack of familiarity regarding appropriate dosing frequency (30.3%) or dosage (25.5%), and confusion due to need for multiple dosage units per dose (13%). CONCLUSIONS: Hospitalized patients taking antiretrovirals are at risk for adverse outcomes due to prescribing errors. This risk has increased with the rising complexity of antiretroviral drug regimens. A limited number of factors are associated with a large proportion of antiretroviral prescribing errors. This information should be considered in the development of medication error prevention strategies necessary to prevent adverse patient outcomes resulting from such errors.

Antiretroviral medication errors for patients with HIV infection.

Errors in prescribing antiretroviral agents for patients with HIV infection may lead to treatment failure, drug resistance, or drug toxicity. Several published reports describe such errors, which appear to be related to a lack of knowledge, inexperience, complexities of the antiretroviral regimens, and sound-alike and look-alike names. Clinicians caring for patients with HIV infection should be aware of the potential for prescribing errors and develop strategies to prevent them.

Infection with the human immunodeficiency virus: epidemiology, pathogenesis, transmission, diagnosis, and manifestations.

The epidemiology, pathogenesis, transmission, and manifestations of infection with the human immunodeficiency virus (HIV) are described, along with the development of diagnostic tests and drugs to combat it. Acquired immunodeficiency syndrome (AIDS) is caused by HIV infection. The syndrome was first reported in 1981, and as of March 31, 1989, nearly 90,000 cases had been reported in the United States alone. Most U.S. adults with AIDS are homosexual or bisexual men; intravenous drug abusers, heterosexuals, hemophiliacs, and blood transfusion recipients account for 17%, 4%, 1%, and 2% of AIDS cases, respectively. HIV is transmitted by sexual, blood, and perinatal routes; infection leads to a profound immunosuppression involving both the cellular and humoral immune systems. The hallmark of AIDS is a quantitative deficiency of T4 lymphocytes bearing CD4+ receptors, to which the virus binds. Monocytes are believed to be the major route of infection into the CNS. There has been rapid progress in the development of sensitive and specific diagnostic tests for HIV infection. The enzyme-linked immunosorbent assay and Western blot test are the most widely used; both are used to detect antibodies to the virus. Two major classes of drugs are under development for use against HIV: antiviral agents and immunomodulatory agents. Thus far only one drug, zidovudine (AZT), has decreased mortality and improved quality of life. Infection with HIV encompasses a broad spectrum of clinical manifestations, from seroconversion to AIDS-related complex to full-blown AIDS. AIDS is a clinical diagnosis based on the presence of recurring opportunistic infections, previously rare cancers, and neurologic manifestations. Because of the many people infected and the long incubation periods, AIDS will continue to be a major issue in health care. Continued education of health-care personnel and the public is needed.

Current concepts in clinical therapeutics: immunologic treatment of human immunodeficiency virus infections.

An overview of the immune system is presented, and the pathogenesis, transmission, diagnostic tests, diagnosis, immunotherapy, and vaccine development for human immunodeficiency virus (HIV) are reviewed. More than 42,000 cases of acquired immunodeficiency syndrome (AIDS) have now been reported in the United States, and an additional 250,000 cases are expected by 1991. The immunopathogenesis of HIV infection involves both cellular and humoral components of the immune system, with a characteristic depletion of helper T lymphocytes, impaired delayed hypersensitivity, and polyclonal B-cell activation. Monocytes and macrophages are also infected, and these cells provide a transport mechanism into the central nervous system. HIV is transmitted primarily by sexual, blood, and perinatal mechanisms. Enzyme-linked immunosorbent and Western blot assays are used in diagnostic tests, and diagnosis of AIDS is based on the presence of secondary infection or tumor at least moderately indicative of cellular immune deficiency in the absence of predisposing factors. Three approaches are being tested for treating HIV infection: immunomodulators, vaccines, and antiviral agents. Immunomodulators--including interferons, interleukin-2, immune reconstitution with bone-marrow transplantation and lymphocyte transfusions, transfer factor, granulocyte-macrophage colony-stimulating factor, inosine pranobex (isoprinosine), and naltrexone--are being tested with no great successes. Various approaches to vaccine development, including genetically engineered subunit proteins, synthetic peptides, and infectious recombinant viruses, are being considered. Primary immune responses do result from at least one vaccine. Future studies will evaluate combination approaches to therapy. HIV infections confront the health-care system with a serious challenge. It is too early to assess the effectiveness of the various therapeutic strategies for immune deficiencies caused by HIV.