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Clinical pharmacy and clinical trials (including case series)
Can a year of pharmacotherapeutic follow-up reduce the incidence of drug-related problems and increase CD4 counts in HIV-positive outpatients?
  1. C.G.R. Costa,
  2. R.C. Carnevale,
  3. V.S.S. Holsback,
  4. N.C. Braz,
  5. C.Z. Santos,
  6. P. Moriel,
  7. P.G. Mazzola
  1. 1Faculty of Medical Sciences, Department of Clinical Pathology, Campinas, Brazil

Abstract

Background Surrogate markers for HIV infection are important and should be used simultaneously with definitive indicators of health and well-being such as drug-related problems (DRPs) within a patient population. Few studies demonstrate the results of pharmacist interventions with statistically significant differences with a comparison group.

Purpose To show that one year of pharmaceutical interventions (PIs) in a group of HIV-positive patients receiving pharmacotherapeutic follow-up (PFU) can significantly reduce the incidence of DRPs and improve clinical outcomes, when compared to a control group.

Materials and methods A prospective controlled study, with a systematic sample by quota controls paired according to random characteristics among cases in 64 HIV-positive outpatients. Patients were divided into a Control Group (CG) and an Intervention Group (PFU). Clinical outcomes were assessed by CD4+ lymphocyte (CD4) and viral load (VL) counts. Lab results, the occurrence of DRPs and types of PI performed were compared.

Results Forty six (71.8%) patients were included in this study and were allocated to the CG (n=23) or the IG (n=23); 28.1% patients discontinued. Ninety-nine PIs were performed (4.3 PIs/patient): 24.2% to prevent DRPs regarding compliance with treatment and 20.2% to guide patients on how to take the medicines. After one year, the DRP count presented a statistically and clinic significant reduction in the IG: 6.1 to 3.1 DRPs/patient (p<0.001; ANOVA TWO-WAY). The CD4 count was statistically (p<0.01; ANOVA TWO-WAY) and clinically significantly higher in the IG: 233.6±69.8 (α=0.05) to 318.4±73.0 (α=0.05); whereas no difference was observed in the CG. Although the difference in VL between the IG or CG was not statistically significant, a significant clinical difference was observed: initially 56% of both groups had an undetectable VL, one year later, 74% of the IG reached CV<50 while the percentage in the CG remained the same.

Conclusions The data indicate with statistical power that one year of PI improves patient clinical outcomes and quality of life by reducing DRPs and increasing the CD4 count compared to a control group.

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