Evolution of adherence to antiretroviral treatment in a spanish hospital during 2001, 2005 and 2008

The aim of this study was to analyze the evolution of adherence to highly active antiretroviral therapy (HAART) in the Hospital General Universitario Gregorio Marañón (Madrid, Spain) over the last 8 years and determine the variables associated with the complexity of treatment and suboptimal adherence. An observational, retrospective method was used to measure adherence during the first 6 months of HAART in 3 cohorts: 2001 cohort (n = 90), 2005 cohort (n = 98), and 2008 cohort (n = 110). The adherence rate was determined using 2 methods: Pharmacy Department dispensation records and virologic response data. The evolution of the complexity of treatment and its influence on the adherence rate was analyzed by logistic regression. Adherence to HAART increased progressively from 45.6 % in 2001 to 56.1 % in 2005 and 77.3 % in 2008. Statistically significant differences were only observed between cohorts in 2005 and 2008. The average daily pill burden was 7, 4, and 4.5 tablets, respectively. The percentage of patients on twice-daily regimens decreased from 93.3 % in 2001 to 63.6 % in 2008, with a parallel increase in once-daily regimens. The proportion of patients with dietary restrictions decreased from 24.4 % to 3.6 %. A statistically significant association was found between the number of medication units per day and adherence and between frequency of administration and adherence. Adherence to HAART has improved significantly in the last 8 years. While the complexity of the treatment was significantly reduced in 2005, the largest increase in adherence occurred in the last cohort, which shows the influence of factors other than treatment simplification.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Reseñas iberoamericanas

Reseñas iberoamericana

Reseñas iberoamericanas

Iberoamerican reviewsReseñas iberoamericana

Factores determinantes de la prescripción farmacológica en los pacientes con EPOC estable: resultados de un estudio multicéntrico español (IDENTEPOC)

Objetivo: Determinar qué factores se relacionan con la prescripción de fármacos en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. Material y métodos: Se estudió a 568 pacientes con EPOC estable. La evaluación realizada incluyó la medición del grado de disnea, la determinación del índice de masa corporal, el estudio de la calidad de vida relacionada con la salud y la realización de una espirometría. Resultados: El volumen espiratorio forzado en el primer segundo se asoció significativamente con la prescripción de ß2-adrenérgicos de acción larga (odds ratio [OR] = 0,98; intervalo de confianza [IC] del 95%, 0,96-1) y corticoides inhalados (OR = 0,98; IC del 95%, 0,96-1). La calidad de vida se relacionó con la administración de ß2-adrenérgicos de acción corta (OR = 1,02; IC del 95%, 1-1,03), ß2-adrenérgicos de acción larga (OR = 1,02; IC del 95%, 1-1,03), bromuro de ipratropio (OR = 1,03; IC del 95%, 1-1,04), teofilinas (OR = 1,02; IC del 95%, 1-1,03) y corticoides inhalados (OR = 1,02; IC del 95%, 1-1,03). El grado de disnea mostró una asociación significativa con la prescripción de corticoides orales (para disnea grado IV, OR = 15,25; IC del 95%, 2,40-97,02). No se encontró ninguna relación entre la administración de fármacos y el índice de masa corporal. Conclusiones: La prescripción farmacológica de los pacientes con EPOC estable viene determinada no sólo por el volumen espiratorio forzado en el primer segundo, sino también por otros parámetros, entre los que se incluyen la calidad de vida relacionada con la salud y la disnea

Calidad de vida en la enfermedad pulmonar obstructiva crónica: influencia del nivel de asistencia de los pacientes

Objetivo: El estudio se realizó con el propósito de determinar los factores que se relacionan con la calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable y evaluar si existen diferencias según el nivel de asistencia de los pacientes (neumología o atención primaria). Material y método: Se trata de un estudio observacional, descriptivo, transversal y multicéntrico. La selección de la muestra se realizó mediante un muestreo aleatorizado estratificado por población regional entre médicos de familia y neumólogos de todo el territorio nacional. Para este trabajo se seleccionó a aquellos en los que se registró el nivel de asistencia y en los que el diagnóstico de EPOC se confirmó por espirometría. Resultados: Se evaluó a 560 pacientes, 100 en atención primaria y 460 en neumología. No se detectaron diferencias significativas en las puntuaciones obtenidas en el cuestionario de calidad de vida (versión española del Cuestionario Respiratorio St. George) en ambos niveles asistenciales. La correlación entre el estado de salud percibido por los pacientes y los parámetros de función pulmonar fue débil. Los factores que se relacionaron con la CVRS en el análisis multivariante fueron la disnea, la existencia de reagudizaciones de la EPOC en el año previo, las visitas a urgencias por este motivo, la edad y el grado de limitación al flujo respiratorio, pero no el ámbito de asistencia de los pacientes. Conclusiones: La CVRS de los pacientes con EPOC estable no se relaciona con el nivel de atención, ya sea asistencia primaria o neumología, pero sí con otros factores como la disnea, la existencia de agudizaciones o visitas a urgencias por este motivo, la edad y el grado de obstrucción al flujo respiratori

Effect of accompanying antiretroviral drugs on virological response to pegylated interferon and ribavirin in patients co-infected with HIV and hepatitis C virus

The effects of antiretroviral drugs on the response to pegylated interferon plus ribavirin remain uncertain. We evaluated whether antiretroviral drugs affected the response to pegylated interferon plus ribavirin in patients co-infected with HIV and hepatitis C virus (HCV). We conducted a retrospective analysis of two cohorts of HIV/HCV-co-infected patients treated with pegylated interferon plus ribavirin between 2001 and 2007 in Spain. The outcome measure was sustained virological response (SVR). Logistic regression models were used to test possible associations between non-response and pre-treatment characteristics, including accompanying antiretroviral drugs. The study sample comprised 1701 patients: 63% were infected with HCV genotype (G) 1 or 4 and 88% were taking highly active antiretroviral therapy (HAART). Factors independently associated with increased odds of SVR were G2 or 3, HVC RNA <500,000 IU/mL and CDC clinical category A or B. When we adjusted for these prognostic factors and dose of ribavirin/kg, the adjusted odds ratio (AOR) of SVR for patients without HAART was 1.31 [95% confidence interval (CI) 0.91-1.88; P = 0.144]. Taking the backbone of tenofovir and lamivudine/emtricitabine as a reference, we found that, with the exception of regimens including zidovudine, the effect of other nucleoside reverse transcriptase inhibitor backbones had little effect on SVR. The AOR of SVR for zidovudine and lamivudine was 0.65 (95% CI 0.46-0.93, P = 0.017). We carried out several sensitivity analyses, the results of which were consistent with the findings of the primary analysis. In conclusion, our results suggest that, with the exception of regimens including zidovudine, accompanying antiretroviral drugs have little effect on the virological response to pegylated interferon plus ribavirin in HIV/HCV-co-infected patients.5.068 JCR (2011) Q1, 7/70 Infectious diseases, 18/114 Microbiology, 20/261 Pharmacology & pharmac

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective