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Am J Health Syst Pharm. 2015 Sep 1;72(17):1463-70. doi: 10.2146/ajhp140727.

Outcomes of pharmacist-assisted management of antiretroviral therapy in patients with HIV infection: A risk-adjusted analysis.

Author information

1
Ofir Noah Nevo, Pharm.D., is Pharmacy Resident, University of California San Diego (UCSD). Catherine R. Lesko, Ph.D., M.P.H., is Research Associate, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bradford Colwell, Pharm.D., AAHIVP, is HIV Pharmacist Specialist; and Craig Ballard,, Pharm.D., AAHIVP, is HIV Pharmacist Specialist, UCSD. Stephen R. Cole, Ph.D., is Professor and Director of Graduate Studies, Department of Epidemiology, University of North Carolina, Chapel Hill. W. Christopher Mathews, M.D., M.S.P.H., is Professor of Clinical Medicine, UCSD. ofir.nevo@ucdenver.edu.
2
Ofir Noah Nevo, Pharm.D., is Pharmacy Resident, University of California San Diego (UCSD). Catherine R. Lesko, Ph.D., M.P.H., is Research Associate, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bradford Colwell, Pharm.D., AAHIVP, is HIV Pharmacist Specialist; and Craig Ballard,, Pharm.D., AAHIVP, is HIV Pharmacist Specialist, UCSD. Stephen R. Cole, Ph.D., is Professor and Director of Graduate Studies, Department of Epidemiology, University of North Carolina, Chapel Hill. W. Christopher Mathews, M.D., M.S.P.H., is Professor of Clinical Medicine, UCSD.

Abstract

PURPOSE:

The impact of pharmacist-assisted management (PAM) of pharmacotherapy for patients with human immunodeficiency virus (HIV) infection was investigated.

METHODS:

A retrospective cohort analysis was conducted to evaluate antiretroviral therapy (ART) outcomes in treatment-naive patients initiated on ART at an HIV clinic. Eligible patients enrolled in the clinic during the period 1999-2013 were classified into two groups: those referred to a clinic-based HIV pharmacist for initiation of ART (the PAM group) and those managed by a primary care provider (the control group). The primary study objective was the median time to viral suppression; secondary objectives included the durability of response to the first ART regimen. Relative hazards for the events of interest were estimated using a marginal structural Cox proportional hazards model and Kaplan-Meier curves, with inverse probability weights used to control for selection and confounding bias.

RESULTS:

Patients referred for PAM services (n = 819) typically had higher baseline viral loads and lower CD4+ cell counts than those in the control group (n = 436). The likelihood of viral suppression during the first two years after ART initiation was significantly higher in the PAM group versus the control group (hazard ratio, 1.37; 95% confidence interval, 1.18-1.59; p < 0.0001). The median durability of the first ART regimen was 100 months in the PAM group versus 44 months in the control group (p > 0.05).

CONCLUSION:

In treatment-naive patients, suppression of HIV viral load occurred earlier when pharmacists assisted with initiating ART than when ART was initiated without that assistance.

PMID:
26294239
PMCID:
PMC4877692
DOI:
10.2146/ajhp140727
[Indexed for MEDLINE]
Free PMC Article

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