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Rate and predictors of INSTI-uptake in a Health service
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2016 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Introduction: The availability of potent, well tolerated and effective antiretroviral therapy (ART) has changed Human Immunodeficiency Virus (HIV) infection, transforming it from a terminal diagnosis, to a controllable chronic infection. Integrase strand transfer inhibitors (INSTIs) are among the most recent discovered class of ART that are well tolerated with high virologic efficacy. Many clinicians have ‘switched’ HIV-positive patients to these new therapies. Aim: To describe the rate and predictors of INSTI-uptake at Melbourne Sexual Health Centre (MSHC). Furthermore, the frequency and nature of pharmacist interventions occurring at time of switching were examined.

Materials and Methods: The electronic medical database at MSHC was reviewed to ascertain all HIV+ patients on ART; those who commenced INSTIs from 1st January 2013 to 31st December 2015 were identified. Predictors associated with switching were described and INSTI-uptake was estimated using Kaplan-Meier. From pharmacist interventions, the incidence of Drug Related Problems (DRPs) at the time of INSTI initiation was determined. Results: Among the 1386 patients that were on ART during the study period, 605 were reported to be on INSTIs. The overall rate of INSTI-uptake was 12.3% with an annual switch rate of 6%. Predictors of INSTI uptake included being male, attending MSHC more frequently and commencing ART after 1st April 2014. Seventy-nine DRPs were identified among 66 patients; the majority being associated with drug-drug interactions (65.9%) and monitoring (20.3%).

Conclusion: A large proportion of new patients at MSHC initiated INSTIs under the study period. This increase in uptake further highlights the good safety profile associated with INSTIs. In addition, a considerable proportion of DRPs were identified among patients at time of switching ART; justifying pharmacist interventions to minimize these problems.

Place, publisher, year, edition, pages
2016. , 34 p.
Keyword [en]
HIV, INSTI, Intergraseinhibitors, dolutegravir, elvitegravir, raltegravir, switch, ART
Keyword [sv]
Integrashämmare, antiretroviralläkemedel, HIV, integrashämmande läkemedel
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-295949OAI: oai:DiVA.org:uu-295949DiVA: diva2:935575
External cooperation
Melbourne Sexual Health Centre, The Alfred Health
Subject / course
Pharmacotherapy
Educational program
Master of Science Programme in Pharmacy
Supervisors
Examiners
Available from: 2016-06-28 Created: 2016-06-10 Last updated: 2016-06-28Bibliographically approved

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