Acute Care Management of the HIV-Infected Patient: A Report from the HIV Practice and Research Network of the American College of Clinical Pharmacy

by Selleckchem | Mar 28 2023

Objective: Patients infected with human immunodeficiency virus (HIV) admitted to the hospital have complex antiretroviral therapy (ART) regimens with an increased medication error rate upon admission. This report provides a resource for clinicians managing HIV-infected patients and ART in the inpatient setting.

Methods: A survey of the authors was conducted to evaluate common issues that arise during an acute hospitalization for HIV-infected patients. After a group consensus, a review of the medical literature was performed to determine the supporting evidence for the following HIV-associated hospital queries: admission/discharge orders, antiretroviral hospital formularies, laboratory monitoring, altered hepatic/renal function, drug-drug interactions (DDIs), enteral administration, and therapeutic drug monitoring.

Results: With any hospital admission for an HIV-infected patient, a specific set of procedures should be followed including a thorough admission medication history and communication with the ambulatory HIV provider to avoid omissions or substitutions in the ART regimen. DDIs are common and should be reviewed at all transitions of care during the hospital admission. ART may be continued if enteral nutrition with a feeding tube is deemed necessary, but the entire regimen should be discontinued if no oral access is available for a prolonged period. Therapeutic drug monitoring is not generally recommended but, if available, should be considered in unique clinical scenarios where antiretroviral pharmacokinetics are difficult to predict. ART may need adjustment if hepatic or renal insufficiency ensues.

Conclusions: Treatment of hospitalized patients with HIV is highly complex. HIV-infected patients are at high risk for medication errors during various transitions of care. Baseline knowledge of the principles of antiretroviral pharmacotherapy is necessary for clinicians managing acutely ill HIV-infected patients to avoid medication errors, identify DDIs, and correctly dose medications if organ dysfunction arises. Timely ambulatory follow-up is essential to prevent readmissions and facilitate improved transitions of care.

Comments：

This report provides a resource for clinicians managing HIV-infected patients and antiretroviral therapy (ART) in the inpatient setting. The authors conducted a survey to evaluate common issues that arise during hospitalizations for HIV-infected patients, followed by a review of the medical literature to determine supporting evidence for various HIV-associated hospital queries.

The report highlights the need for a thorough admission medication history and communication with the ambulatory HIV provider to avoid omissions or substitutions in the ART regimen. Drug-drug interactions (DDIs) are common and should be reviewed at all transitions of care during the hospital admission. The authors recommend discontinuing the entire ART regimen if no oral access is available for a prolonged period, but ART may be continued if enteral nutrition with a feeding tube is deemed necessary. Therapeutic drug monitoring is not generally recommended but should be considered in unique clinical scenarios where antiretroviral pharmacokinetics are difficult to predict. Finally, ART may need adjustment if hepatic or renal insufficiency ensues.

The report emphasizes the complexity of treating hospitalized patients with HIV and the high risk for medication errors during various transitions of care. The authors stress the importance of baseline knowledge of the principles of antiretroviral pharmacotherapy for clinicians managing acutely ill HIV-infected patients to avoid medication errors, identify DDIs, and correctly dose medications if organ dysfunction arises. Timely ambulatory follow-up is also essential to prevent readmissions and facilitate improved transitions of care.