Friday, March 11, 2016

Antiretroviral Stewardship in a Pediatric HIV Clinic: Development, Implementation, and Improved Clinical Outcomes

Antiretroviral (ARV) management in pediatrics is a challenging process in which multiple barriers to optimal therapy can lead to poor clinical outcomes. In a pediatric HIV clinic, we implemented a systematic ARV stewardship program to evaluate ARV regimens and make recommendations for optimization when indicated.

A comprehensive assessment tool was used to screen for issues related to genotypic resistance, virologic/immunologic response, drug-drug interactions, side effects, and potential for regimen simplification. The ARV stewardship team (AST) made recommendations to the HIV clinic provider, and followed patients prospectively to assess clinical outcomes at 6 and 12 months.

The most common interventions made by the AST included regimen optimization in patients on suboptimal regimens based on resistance mutations (35.4%), switching to safer ARVs (33.3%), and averting significant drug-drug interactions (10.4%). In patients anticipated to have a change in viral load (VL) as a result of the AST recommendations, we identified a significant benefit in virologic outcomes at 6 and 12 months when recommendations were implemented within 6 months of ARV review. Patients who had recommendations implemented within 6 months had a 7-fold higher probability of achieving a 0.7 log10 reduction in VL by 6 months, and this benefit remained significant after controlling for adherence.

A systematic ARV stewardship program implemented at a pediatric HIV clinic significantly improved clinical outcomes. ARV stewardship programs can be considered a core strategy for continuous quality improvement in the management of HIV-infected children and adolescents.

Purchase full article at:

  • 1 The Johns Hopkins Hospital, Department of Pharmacy, Division of Pediatric Pharmacy, Baltimore, MD, USA 
  • 2 Howard University College of Medicine, Washington, DC, USA 
  • 3 Medical University of South Carolina, Charleston, SC, USA 
  • 4 The Johns Hopkins University School of Medicine, Department of Pediatrics, Division of General Pediatrics & Adolescent Medicine, Baltimore, MD, USA 
  • 5 The Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Baltimore, MD, USA.
  •  2016 Feb 19.  

No comments:

Post a Comment