Managing the HIV-infected adult patient in the emergency department.

As highly active antiretroviral therapies have advanced, HIV patients who are treatment-adherent can achieve undetectable viral loads, virtual elimination of opportunistic infection, improved quality of life, and normal life expectancy. This issue focuses on emergency department management of HIV patients both with successful disease suppression from long-term therapy as well as the patient with low CD4 counts in the context of lack of engagement with care, nonadherence, or undiagnosed disease. Optimal emergency department management of patients with HIV also includes identifying and treating undiagnosed patients, helping to re-establish care for those who have been lost to followup, and preventing new HIV infections with pre-exposure and postexposure prophylaxis.

Older HIV-infected adults. Complex patients (III): Polypharmacy.

Polypharmacy is a well-described problem in the geriatric population. It is a relatively new problem for people living with HIV (PLWH), as this group now has a life expectancy approaching that of the general population. Defining polypharmacy for PLWH is difficult, since the most common traditional definition of at least five medications would encompass a large percentage of PLWH who are on antiretrovirals (ARVs) and medications for other medical comorbidities.

Management of hepatitis B and C infections in rheumatologic disease.

Hepatitis B and C viruses present dual considerations in rheumatic disease as both etiologic factors and important comorbidities that must be assessed and addressed. This review summarizes the link between hepatitis B and arthritis and polyarteritis nodosa as well as hepatitis C and arthritis, Sicca syndrome and cryoglobulinemic vasculitis. Recent data pertaining to the antiviral management in these conditions, especially regarding the use of the direct-acting antivirals in hepatitis C, are also presented.

Relationship Between Single Tablet Antiretroviral Regimen and Adherence to Antiretroviral and Non-Antiretroviral Medications Among Veterans' Affairs Patients with Human Immunodeficiency Virus.

Several antiretrovirals (ART) have been coformulated as single tablet regimens (STR). Study objectives were to compare ART and non-ART adherence between STR and multiple tablet regimens (MTR) recipients, determine whether STR independently predicts ART adherence, and determine whether ART adherence influences non-ART adherence. A retrospective cohort study was performed among Upstate New York Veterans' Healthcare Administration (VISN-2) patients from 2000 to 2013.

HIV/HCV Antiviral Drug Interactions in the Era of Direct-acting Antivirals.

Therapy for human immunodeficiency virus (HIV) and chronic hepatitis C has evolved over the past decade, resulting in better control of infection and clinical outcomes; however, drug-drug interactions remain a significant hazard. Joint recommendations from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America regarding drug-drug interactions between HIV antiretroviral agents and direct-acting antiviral agents for treatment of hepatitis C virus (HCV) infection are reviewed here. This review is oriented to facilitate appropriate selection of an antiviral therapy regimen for HCV infection based on the choice of antiretroviral therapy being administered and, if necessary, switching antiretroviral regimens.

Desirable Characteristics of Hepatitis C Treatment Regimens: A Review of What We Have and What We Need.

There have been dramatic advancements in the treatment of chronic hepatitis C (HCV) infection. This is largely due to the approval of several direct-acting antiviral agents (DAAs) from a variety of medication classes with novel mechanisms of action. These therapies are a welcomed advancement given their improved efficacy and tolerability compared to pegylated interferon and ribavirin (RBV)-based regimens.

Prevalence and risk factors for clinically significant drug interactions with antiretroviral therapy.

Study Objectives: To identify the prevalence and types of clinically significant drug interactions (CSDIs) in the drug regimens of patients with human immunodeficiency virus (HIV) infection who were receiving antiretroviral therapy, and to explore risk factors for these CSDIs.

Design: Retrospective medical record review.

Setting: Academic HIV specialty clinic.

Community pharmacy Target Intervention Program to improve aspirin use in persons with diabetes.

Objective: To identify the rate of aspirin or antiplatelet/anticoagulant use in persons with diabetes presenting to community pharmacies and determine whether a student pharmacist-driven Target Intervention Program (TIP) could increase the number of eligible persons with diabetes receiving aspirin therapy in accordance with American Diabetes Association (ADA) recommendations.

Design: Unblinded, single intervention.

Setting: Eight Community Pharmacy Advanced Practice Experience (CPAPE) sites in New York State.

An assessment of herbal therapy use, adherence and utilization of pharmacy services in HIV clinics.

Objective: To assess herbal therapy use, adherence to antiretroviral therapy (ART) and pharmacy service utilization in two HIV clinics using a prospective questionnaire-based assessment.

Results: Seventy-six patients completed the questionnaire. Twenty-six patients (34%) reported using at least one herbal therapy; 14 (54%) reported this to their provider.

Drug interactions associated with HAART: focus on treatments for addiction and recreational drugs.

The advent of HAART has improved survival in patients infected with HIV; however, treatment is complicated by potential drug interactions. The risk of drug interactions is compounded by the use of additional therapies for comorbid conditions, such as substance abuse, and by the use of recreational drugs. HIV health care providers should be aware of the potential interaction of recreational drugs and addiction treatments with HAART because of the potential for significant adverse effects for their HIV-infected patients.

Update on prescribing errors with HAART.

Medication-prescribing errors associated with HAART may lead to treatment failure, development of resistance, or drug toxicity. Reports have described HAART-related medication-prescribing errors; the causes of these errors are often multifactorial and include lack of knowledge about HIV treatments, complexity of regimens, and sound-alike/look-alike names of medications. Clinicians caring for HIV-infected patients should be aware of the potential for prescribing errors associated with HAART and employ strategies to prevent them.

Improving aspirin prophylaxis in a primary care diabetic population.

Study Objective: To evaluate and improve adherence to American Diabetes Association guidelines for prophylactic aspirin therapy in ambulatory patients with diabetes using a pharmacy-directed intervention.

Design: Unblinded, single intervention.

Setting: Rural, primary care clinic.

Case report. Hepatitis B virus and HIV coinfection.

Coinfection with HIV and hepatitis B virus (HBV) is more common than that with HIV and hepatitis C virus (HCV), although more attention has been given to HCV coinfection as a result of its higher frequency of chronic disease. Natural history studies with HIV-HCV coinfection have also shown more rapid progression of liver disease, and end-stage liver disease due to hepatitis C is now a leading cause of death in HIV-infected patients. Like HCV infection, HBV infection can also be associated with significant morbidity and mortality in patients with HIV infection.