[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy].
OBJECTIVE
To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome.


METHODS
A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points).


RESULTS
541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up.


CONCLUSIONS
Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.
Codina Jané
C
C
Servicio de Farmacia, Hospital Clín, 08036 Barcelona. ccodina@clinic.ub.es
Tuset Creus
M
M
Ibarra Barrueta
O
O
Delgado Sánchez
O
O
Morancho Echevarría
O
O
García Díaz
B
B
Escobar
A
A
Martínez
B
B
Butiñá
T
T
Amador
P
P
Estaún
E
E
Sáinz
A
A
Martínez
N
N
Cal
S
S
Gómez
M R
MR
López
R M
RM
Carmona
A
A
Jiménez
I
I
Moriel
C
C
León
J
J
Iranzo
M D
MD
Caro
L
L
Castillo
I
I
Bachiller
P
P
Irastorza
B
B
Gine
M
M
Sala
M L
ML
Requena
T
T
Santolaya
R
R
Lluch
A
A
Iruin
A
A
Alfaro
J
J
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital; D015397:Program Evaluation; D011446:Prospective Studies
D044966:Anti-Retroviral Agents