title: Antiretroviral drug dosing errors in HIV-infected patients undergoing hemodialysis.
abstract: BACKGROUND
  Several studies have revealed the frequency of antiretroviral (ARV) drug prescription errors. We analyzed highly active antiretroviral therapy (HAART) prescribing practices for human immunodeficiency virus (HIV)-infected patients undergoing hemodialysis in France.
  
  
  METHODS
  Prescribed ARV drug doses in our cohort (consisting of all HIV-infected patients who underwent hemodialysis from 1 January 2002 and were prospectively followed up until 1 January 2004) were compared with the recommended doses for patients undergoing hemodialysis. The log-rank test was used to compare the outcomes among different groups of treated patients.
  
  
  RESULTS
  One hundred seven of the 129 patients in our cohort received a total of 317 ARV drugs, 59% of which were improperly prescribed. The dosing was too low for 18% of the patients and too high for 39% of the patients. Twenty-eight patients (26%) did not receive any of their ARV drugs at the recommended dose. The lowest prescribed dose (8% of the daily recommended dose) was observed with indinavir and zidovudine, and the highest prescribed dose (1000% of the recommended dose) was observed with stavudine. Among patients who received HAART, those who were prescribed an insufficient dose of a protease inhibitor had more-severe HIV disease and worse 2-year survival than did the other patients (mean rate of survival+/-standard deviation, 79.5%+/-7.5% vs. 95.4%+/-2.6%, respectively; P<.02). For dialyzable ARV drugs, the delay between ARV drug receipt by the patients and dialysis sessions was not respected in 9% of cases, and in 73% of cases, it was not known whether the patients took the ARV drugs before or after dialysis sessions.
  
  
  CONCLUSIONS
  This is, to our knowledge, the first study to show a significant association between ARV drug prescription errors and survival in patients undergoing dialysis.
authors: Nephrology Department, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. jtourret@yahoo.com
authors: Jérôme
authors: J
authors: Tourret
authors: Isabelle
authors: I
authors: Tostivint
authors: Sophie
authors: S
authors: Tézenas Du Montcel
authors: Svetlana
authors: S
authors: Karie
authors: Vincent
authors: V
authors: Launay-Vacher
authors: Cécile
authors: C
authors: Vigneau
authors: Christel
authors: C
authors: Bessette
authors: Gilbert
authors: G
authors: Deray
authors: Corinne Isnard
authors: CI
authors: Bagnis
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008508:Medication Errors / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006435:Renal Dialysis; D018119:Stavudine / Q000008:administration & dosage / Q000627:therapeutic use; D015215:Zidovudine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D015215:Zidovudine; D019469:Indinavir; D018119:Stavudine