title: Impact of pharmacist interventions on drug-related problems and laboratory markers in outpatients with human immunodeficiency virus infection.
abstract: BACKGROUND
  Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection.
  
  
  METHODS
  In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load.
  
  
  RESULTS
  After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load.
  
  
  CONCLUSIONS
  This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Caroline de Godoi Rezende Costa
authors.initials: Cde G
authors.lastname: Molino
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Renata Cavalcanti
authors.initials: RC
authors.lastname: Carnevale
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Aline Teotonio
authors.initials: AT
authors.lastname: Rodrigues
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Marília Berlofa
authors.initials: MB
authors.lastname: Visacri
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moriel
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), São Paulo, Brazil.
authors.forename: Priscila Gava
authors.initials: PG
authors.lastname: Mazzola
keywords: AIDS; CD4+ T lymphocyte count; HIV; clinical pharmacy; pharmaceutical care; pharmacy service