Abstract
To characterize and compare the rates of adverse drug reactions (ADRs) and interactions on admission in two, one-year periods: pre-highly active antiretroviral therapy (HAART) (phase 1) and post-HAART (phase 2). Retrospective chart review. University-affiliated tertiary care centre. HIV-positive patients admitted to hospital. In phase 1, 436 of 517 admissions, and, in phase 2, 323 of 350 admissions were analyzed. Over 92% of patients were male, with a mean age of 38 years. Significant differences (P<0.05) in the mean length of stay (12.08 versus 10.02 days), the CD4 counts (99.25 versus 129.45) and the number of concurrent diseases (4.20 versus 3.63) were found between phase 1 and 2, respectively. The mean number of medications taken (5.52 versus 5.94) and the rates of hospitalization with ADRs (20.4% versus 21.4%) or interactions (2.5% versus 2.16%) were similar between the two phases. Antiretrovirals were more common in ADR admissions post-HAART (21.3% versus 36.2%), while antiparasitics, psychotherapeutics and antineoplastics were more common pre-HAART. Other classes of drugs involved in both phases were sulphonamides, narcotics, ganciclovir, foscarnet, antimycobacterials and antifungals. ADR causality was possible or probable in more than 80% of cases. Over 60% of ADRs were grades 3 to 4, and about 85% were either the main or contributing reason for admission. About 65% of patients had at least partial recovery at the time of discharge. In phases 1 and 2, 8.9% and 2.9% of admissions,respectively, with ADRs were fatal. Although hospitalizations with ADRs and interactions were similar in both phases, HAART therapy has had a significant impact on the incidence and nature of ADRs at St Michael's Hospital, Wellesley Central Site, Toronto, Ontario.
Highlights
MM Foisy, K Gough, CM Quan, K Harris, D Ibanez, A Phillips
It is likely that this trend is even more pronounced today, given the widespread use of highly active antiretroviral therapy (HAART), the use of ‘mega-HAART’ regimens such as salvage therapy [21,22], double protease inhibitors (PIs) combinations [21,22,23] and the availability of even more antiretrovirals since the time of our study
We and others have subsequently seen admissions from nelfinavir [26,27,28]; PIs in general [29,30,31,32,33]; indinavir [34,35,36]; abacavir [37]; efavirenz [38]; and nucleoside reverse transcriptase inhibitors (NNRTIs) [38]
Summary
A retrospective chart review was conducted at St Michael’s Hospital, Wellesley-Central Site, Toronto, Ontario, which is a university-affiliated tertiary care centre. Data were collected by a pharmacist and several infectious disease physicians with expertise in HIV. These practitioners were involved in the care of the admitted patients during the periods under study. The time period for phase 2 was selected given that ritonavir (Norvir, Abbott Laboratories Limited, Saint-Laurent, Quebec), saquinavir (Invirase, Hoffman-La Roche Limited, Mississauga, Ontario) and indinavir were all marketed in Canada by August 1996. Population studied: Data were collected from the charts of all patients with a diagnosis of HIV infection at the time of admission. The patients were screened for ADRs and significant drug interactions present at the time of admission
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