THE IMPACT OF A MEDICATION ADHERENCE PROGRAM ON THE IMMUNOLOGIC AND VIROLOGIC RESPONSES OF HIV-INFECTED INFANTS AND CHILDREN.

Abstract

Objective To assess the impact of a medication adherence program started in January 2004 by comparing the immunologic and virologic responses of HIV-infected infants and children followed at the University of South Alabama Family Specialty Clinic (USAFSC) before and after a pharmacist-based educational program was started. Methods A retrospective review was performed on the medical charts of HIV-infected infants and children at the USAFSC from September 2001 through December 2005. The following data were obtained from the charts: epidemiologic information, CD4+ cell counts, plasma HIV-1 RNA levels, antiretroviral drug history, and pharmacist-based medication adherence notes. A comparison of data was then made before (September 2001 through December 2003) and after (January 2004 through December 2005) the pharmacist-based medication adherence was started. A t-test was performed to compare patient groups. Results There were 19 HIV-infected infants and children whose data were available to compare before and after the pharmacist-based medication adherence program was started. The patients9 ages ranged from 1 through 16 years of age; there were 9 females and 10 males. Seven patients had AIDS-defining illness during the study period. There were a mean number of 2.6 visits with pharmacist-based intervention per patient per year. After the medication adherence program started, 14 patients had decreased mean CD4+ cell counts (p = .027), whereas 5 patients had increased plasma HIV-1 RNA levels (p = .173). Conclusions After receiving pharmacist-based medication adherence education, our study revealed that there was a statistically significant decrease in CD4+ cell counts, whereas there was an observed decrease in plasma HIV-1 RNA levels (which was not statistically significant). The reasons for these findings are unclear but could be secondary to the variability of the HIV disease process or any intercurrent illness in a small sample size of patients.