1511. Clinically Significant Drug Interactions Among HIV Positive Outpatients on Antiretroviral Therapy
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 28, 2016
Room: Poster Hall
Background: Clinically significant drug interactions (CSDI) are a cause of medication error with potential to harm patients and increase healthcare costs. Treatment of human immunodeficiency virus (HIV) is complicated by antiretrovirals (ARVs) prone to CSDI in an aging population susceptible to polypharmacy. The objectives of this project were to assess the frequency of CSDI and to examine the associations between CSDI and patient and medication characteristics and level of provider training in an outpatient HIV clinic.

Methods: A clinical pharmacist examined medication lists of randomly selected, adult, HIV positive patients on ARVs for accuracy and presence of a CSDI, which was defined as a grade C, D, or X CSDI when analyzed using Lexicomp software. Patient and medication characteristics were compared between patients with and without CDSIs by χ2 tests for categorical variables and t-tests for continuous variables and by multivariable unconditional logistic regression to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). The associations between provider type [infectious disease (ID) physician, ID fellow, and nurse practitioner (NP)] and the number of CSDI per patient (0, 1-3, 4-6, 7+) and provider response to being informed of a CSDI were analyzed using χ2 tests.

Results: Of the 107 patient records reviewed, 405 CSDI were identified in 83 (76%) patient records. The presence of a CSDI was associated with older age group, use of a higher number of medications, PI based regimen, medication list inaccuracies, and a higher number of inaccuracies. Patients with CSDI did not differ with patients without CSDIs in sex, race, HIV viral load, or NNRTI based regimen. On multivariate analysis, older age and being on a PI based regimen were associated with having a CSDI [OR (95% CI): 3.54 (1.23-11.45) for 20 year age group and 8.21 (2.17-42.66) for PI based regimen]. ID fellows were more likely to report being unaware of the CSDI (37%) than ID physicians (9%) and NPs (18%) (P < 0.0001) and to request additional information (65%) than ID physicians (11%) and NPs (0%) (P <0.0001).

Conclusion: ID providers, especially ID fellows, may benefit from having a clinical pharmacist involved in the ID care team to identify CSDIs and to educate providers about CSDIs.

Lea Monday, PharmD, MD Candidate 2016, Wayne State University School of Medicine, Detroit, MI, Alison Van Dyke, MD, PhD, National Cancer Institute, Bethesda, MD and Jennifer Veltman, MD, Detroit Medical Center/Wayne State University, Detroit, MI

Disclosures:

L. Monday, None

A. Van Dyke, None

J. Veltman, None

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