In-Hospital Missed Doses, Treatment Errors Compromise ART Adherence

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Lower-than-expected ART adherence rates in hospitalized patients with HIV can be linked to medication errors and missed dosing.

Interruption of antiretroviral therapy (ART) due to medication errors in hospitalized patients with HIV led to lower-than-expected ART adherence rates, according to research presented at IDWeek 2016.1

Arnold Decano, PharmD, of the department of pharmacy at NYU Langone Medical Center in New York City, and colleagues retrospectively assessed 101 patients (median age 55 years; interquartile range [IQR]: 51-63 years) with HIV to determine adherence rates and reasons for nonadherence.

Patients’ median CD4 count was 447 cells/μL (IQR: 210-641 cells/μL); median CD4 percentage was 22% (IQR: 13%-36%). HIV-1 RNA viral load was undetectable in 56% of patients, while 26% of patients had an undetectable HIV-1 RNA viral load.

Patients were hospitalized for a median of 4 days (IQR: 3-7 days). Overall adherence rate to ART therapy was 91% for all patients who received ART during their hospitalization; 40% had at least one missed dose, and the most common reason was patient refusal (39%). A prescribing error occurred in 45% of treatment courses; this was more frequently associated with a multi-tablet regimen. Most errors were corrected within 24 hours of prescribing.

“Adherence rates may be lower than expected in hospitalized patients due to nonpreventable interruptions in therapy,” the researchers concluded. “Nonadherence during hospitalization should be acknowledged as a contributing factor to overall adherence in [patients with HIV] receiving ART.”

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  1. Decano A, Dubrovskaya Y, Horowitz H, Mehta D, Scipione MR. Adherence to antiretroviral therapy in hospitalized HIV-positive patients. Presented at: IDWeek 2016; October 26-30, 2016; New Orleans, LA. Poster 1495.