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Antiretroviral Drug Dosing Errors in HIV-Infected Patients Undergoing Hemodialysis

Jérôme Tourret, Isabelle Tostivint, Sophie Tézenas Du Montcel, Svetlana Karie, Vincent Launay-Vacher, Cécile Vigneau, Christel Bessette, Gilbert Deray and Corinne Isnard Bagnis
Clinical Infectious Diseases
Vol. 45, No. 6 (Sep. 15, 2007), pp. 779-784
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/4485565
Page Count: 6
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Antiretroviral Drug Dosing Errors in HIV-Infected Patients Undergoing Hemodialysis
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Abstract

Background. Several studies have revealed the frequency of antiretroviral (ARV) drug prescription errors. We analyzed highly active antiretroviral therapy (HAART) prescribing practices for human immunodeficiency virus (HIV)-infected patients undergoing hemodialysis in France. Methods. Prescribed ARV drug doses in our cohort (consisting of all HIV-infected patients who underwent hemodialysis from 1 January 2002 and were prospectively followed up until 1 January 2004) were compared with the recommended doses for patients undergoing hemodialysis. The log-rank test was used to compare the outcomes among different groups of treated patients. Results. One hundred seven of the 129 patients in our cohort received a total of 317 ARV drugs, 59% of which were improperly prescribed. The dosing was too low for 18% of the patients and too high for 39% of the patients. Twenty-eight patients (26%) did not receive any of their ARV drugs at the recommended dose. The lowest prescribed dose (8% of the daily recommended dose) was observed with indinavir and zidovudine, and the highest prescribed dose (1000% of the recommended dose) was observed with stavudine. Among patients who received HAART, those who were prescribed an insufficient dose of a protease inhibitor had more-severe HIV disease and worse 2-year survival than did the other patients (mean rate of survival ± standard deviation, 79.5% ± 7.5% vs. 95.4% ± 2.6%, respectively; P < .02). For dialyzable ARV drugs, the delay between ARV drug receipt by the patients and dialysis sessions was not respected in 9% of cases, and in 73% of cases, it was not known whether the patients took the ARV drugs before or after dialysis sessions. Conclusion. This is, to our knowledge, the first study to show a significant association between ARV drug prescription errors and survival in patients undergoing dialysis.

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