Nevo Ofir Noah, Lesko Catherine R, Colwell Bradford, Ballard Craig, Cole Stephen R, Mathews W Christopher
Ofir Noah Nevo, Pharm.D., is Pharmacy Resident, University of California San Diego (UCSD). Catherine R. Lesko, Ph.D., M.P.H., is Research Associate, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bradford Colwell, Pharm.D., AAHIVP, is HIV Pharmacist Specialist; and Craig Ballard,, Pharm.D., AAHIVP, is HIV Pharmacist Specialist, UCSD. Stephen R. Cole, Ph.D., is Professor and Director of Graduate Studies, Department of Epidemiology, University of North Carolina, Chapel Hill. W. Christopher Mathews, M.D., M.S.P.H., is Professor of Clinical Medicine, UCSD.
Am J Health Syst Pharm. 2015 Sep 1;72(17):1463-70. doi: 10.2146/ajhp140727.
The impact of pharmacist-assisted management (PAM) of pharmacotherapy for patients with human immunodeficiency virus (HIV) infection was investigated.
A retrospective cohort analysis was conducted to evaluate antiretroviral therapy (ART) outcomes in treatment-naive patients initiated on ART at an HIV clinic. Eligible patients enrolled in the clinic during the period 1999-2013 were classified into two groups: those referred to a clinic-based HIV pharmacist for initiation of ART (the PAM group) and those managed by a primary care provider (the control group). The primary study objective was the median time to viral suppression; secondary objectives included the durability of response to the first ART regimen. Relative hazards for the events of interest were estimated using a marginal structural Cox proportional hazards model and Kaplan-Meier curves, with inverse probability weights used to control for selection and confounding bias.
Patients referred for PAM services (n = 819) typically had higher baseline viral loads and lower CD4+ cell counts than those in the control group (n = 436). The likelihood of viral suppression during the first two years after ART initiation was significantly higher in the PAM group versus the control group (hazard ratio, 1.37; 95% confidence interval, 1.18-1.59; p < 0.0001). The median durability of the first ART regimen was 100 months in the PAM group versus 44 months in the control group (p > 0.05).
In treatment-naive patients, suppression of HIV viral load occurred earlier when pharmacists assisted with initiating ART than when ART was initiated without that assistance.
研究药剂师辅助管理（PAM）对人类免疫缺陷病毒（HIV）感染患者药物治疗的影响。
进行了一项回顾性队列分析，以评估在一家HIV诊所开始接受抗逆转录病毒治疗（ART）的初治患者的ART治疗效果。1999年至2013年期间在该诊所登记的符合条件的患者被分为两组：那些被转介给诊所的HIV药剂师开始ART治疗的患者（PAM组）和那些由初级保健提供者管理的患者（对照组）。主要研究目标是病毒抑制的中位时间；次要目标包括对第一个ART方案反应的持久性。使用边际结构Cox比例风险模型和Kaplan-Meier曲线估计感兴趣事件的相对风险，并使用逆概率权重来控制选择和混杂偏倚。
被转介接受PAM服务的患者（n = 819）与对照组（n = 436）相比，通常基线病毒载量更高，CD4 +细胞计数更低。在开始ART治疗后的头两年内，PAM组病毒抑制的可能性明显高于对照组（风险比，1.37；95%置信区间，1.18 - 1.59；p < 0.0001）。PAM组第一个ART方案的中位持久性为100个月，而对照组为44个月（p > 0.05）。
在初治患者中，药剂师协助开始ART治疗时，HIV病毒载量的抑制比没有这种协助时更早发生。
