Durham Spencer H, Badowski Melissa E, Liedtke Michelle D, Rathbun R Chris, Pecora Fulco Patricia
Department Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, Alabama.
Section of Infectious Diseases, Department of Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois.
Pharmacotherapy. 2017 May;37(5):611-629. doi: 10.1002/phar.1921. Epub 2017 May 9.
Patients infected with human immunodeficiency virus (HIV) admitted to the hospital have complex antiretroviral therapy (ART) regimens with an increased medication error rate upon admission. This report provides a resource for clinicians managing HIV-infected patients and ART in the inpatient setting.
A survey of the authors was conducted to evaluate common issues that arise during an acute hospitalization for HIV-infected patients. After a group consensus, a review of the medical literature was performed to determine the supporting evidence for the following HIV-associated hospital queries: admission/discharge orders, antiretroviral hospital formularies, laboratory monitoring, altered hepatic/renal function, drug-drug interactions (DDIs), enteral administration, and therapeutic drug monitoring.
With any hospital admission for an HIV-infected patient, a specific set of procedures should be followed including a thorough admission medication history and communication with the ambulatory HIV provider to avoid omissions or substitutions in the ART regimen. DDIs are common and should be reviewed at all transitions of care during the hospital admission. ART may be continued if enteral nutrition with a feeding tube is deemed necessary, but the entire regimen should be discontinued if no oral access is available for a prolonged period. Therapeutic drug monitoring is not generally recommended but, if available, should be considered in unique clinical scenarios where antiretroviral pharmacokinetics are difficult to predict. ART may need adjustment if hepatic or renal insufficiency ensues.
Treatment of hospitalized patients with HIV is highly complex. HIV-infected patients are at high risk for medication errors during various transitions of care. Baseline knowledge of the principles of antiretroviral pharmacotherapy is necessary for clinicians managing acutely ill HIV-infected patients to avoid medication errors, identify DDIs, and correctly dose medications if organ dysfunction arises. Timely ambulatory follow-up is essential to prevent readmissions and facilitate improved transitions of care.
住院的人类免疫缺陷病毒（HIV）感染者有复杂的抗逆转录病毒治疗（ART）方案，入院时用药错误率增加。本报告为在住院环境中管理HIV感染患者及ART的临床医生提供参考资料。
对作者进行了一项调查，以评估HIV感染患者急性住院期间出现的常见问题。经过小组讨论达成共识后，对医学文献进行了回顾，以确定以下与HIV相关的医院问题的支持证据：入院/出院医嘱、抗逆转录病毒医院处方集、实验室监测、肝/肾功能改变、药物相互作用（DDIs）、肠内给药和治疗药物监测。
对于任何HIV感染患者入院，都应遵循一套特定的程序，包括全面的入院用药史以及与门诊HIV治疗医生沟通，以避免ART方案中的遗漏或替换。DDIs很常见，在住院期间的所有护理交接时都应进行审查。如果认为有必要通过鼻饲管进行肠内营养，则可以继续ART，但如果长时间无法经口进食，则应停用整个方案。一般不建议进行治疗药物监测，但如果可行，在抗逆转录病毒药代动力学难以预测的特殊临床情况下应予以考虑。如果出现肝或肾功能不全，可能需要调整ART。
HIV感染住院患者的治疗非常复杂。HIV感染患者在各种护理交接期间发生用药错误的风险很高。管理急性病HIV感染患者的临床医生必须具备抗逆转录病毒药物治疗原则的基础知识，以避免用药错误、识别DDIs，并在出现器官功能障碍时正确给药。及时的门诊随访对于预防再次入院和促进改善护理交接至关重要。
