cardiovascular-agents and Acquired-Immunodeficiency-Syndrome

The agents covered in this article are useful in a wide range of illnesses, including infections, cancers, cardiovascular and gastrointestinal diseases, and others. One of the major forces driving the development of new drugs is the use of biotechnology. Biotechnology encompasses the techniques of recombinant DNA and monoclonal antibody technologies to produce protein drugs that have not been previously available in sufficiently pure form or in adequate quantities. As new drugs are developed, the authors hope that intensified efforts will be geared towards the development of unique drugs that offer important therapeutic gains.

Topics: Acquired Immunodeficiency Syndrome; Aminosalicylic Acids; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antiemetics; Antineoplastic Agents; Antiviral Agents; Cardiovascular Agents; Dose-Response Relationship, Drug; Drug Interactions; Foscarnet; Hematinics; Humans; Imidazoles; Ofloxacin; Ondansetron; Pharmaceutical Preparations; Phosphonoacetic Acid; Serotonin Antagonists

It is estimated that by 2015 more than half of all HIV-infected individuals in the United States will be 50 years of age or older. As this population ages, the frequency of non-AIDS related comorbidities increases, which includes cardiovascular, metabolic, gastrointestinal, genitourinary and psychiatric disorders. As a result, medical management of the aging HIV population can be complicated by polypharmacy and higher pill burden, leading to poorer antiretroviral therapy (ART) adherence. Adherence to ART is generally better in older populations when compared to younger populations; however, cognitive impairment in elderly patients can impair adherence, leading to worse treatment outcomes. Practical monitoring tools can improve adherence and increase rates of viral load suppression. Several antiretroviral drugs exhibit inhibitory and/or inducing effects on cytochrome P450 isoenzymes, which are responsible for the metabolism of many medications used for the treatment of comorbidities in the aging HIV population. The combination of ART with polypharmacy significantly increases the chance of potentially serious drug-drug interactions (DDIs), which can lead to drug toxicity, poorer ART adherence, loss of efficacy of the coadministered medication, or virologic breakthrough. Increasing clinicians awareness of common DDIs and the use of DDI programs can prevent coadministration of potentially harmful combinations in elderly HIV-infected individuals. Well designed ART adherence interventions and DDI studies are needed in the elderly HIV population.

Topics: Acquired Immunodeficiency Syndrome; Aged; Aged, 80 and over; Aging; Anti-HIV Agents; Anticoagulants; Cardiovascular Agents; CD4 Lymphocyte Count; Comorbidity; Drug Interactions; Female; Humans; Life Expectancy; Male; Medication Adherence; Middle Aged; Polypharmacy; Population Surveillance; United States; Viral Load

In the United States, mortality from cardiovascular disease has become increasingly common among HIV-infected persons. One-third of HIV-infected persons in care may rely on state-run AIDS Drug Assistance Programs (ADAPs) for cardiovascular disease-related prescription drugs. There is no federal mandate regarding ADAP coverage for non-HIV medications.. To assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.. Cross-sectional survey of 53 state and territorial ADAP formularies.. ADAPs covering all first-line drugs for a cardiovascular risk factor were categorized as "consistent" with guidelines, while ADAPs covering at least one first-line drug, but not all, for a cardiovascular risk factor, were categorized as "partially consistent". ADAPs without coverage were categorized as "no coverage".. Of 53 ADAPs, four (7.5%) provided coverage consistent with guidelines (coverage for all first-line drugs) for all four cardiovascular risk factors. Thirteen (24.5%) provided no coverage for all four risk factors. Thirty-six (68%) provided at least partially consistent coverage for at least one surveyed risk factor. State ADAPs provided coverage consistent with guidelines most frequently for type 2 diabetes (28%), followed by hypertension (25%), hyperlipidemia (15%) and smoking cessation (8%). Statins (66%) were most commonly covered and nicotine replacement therapies (9%) least often. Many ADAPs provided no first-line treatment coverage for hypertension (60%), type 2 diabetes (51%), smoking cessation (45%), and hyperlipidemia (32%).. Consistency of ADAP coverage with guidelines for the surveyed cardiovascular risk factors varies widely. Given the increasing lifespan of HIV-infected persons and restricted ADAP budgets, we recommend ADAP coverage be consistent with guidelines for cardiovascular risk factors.

Topics: Acquired Immunodeficiency Syndrome; Cardiovascular Agents; Cardiovascular Diseases; Cross-Sectional Studies; Humans; Insurance Coverage; Insurance, Pharmaceutical Services; Medical Assistance; Prescription Drugs; Risk Factors; United States

What is already known about this subject. Studies conducted primarily in developed countries have shown that adverse drug reactions (ADRs) are a significant cause of hospital admission, prolong hospital stay and consequently increase the cost of disease management in patients. Cardiovascular medicines, hypoglycaemic agents, nonsteroidal anti-inflammatory drugs and antibiotics are the most frequently implicated medicines in these studies. A large proportion of these ADRs have been shown to be preventable through improved drug prescribing, administration and monitoring for adverse effects. What this paper adds. This is the first Sub-Saharan African study in the HIV/AIDS era that describes the contribution of ADRs to patient morbidity, hospitalisation and mortality. Cardiovascular medicines and antiretroviral therapy contributed the most to community-acquired ADRs at the time of hospital admission while medicines used for opportunistic infections (such as antifungals, antibiotics and antituberculosis medicines were most frequently implicated in hospital acquired ADRs. ADRs in HIV-infected patients were less likely to be preventable.. To describe the frequency, nature and preventability of community-acquired and hospital-acquired adverse drug reactions (ADRs) in a South African hospital serving a community with a high prevalence of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome.. A 3-month prospective observational study of 665 adults admitted to two medical wards.. Forty-one (6.3%) patients were admitted as a result of an ADR and 41 (6.3%) developed an ADR in hospital. Many of the ADRs (46.2%) were considered preventable, although less likely to be preventable in HIV-infected patients than in those with negative or unknown HIV status (community-acquired ADRs 2/24 vs. 35/42; P < 0.0001; hospital-acquired ADRs 3/25 vs. 14/26; P = 0.003). Patients admitted with ADRs were older than patients not admitted with an ADR (median 53 vs. 42 years, P = 0.003), but 60% of community-acquired ADRs at hospital admission were in patients <60 years old. Among patients <60 years old, those HIV infected were more likely to be admitted with an ADR [odds ratio (OR) 2.32, 95% confidence interval (CI) 1.17, 4.61; P = 0.017]. Among HIV-infected patients, those receiving antiretroviral therapy (ART) were more likely to be admitted with an ADR than those not receiving ART (OR 10.34, 95% CI 4.50, 23.77; P < 0.0001). No ART-related ADRs were fatal. Antibiotics and drugs used for opportunistic infections were implicated in two-thirds of hospital-acquired ADRs.. ADRs are an important, often preventable cause of hospitalizations and inpatient morbidity in South Africa, particularly among the elderly and HIV-infected. Although ART-related injury contributed to hospital admissions, many HIV-related admissions were among patients not receiving ART, and many ADRs were associated with medicines used for managing opportunistic infections.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Anti-Retroviral Agents; Cardiovascular Agents; Cohort Studies; Drug-Related Side Effects and Adverse Reactions; Female; HIV Infections; Hospital Mortality; Hospitalization; Hospitals, Teaching; Humans; Male; Middle Aged; Pharmaceutical Preparations; Prevalence; Prospective Studies; South Africa