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Antiretroviral Stewardship in a Pediatric HIV Clinic: Development, Implementation and Improved Clinical Outcomes

Alice J Hsu1, Asha Neptune, Constants Adams

  • 1From the *Division of Pediatric Pharmacy, Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland; †Howard University College of Medicine, Washington, DC; ‡Medical University of South Carolina, Charleston, South Carolina; §Division of General Pediatrics & Adolescent Medicine, and ¶Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Pediatric Infectious Disease Journal
|February 25, 2016
PubMed

Insights

Implementing an Antiretroviral (ARV) stewardship program in pediatric HIV care significantly improved patient outcomes. This systematic approach optimized ARV regimens, leading to better viral load reduction and enhanced clinical management for children and adolescents with HIV.

Area of Science:

  • Pediatric infectious diseases
  • Clinical pharmacology
  • HIV/AIDS management

Background:

  • Pediatric Antiretroviral (ARV) management presents unique challenges, with barriers often leading to suboptimal clinical outcomes.
  • A pediatric HIV clinic established a systematic ARV stewardship program to address these challenges.

Purpose of the Study:

  • To evaluate the impact of a systematic ARV stewardship program on clinical outcomes in pediatric HIV patients.
  • To identify key interventions for optimizing ARV therapy in children and adolescents.

Main Methods:

  • A comprehensive assessment tool evaluated genotypic resistance, treatment response, drug interactions, and side effects.
  • An ARV stewardship team (AST) provided recommendations to clinicians and prospectively followed patient outcomes at 6 and 12 months.

Main Results:

  • Common interventions included regimen optimization for resistance mutations (35.4%), switching to safer ARVs (33.3%), and preventing drug-drug interactions (10.4%).
  • Patients with implemented recommendations within 6 months showed a 7-fold higher probability of achieving a 0.7 log10 viral load reduction by 6 months.

Conclusions:

  • A systematic ARV stewardship program significantly improved clinical outcomes in a pediatric HIV clinic.
  • ARV stewardship is a valuable strategy for continuous quality improvement in managing HIV-infected children and adolescents.
Abstract

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