Asunto(s)
Androstadienos , Antirretrovirales , Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Hipolipemiantes , Comunicación Interdisciplinaria , Adulto , Androstadienos/administración & dosificación , Androstadienos/farmacocinética , Antiinflamatorios/administración & dosificación , Antiinflamatorios/farmacocinética , Antirretrovirales/administración & dosificación , Antirretrovirales/efectos adversos , Antirretrovirales/farmacocinética , Manejo de la Enfermedad , Interacciones Farmacológicas , Fluticasona , Humanos , Hiperlipidemias/inducido químicamente , Hiperlipidemias/tratamiento farmacológico , Hipolipemiantes/administración & dosificación , Hipolipemiantes/farmacocinética , MasculinoRESUMEN
Serious adverse events and medication errors are common in clinical practice and are associated with significant morbidity and mortality. Management of HIV-positive patients is likely to become more complex as people age, developing multiple medical conditions and thus requiring polypharmacy. We undertook a casenote review and interview of patients on antiretroviral therapy (ART) to audit the safety of devolving statin prescribing to general practitioners (GPs). Of 26 patients only 50% had their statin prescribing successfully been devolved to GPs. Many experienced significant difficulties and two of 26 (8%) were switched to simvastatin while receiving a protease inhibitor. We demonstrate that prescribing ART and non-ART medication by different practitioners on different sites can potentially expose patients to serious life-threatening adverse events. We make recommendations to minimize these risks and suggest that care pathways are reviewed to ensure they remain both convenient and user-friendly without compromising patient safety.
Asunto(s)
Antirretrovirales/uso terapéutico , Interacciones Farmacológicas , Medicina Familiar y Comunitaria , Infecciones por VIH/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Errores de Medicación , Adulto , Anciano , Prescripciones de Medicamentos , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Masculino , Persona de Mediana Edad , Polifarmacia , Calidad de la Atención de SaludRESUMEN
BACKGROUND: Rates of bacterial sexually transmitted infections (STIs) continue to rise among men who have sex with men (MSM) in the UK. OBJECTIVE: To evaluate factors associated with Chlamydia trachomatis and Neisseria gonorrhoeae among MSM attending a genitourinary medicine clinic in inner London. STUDY DESIGN: 599 MSM undergoing testing for STIs were recruited. Specimens for ligase chain reaction (LCR), strand displacement amplification (SDA) assay and culture were collected from the pharynx, urethra and rectum for the detection of C trachomatis and N gonorrhoeae. Details regarding demographics, symptoms, signs and sexual behaviour were recorded. Associations of these factors with each infection were tested, adjusting for other risk factors. RESULTS: The prevalence of C trachomatis and N gonorrhoeae was 11.0% and 16.0%, respectively. LCR and SDA performed well for the detection of C trachomatis and N gonorrhoeae from urethra and rectum. Using either method, compared with our current testing policy, over 18% of those with C trachomatis and N gonorrhoeae would not have had their infection diagnosed or treated. Age, sexual behaviour, urethral and rectal symptoms and signs were strongly associated with both infections. A total of 33.7% of men reported at least one episode of unprotected anal intercourse in the previous month. Men reporting multiple episodes were markedly more likely to be HIV positive. CONCLUSION: The prevalence of infection, rates of partner acquisition and unprotected anal intercourse reported among these MSM are alarming. Improved detection of C trachomatis and N gonorrhoeae using nucleic acid amplification tests has major public health implications for STI and possibly HIV transmission in this population.
Asunto(s)
Infecciones por Chlamydia/psicología , Gonorrea/psicología , Homosexualidad Masculina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Gonorrea/diagnóstico , Gonorrea/epidemiología , Humanos , Londres/epidemiología , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/normas , Persona de Mediana Edad , Neisseria gonorrhoeae/aislamiento & purificación , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/epidemiología , Enfermedades Faríngeas/microbiología , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/epidemiología , Enfermedades del Recto/microbiología , Sensibilidad y Especificidad , Enfermedades Uretrales/diagnóstico , Enfermedades Uretrales/epidemiología , Enfermedades Uretrales/microbiologíaRESUMEN
Evidence suggests that nevirapine, a non-nucleoside reverse-transcriptase inhibitor, might be very effective in the prevention of HIV-1 integration and the reduction of risk of HIV-1 acquisition after exposure. We used a triple combination regimen, including nevirapine, for prophylaxis after occupational or sexual exposure to HIV-1 infection. Of 57 individuals who started therapy, only 41 returned for follow-up. Five had a grade three or four drug-induced hepatitis, two of whom also had a rash. This high rate of major adverse events raises concerns over the safety of such a regimen for its use in this population.