Antiretroviral Stewardship: A Review of Published Outcomes with Recommendations for Program Implementation

Michienzi, Sarah M; Ladak, Amber F; Pérez, Sarah E.; Chastain, Daniel B

doi:10.1177/2325958219898457

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…( 11 ) An analysis of 6 studies found a significant reduction in errors in the postimplementation of antiretroviral stewardship. ( 12 ) Furthermore, a stewardship protocol may optimize antifungal prescriptions. ( 13 )…”

Section: Discussionmentioning

confidence: 99%

Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters

Moreira,

Accorsi,

Amicis

et al. 2024

Einstein (São Paulo)

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Section: Discussionmentioning

confidence: 99%

Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters

Moreira,

Accorsi,

Amicis

et al. 2024

Einstein (São Paulo)

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“…Despite the diverse etiologies of ICU admissions among PWH, guidance on pharmacotherapy-related decision-making tools specifically tailored to this critically ill patient population are lacking. A recent article emphasized the need for ART stewardship and provided recommendations for program consideration and implementation, highlighting the gap in literature compared to other commonly used medications for infectious diseases [ 94 ]. The proposed core elements for antiretroviral stewardship programs (ARVSPs) emphasized leadership commitment, accountability, drug expertise, key support, tracking, reporting, and comprehensive education.…”

Section: Antiretroviral Stewardship In the Icumentioning

confidence: 99%

Managing Modern Antiretroviral Therapy in the Intensive Care Unit: Overcoming Challenges for Critically Ill People With Human Immunodeficiency Virus

Chastain,

Tu,

Brizzi

et al. 2024

Open Forum Infectious Diseases

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People with HIV (PWH) have a 50% excess risk for intensive care unit (ICU) admission, often for non-HIV-related conditions. Despite this, clear guidance for managing antiretroviral therapy (ART) in this setting is lacking. Selecting appropriate ART in the ICU is complex due to drug interactions, absorption issues, and dosing adjustments. Continuing ART in the ICU can be challenging due to organ dysfunction, drug interactions, and formulary limitations. However, with careful consideration, continuation is often feasible through dose adjustments or alternative administration methods. Temporary discontinuation of ART may be beneficial depending on the clinical scenario. Clinicians should actively seek resources and support to mitigate adverse events and drug interactions in critically ill PWH. Navigating challenges in the ICU can optimize ART and improve care and outcomes for critically ill PWH. This review aims to identify strategies for addressing the challenges associated with the use of modern ART in the ICU.

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“…In addition to clinical considerations, various programmatic elements are needed to help ensure success of the ASP. Taken from literature describing CMV AVS as well as HIV antiretroviral stewardship programs [27 ▪ ,30], the following core elements should be included in CMV ASP:…”

Section: Core Elements Of Cytomegalovirus Antiviral Stewardshipmentioning

confidence: 99%

The next frontier: cytomegalovirus antiviral stewardship programs in solid organ transplant

Kleiboeker,

Saddler,

Jorgenson

2023

Current Opinion in Infectious Diseases

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Purpose of review Cytomegalovirus (CMV) is a driver of negative patient and allograft outcomes after solid organ transplantation (SOT) and new tools are needed to circumvent these outcomes. We will review key elements of CMV antiviral stewardship in SOT, discuss the available evidence for CMV antiviral stewardship programs and feature areas for expansion in the current landscape of CMV management. Recent findings CMV remains a common complication after SOT. While consensus guidelines provide recommendations for the prevention and treatment of CMV, a one-size-fits-all approach is not necessarily appropriate for all unique patients and posttransplant courses, types of SOT recipients and transplant centers. Additionally, consensus guidelines have not been updated since the approval of two new antiviral therapies for the treatment of CMV after SOT or emerging evidence for the incorporation of immune functional assays into clinical practice. From the models provided in recent literature, CMV antiviral stewardship programs have demonstrated efficacy by increasing successful treatment of viremia, optimizing and reducing unnecessary use of (val)ganciclovir for both prophylaxis and treatment, and preventing development of ganciclovir-resistant CMV infections. These models highlight the multidisciplinary approach required of CMV antiviral stewardship programs to provide standardization of management, including incorporation of new therapies and diagnostic tools. Summary CMV antiviral stewardship programs represent a promising avenue to considerably improve the management of CMV after SOT. Future studies are needed to evaluate a potential positive impact on graft outcomes and patient survival.

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Antiretroviral Stewardship: A Review of Published Outcomes with Recommendations for Program Implementation

Cited by 7 publications

References 25 publications

Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters

Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters

Managing Modern Antiretroviral Therapy in the Intensive Care Unit: Overcoming Challenges for Critically Ill People With Human Immunodeficiency Virus

The next frontier: cytomegalovirus antiviral stewardship programs in solid organ transplant

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