Category: Federal Forum Posters
Purpose: A growing body of evidence supports the use of CD4/CD8 ratios as an additional tool in the assessment of anti-retroviral therapy(ART) efficacy. Low ratios (<0.4) can represent immune dysregulation that can increase the incidence of non-acquired immunodeficiency syndrome (AIDS) morbidity and mortality. We wish to determine if specific medication factors, including adherence and individual HIV medication or class of medication, affect CD4/CD8 ratios in Veterans infected with HIV.
Methods: A retrospective chart review was completed for 145 Veterans who received HIV care at the William S. Middleton Veterans Memorial Hospital between 1995 and 2017. Of these, 14 Veterans were excluded as they had incomplete medication use data, died prior to 1995, or never started ART. Exact fill dates of all anti-retroviral medications were obtained to establish specific time points of therapy, such as initiation date and any interruptions from ART. Time points were then graphed and compared to both viral load and CD4/CD8 ratios to establish if medication factors such as adherence and individual medication or class affected CD4/CD8 ratios.
Results: To date, 45 full chart reviews have been completed. Data points have been graphed and they represent the complete ‘HIV story’ of these Veterans. By looking at these graphs, analysis of the effect non-adherence plays in CD4/CD8 ratio rise and fall can be seen. With the complete data, the goal is to compare Veterans who were started on ART with high ratios (>0.8) at baseline compared to those with low ratios. We can also analyze the effect integrase inhibitor addition has on ratio rise/fall.
Conclusion: Due to recent advancements in therapy, HIV is starting to be treated more like a chronic disease state. With evidence now supporting the impact of CD4/CD8 ratios on non-AIDS morbidity and mortality, pharmacists are able to use CD4/CD8 ratios to analyze the importance of various medications factors, including adherence and medication class. With this evidence, we hope to create a tool to better manage these patients and extend lifespan.
Andrew Cannon– PGY2 Ambulatory Care Pharmacy Resident, William S. Middleton Memorial Veterans Hospital, Fitchburg, WI