1. INTRODUCTION Evaluation of Outcomes in Patients Starting Antiretroviral Therapy During Hospitalization Leigh E. Efird, PharmD 1, Manish Patel, PharmD 1, and Minh Nguyen, MD 2 Grady Health System, Department of Pharmacy and Drug Information, Atlanta, GA 1 and Emory University School of Medicine, Atlanta, GA 2 Primary Objective  To evaluate duration of uninterrupted CART after initiation of therapy in the hospital Secondary Objective  To determine change in HIV viral load and CD4 count  To determine rehospitalization, mortality, and provider follow-up rates  CART recommended for all patients with an AIDS- defining illness  Since the introduction of CART, a significant reduction in mortality has resulted  CART provides a significant benefit to patients with opportunistic infections with limited or no treatment options Primary Outcome Measure  Duration of uninterrupted CART up to six months after hospital initiation Secondary Outcome Measures  Change in virologic response (HIV viral load)  Change in immunologic response (CD4 cell count)  Percentage of re-hospitalizations  Mortality  Percentage of outpatient provider follow-up Study Design  Retrospective observational study Inclusion Criteria  Patients ≥ 18 years of age, started on CART while in the hospital between August 1, 2006 and May 1, 2007 Exclusion Criteria  Patients on CART prior to hospitalization (i.e. continuation of therapy or discontinuation less than one month)  Outpatient HIV follow-up care not at a GHS affiliated clinic OBJECTIVES OUTCOME MEASURES RESULTS METHODS Antiretroviral Therapy Indication Secondary Outcomes CONCLUSIONS 930 Parameter Patients n=36, (%) Sex Males27 (75) Age, years Median43 Range18-62 Race, n=36 African American35 (97) Caucasian1 (3 Antiretroviral Agents, number (%) Protease Inhibitors Nucleoside Reverse Transcriptase Inhibitors Lopinavir/rtv20 (55)Tenofovir21 (58) Atazanavir/rtv3 (19)Emtricitabine21 (58) Nelfinavir2 (6)Zidovudine14 (39) Daurunavir/rtv1 (3)Lamivudine13 (36) Fosamprenavir/rtv1 (3)Abacavir3 (8) Didanosine2 (6) Non-Nucleoside Reverse Tanscriptase Inhibitors Efavirenz8 (22) Nevirapine1 (3) Baseline Characteristics Presented at the 45 th Annual IDSA Meeting, October 4-7 2007, San Diego, California RESULTS (CONTINUED) Percent of patients with defined diagnosis, n=36 Background: Combined antiretroviral therapy (CART) is recommended in all patients with an AIDS defining illness. In the past few years patients have been started on CART for urgent indications during their hospitalization. However, little is known on the outcome of those patients. Methods: This is a retrospective chart review of HIV/AIDS hospitalized patients from 8/1/06 to 3/31/07 who initiated CART during their hospital stay. Excluded were those who continued or restarted CART, and those who did not have follow up at an affiliated clinic. Demographic data, rationale for initiating CART, date of initiation, baseline and subsequent HIV viral load and CD4 count, 6 month mortality, pharmacy pick up as well as frequency of medical follow up were collected. Outcome measures included: proportion on CART at 1, 3, 6 months, percentage with undetectable viral load (UVL [<400 copies/ml]), mean CD4 count and mortality at 3 and 6 months. Analysis of the data for continuous and categorical variables were performed using SAS 9.1. Results: Forty four patients were identified, of which 36 met inclusion criteria. Median age was 43 years, 27 (75 %) male, 35 (97%) Aftrican Americans. Principal reasons for starting inpatient CART were: HIV-associated dementia complex (25%), HIVAN (14%), KS (11%), cryptosporidiosis (11%), PML (6%), PCNSL (3%). One month after initiation, 79% of 28 patients had continued CART uninterrupted, 64% of 25 at 3 months, and 65% of 17 at 6 months. At three months, 86% of 22 patients had UVL. At six months, 64% of 14 patients had UVL. The median CD4 count at baseline was 16, at 3 months 64, and at 6 months 64 cells/mm 3 for 36, 24 and 14 evaluable patients respectively. Re-hospitalization rates were 11% at 1 month, 34% at 3 months and 53% at 6 months. Mortality rates were 8% at 1 month, 17% at 3 months and 22% at 6 months. Conclusions: This study showed that few patients who initiated CART in the hospital remained on it, with the greatest drop off at month after discharge. There is a need to intensify our follow up of those patients at discharge  Majority of patients discontinued CART prior to study completion  Undectable HIV viral loads achieved and CD4 counts increased over time ParameterPatients (%) Undetectable HIV viral load [<400 copies/ml] Month 3 (n=22) Month 6 (n=14) 19 (86) 9 (64) CD4 count (cells/mm3) Median (Range) Baseline (n=36) Month 3 (n=24) Month 6 (n=14) 16 (2 – 277) 64 (6 – 971) 64 (5 – 500) TimeRe-hospitalizationProvider follow-up Month 1 Month 3 Month 6 11% (n=35) 34% (n=29) 53% (n=19) 66% (n=32) 66% (n=29) 84% (n=19) Correspondence: Leigh E. Efird, PharmD Johns Hopkins Hospital Department of Pharmacy 600 N Wolfe St Baltimore, MD 21287 lefird1@jhmi.edu Pager: (410) 434-1108 Disclosure The authors of this presentation have the following disclosures concerning possible financial or personal relationships with commercial entities: Leigh Efird: Nothing to disclose;,Manish Patel: Nothing to disclose; Minh Nguyen: Nothing to disclose Duration of Uninterrupted CART