Evaluation of Potential Drug-Drug Interactions among the People Living with HIV with Highly Active Antiretroviral Therapy at Kasturba Hospital

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8

Objectives: Safety concerns regarding severe adverse events associated with codeine have resulted in policy decisions to restrict its use in pediatrics both in Taiwan and other countries. The aim of this study is to investigate the epidemiology and determinants of codeine use in Taiwanese children, and to assess whether changes in prescription trends reflected the impact of regulatory action.  Methods: A population-based study was performed using the 2003 -2010 Taiwan’s National Health Insurance Research Database. Patients under 18 years who experienced an outpatient visit for upper respiratory infection (URI) or cough were identified as the study population. During the 8-year study period, annual data of codeine prescription rates of URI/cough visits were reported, and the Cochran-Armitage trend test was used to analyze prescription trends over time. For each URI/cough visit, characteristics of the patient and the prescriber were collected, and multivariable logistic regression models were used to explore significant determinants associated with the use of codeine.  Results: There were 11,627,125 URI/cough visits in children during 2003-2010. The prescription rate of codeine decreased from 6.2% to 3.7% of visits from 2003 to 2010 (p< 0.01 for trend) and plummeted after a regulatory action in 2007. Age-stratified analyses showed a greater reduction in the codeine prescription rates in children aged < 2 (from 4.3% to 0.2%) and those aged 2-5 (from 7.0% to 3.6%). Noteworthy, physicians at clinics (OR 6.54, 95% CI 5.65-7.57) and those in less urbanized area (OR 1.65, 95% CI 1.61-1.70) prescribed codeine more frequently. Most of the codeine prescriptions were for multiple-ingredient products, and the proportion of therapeutic duplication was 41.1% in 2010.  Conclusions: Although the prescription rate of codeine in Taiwanese children was greatly reduced after the regulatory action, more attention should be paid to the determinants of prescribing codeine and the high proportion of therapeutic duplication.

INFECTION – Clinical Outcomes Studies PIN1 Evaluation of Potential Drug-Drug Interactions among the People Living with HIV with Highly Active Antiretroviral Therapy at Kasturba Hospital Immadisetti K1, Poka P2, Rajesh R2, Varma M3 1Manipal University, manipal, India, 2Manipal college of pharmaceutical sciences, Manipal University, MANIPAL, INDIA, India, 3Manipal University, Manipal, India

Objectives: The main objective of this study was to evaluate drug-drug interactions(DDIs), estimate prevalence and identify significant risk factors contributing to all possible DDIs with different classes of Highly Active Anti-Retroviral Therapy (HAART).  Methods: A retrospective observational study was conducted on patients admitted between January 2014 to December 2014 in KMC hospital, South Western Coastal part of India. The DDIs were evaluated using the University of Liverpool Drug Interaction Database and were assessed , documented and classified based on three indications, red flag (contraindicated), orange flag (need close monitoring) and green flag (no significant interaction). Data entry and statistical analysis was done using software version of SPSS 15. Zero-inflated Poisson Regression was used to identify significant risk factors.  Results: Out of 700 HIV patients, 240 (34.28%) were prescribed with HAART therapy. The prevalence of DDIs among patients receiving HAART was found to be 44.58%. 267 DDIs were found among 107 patients. Red and orange flag DDIs were accounted to 14 (5.2%) and 253 (94.8%) respectively. The most common potential DDI was found between Lamivudine and Cotrimoxazole (13.85%). Efavirenz was found to have more interactions (18.35%) compared to other anti-retroviral drugs. The drug class most commonly implicated with DDIs (50.6%) was found to be Nucleoside Reverse Transcriptase Inhibitors(NRTIs). From our results, significant risk factors for DDIs were found to be presence of psychiatric disorders (p= 0.001,95% CI= 0.3-0.6), respiratory tract infections (p= 0.008,95% CI= 0.55-0.98), diabetes mellitus (p= 0.036,95% CI= 0.57-1.16), hypertension (p= 0.026,95% CI= 0.751.54), cardiovascular attack (p= 0.003,95% CI= 0.35-0.81), ischemic heart disease (p= 0.025,95% CI= 0.5-1.9) and pneumocystis carinii pneumonia(p= 0.002,95% CI= 0.651.6).  Conclusions: The risk of DDIs increases with the increased use of HAART and with treatment of comorbidities and opportunistic infections among people living with HIV. Therefore, Clinicians must concentrate on preventing potential drug interactions among patients receiving HAART therapy either by dose modification of the prescribed drugs or by using alternate therapy. PIN2 Reviewing the Economic Impact of Extending the National Immunization Program in Egypt Atef M, Khataby N Ministry of Health, Cairo, Egypt

Objectives: To compare various stakeholders policies to review the methodological approach of extending the national immunization program in Egypt for more than two years. Reviewing the cost effectiveness of adding rotavirus vaccines to the compulsory free schedule of vaccination in the health care facilities in Egypt compared to other low and middle income countries.  Methods: Review of the literature about the extended immunization programs in different countries. Reviewing the cost effectiveness modeling studies of adding rotavirus vaccines to the national immunization programs of some countries. In depth interviews with the national immunization program stakeholders in ministry of health and population in Egypt.  Results: It was found that it is highly cost effective to extend the immunization program in Egypt through the duration and the scope.  Conclusions: The ministry of health and population in Egypt should start extending the coverage ages in the national immunization program gradually and adding the rotavirus vaccines to the compulsory schedule. PIN3 Effect of Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers, and Statins on Sepsis-Related Outcomes

Suh JK1, Lee S2 1National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea, 2Seoul National University Hospital, Seoul, South Korea

Objectives: Inhibitors of the renin-angiotensin system, namely, angiotensinconverting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), and HMG-CoA reductase inhibitors, statins, have been reported to have anti-inflammatory effects. This study is to assess the association of ACEI, ARB, and statin with sepsis-related outcomes.  Methods: A retrospective cohort study was conducted using the Health Insurance Review and Assessment Service (HIRA) claims data. In adult patients hospitalized with sepsis in 2012, those who took ARB, ACEI, or statin 30 days before admission were identified. The outcomes were in-hospital death and length of stay (LOS) and the logistic regression and generalized linear model were carried out to examine the relation between the prior use of medication and the outcomes.  Results: A total of 27,365 sepsis patients were included in the analysis, where the number of patients taking ACEI, ARB, or statin prior to sepsis hospitalization were 1,207 (4.41%), 3,951 (14.44%), and 2,473 (9.04%), respectively. After adjusting for age, sex, characteristics of hospitalization, and comorbidities, prior use of ACEI (Odds Ratio (OR) 0.752, 95% Confidence Interval (CI): 0.661-0.855), ARB (OR 0.575, 95% CI: 0.532-0.621), or statin (OR 0.716, 95% CI: 0.651-0.788) were significantly associated with decreased in-hospital mortality. Although the treatment of ACEI, ARB, or statin before admission were related to increased LOS, prior use of ARB was only associated with increased LOS after excluding death cases (OR 1.24, 95% CI: 1.16-1.32).  Conclusions: Use of ACEI, ARB, or statin before hospitalization appeared to be associated with decreased mortality in sepsis patients. Further prospective randomized control trials are needed to evaluate the beneficial effect of ACEI, ARB, and statin in sepsis. PIN4 Australian Influenza National Surveillance Data (2009 to 2014) – Variations by Sex, Age Group, and Influenza Type Wong KC1, Luscombe G2 Sydney University, Bathurst, NSW, Australia, 2University of Sydney, Orange, NSW, Australia

1Western

Objectives: The World Health Organization evaluation on the first wave of 2009 H1N1 pandemics revealed that the outcome of infection was generally worse for females, but sex disparity in influenza infection has not been explored extensively. This study investigates sex disparity in laboratory-confirmed influenza notifications by age and influenza type.  Methods: The Australian National Notifiable Diseases Surveillance System Influenza Public Dataset (http://www9.health.gov. au/cda/source/pub_influ.cfm) was accessed on 13 March 2016. The variables in the dataset included: notification date, influenza type, age, sex, and Indigenous status. The dataset was analysed using IBM SPSS v22.  Results: A total of 236,241 cases of influenza were collected over six years, with Influenza A the most common sub-type. Considering all influenza types, males had a marginally higher number of notifications at ages 0 to 19 years. However, the number of female notifications overtook from ages 20 to 39 years, and the sex disparity became less pronounced from age 45 years onwards. Similar trends were observed regardless of influenza sub-type. There were 180,475 cases (76.4%) without identification of Indigeneity, which rendered the variable inappropriate for analysis.  Conclusions: This study on a large dataset revealed that the number of notifications of influenza infection was associated with sex and age. Notifications are influenced by utilisation of healthcare, and healthcare use is generally higher in females. We confirmed known, age-dependent sex disparity in influenza patterns independent of influenza subtype. Females aged 20 to 39 years had higher age-adjusted notification rates per 100,000 population, which is presumably related to being of child-bearing age, i.e. pregnancy-related reduced immunity against influenza. It is recommended that the surveillance authority should request information on pregnancy status. Other variables such as Indigenous status may shed light on susceptibility to influenza infection. These data are not universally recorded across Australia but are important to inform targeted preventive strategies.

PIN5 Disease Burden of Herpes Zoster in Taiwan: A Five-Year PopulationBased Study Lu W1, Chuang H1, Chen L2, Hsiao F1 University, Taipei, Taiwan, 2Taipei Veterans General Hospital, Taipei, Taiwan

1National Taiwan

Objectives: Herpes zoster has resulted in considerable morbidity and mortality worldwide. Previous studies which explored the epidemiology of herpes zoster were limited in one-year cross-sectional evaluation and focused on the high-risk population. Using National Health Insurance Research Database, this study investigated the disease burden of herpes zoster among the general population over a 5-year (2004-2008) period in Taiwan.  Methods: We identified patients who were newly diagnosed with herpes zoster as our study cohort and investigated incidence rates of herpes zoster in each age stage. The proportion of herpes zoster-related admission and post-herpetic neuralgia (PHN), defined as having at least one diagnosis of PHN during 90 to 180 days after the onset of herpes zoster, were also examined by age and gender.  Results: Between 2004 and 2008, about 0.6 million newly diagnosed herpes zoster patients were identified in Taiwan. The annual incidence rate of herpes zoster raised from 5.0 in 2004 to 5.6 cases per 1000 person-year in 2008 (p-value for trend < 0.01). The incidence increased with age, which was 3.5 cases per 1000 person-year in people younger than 50 but was 12 cases per 1000 person-year in the elderly. Seasonal variation in number of herpes zoster cases was observed. Most of cases were identified in summer. This seasonal effect, however, became unobvious among people in older age. Female accounted for the majority of herpes zoster cases. Nevertheless, male cases admitted for herpes zoster more and suffered from PHN more, especially in those aged 50 to 84.  Conclusions: This study revealed an increasing burden of herpes zoster in Taiwan. In addition, different management strategies may be warranted for herpes zoster patients in different