More than 80% of patients had drug-related problems, highlighting the need for inpatient antiretroviral stewardship.
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A pilot stewardship program led by an infectious diseases pharmacy resident at Upstate University Hospital found that more than 80% of hospitalized adults living with HIV (PLWH) experienced at least one antiretroviral therapy (ART)-related drug-related problem (DRP), underscoring a significant opportunity to improve inpatient HIV care through pharmacist intervention.
Between December 2024 and March 2025, 51 adult PLWH were included in a retrospective analysis after being admitted to the hospital. Patients on ART for other indications, such as hepatitis B virus, pre-exposure prophylaxis (PrEP), or post-exposure prophylaxis (PEP), were excluded from the study to focus exclusively on HIV treatment.
Among the included cohort, 80.4% (41/51) had at least one ART-related DRP, with a total of 88 issues identified. The majority of problems were linked to integrase strand transfer inhibitor (INSTI)–based regimens, especially bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), which accounted for more than 60% of DRPs. Nearly all DRPs (94.3%) were related to treatment effectiveness, while a smaller fraction (5.7%) involved safety concerns.
The most common issue was chelation-related drug interactions, particularly from coadministration of INSTIs with calcium, magnesium, or iron-containing agents, interactions that can reduce ART absorption. Other errors included incomplete or missing ART components and inappropriate dosing schedules.
Antiretroviral-related drug problems were identified in 80% of hospitalized adults living with HIV, primarily due to drug interactions and dosing issues.
Most issues involved integrase inhibitor–based regimens, especially bictegravir/emtricitabine/tenofovir alafenamide.
Pharmacist interventions were rapidly implemented and widely accepted, resolving all problems within 24 hours.
“These findings reflect how even simplified, once-daily ART regimens are vulnerable to inpatient medication errors without dedicated oversight,” said presenting author Hien Lam, PharmD, a PGY2 infectious diseases pharmacy resident certified in HIV care.
A total of 75 pharmacist interventions were made, with a 97.3% acceptance rate by providers. Notably, all DRPs were addressed within 24 hours of identification. Median time from admission to first chart review was 2 days, and most problems were flagged within 1 day of admission.
This pharmacist-led initiative, with oversight by an HIV-certified pharmacist, underscores the ongoing need for real-time antiretroviral stewardship in hospitals, especially as errors can easily occur when transitioning patients from outpatient to inpatient care settings.
The authors note that many prior studies on ART inpatient safety are outdated, and that their findings, particularly the high frequency of INSTI-related interactions, differ from earlier reports focused more on transcription or omission errors. The study supports expanding the role of HIV-trained pharmacists in managing hospitalized patients with HIV to ensure accurate ART administration and reduce risks of treatment failure or resistance.
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