The development of the nursing profession has continued to develop over decades. Whether it's a LVN, LPN, PCT, RN, BSN... certification you have earned, the standards of each program increases with every graduating class. The curriculum has expanded (at my school specifically) by incorporating different aspects of nursing, such as research. For this assignment, we simply had to find an article discussing evidenced-based research, present it in a specific "PICO paper" format, and use APA 6th edition.
TREATMENT FOR PATIENTS CO-INFECTED WITH HIV AND HCV
P = Patient/Problem = Sixty individuals co-infected with Hepatitis C (HCV) and Human Immunodeficiency virus (HIV)
I = Intervention = Twelve weeks of standard therapy with pegylated interferon-alfa and ribavirin in combination with a direct-acting agent, telaprevir
C = Comparison = Standard therapy alone
O = Outcome = Increased virologic response rate of co-infected patients with dual treatment
PICO question:
What is the effectiveness of dual treatment for patients co-infected with HIV as compared to patients receiving standard treatment alone?
Article Reference
Sherman, K. (2011). Telaprevir combination with peginterferon alfa - 2a/ribavirin in hcv/hiv co-infected patients: 24-week treatment interim analysis. Hepatology 2011, Abstract LB-8.
What Intervention is Studied?
Pegylated interferon-alfa and ribavirin in combination with a direct-acting agent, telaprevir, was the intervention evaluated in Sherman’s et al. (2011) research study.
What Outcome is Measured?
One of the outcomes measured is the increased virologic response rate, defined as undetectable Hepatitis C, to dual treatment.
Who is Studied?
Sixty patients co-infected with HIV and HCV were randomly assigned to receive twelve weeks of standard therapy with pegylated interferon-alfa and ribavirin, or to receive their current treatment with the addition of telaprevir. The initial twelve weeks was to be followed by a further thirty-six weeks on pegylated interferon and ribavirin alone. Race, age, and sex were not reported. The study took place in San Francisco, California.
What is the Research Design?
The study had a randomized control trial research design.
What are the Results?
Treatment with the protease inhibitor telaprevir, combined with standard therapy, led to twenty-four week virologic response rates of seventy-one percent. In contrast, fifty-five percent of patients getting standard treatment alone had undetectable hepatitis C virus after twenty-four weeks.
What is the Final Analysis?
Evidence was elucidated by Sherman’s et al (2011) randomized control study’s findings of increased virologic response rate with dual treatment as compared to standard treatment alone.
What are the Study’s Limitations?
The patients, all with the difficult to treat genotype 1 hepatitis C virus, were also stratified by their anti-HIV regimen into three groups: no therapy, efavirenz-based triple therapy, and atazanavir-based triple therapy. Patients taking efavirenz-based triple therapy required an increased dose of telaprevir to compensate. In previous studies, these patients were unable to participate due to drug interactions. The results only reflect a short-term switch and virologic response rates may not be sustained after treatment is discontinued.
What is the Practical Application of the Study’s Findings?
Patients co-infected with HIV and HCV receiving standard treatment, pegylated interferon-alfa and ribavirin, in combination with a direct-acting agent, telaprevir, yielded increased virologic response rates compared to patients receiving standard treatment alone. While there has been concern about drug interactions, especially for patients taking efavirenz, most people providing HIV care may be preparing co-infected patients by switching their regimens in advance of hepatitis treatment (Sherman, et al., 2011). The results reported are very encouraging and at the twenty-four week mark, there appears to be no adverse effect on HIV control.
