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Whilst it may have been appropriate during the acute illness, prolonged discontinuation may have had an effect on the stability of co-morbid disease in the longer term.
Second, we analyzed the association between stock-out-related treatment modification or prolonged discontinuation and interruption in care or death in the 975 patients who were on cART for at least six months during the study period (Figure 1).
In this sensitivity analysis, drug stock-out was defined as any treatment prolonged discontinuation (more than one month), was not accompanied by a specific explanation in the medical record, and occurred during a period of shortages in one of the patient's antiretroviral drugs, as reported by the study center pharmacy.
It has been shown that prolonged discontinuation of ASA therapy increases thrombotic risk [ 4].
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Stock-out-related discontinuations continued to be independently associated with interruption in care or death (adjusted HR, 3.09; 95% CI, 1.36 7.05) when we assumed that all treatment prolonged discontinuations during drug shortage periods, as reported by the pharmacy, were due to drug stock-outs, regardless of the explanation in the patient's medical record (Table 3).
Drug stock-outs led to 72 prolonged treatment discontinuations and 98 regimen modifications, representing 11% of the 1,554 patients who started cART between February 1, 2006 and February 1 , 2007
If there is evidence of CI-AKI, it is recommended to repeat these tests on days 3 5 after contrast media administration, monitoring also urine output, and it is reasonable to prolong the discontinuation of the therapeutic treatment with NSAIDs, aminoglycosides, high dose diuretics, antineoplastic drugs, and metformin [ 70].
Treatment interruption, in contrast to lowering the dose, usually led to prolonged or permanent discontinuation of therapy.
In addition, it is important to recognize that adrenal suppression can persist for prolonged periods after discontinuation of GC therapy (32).
Median time from cART initiation to first prolonged stock-out-related discontinuation or modification was 9 months (IQR, 5 13).
Anti-TNF non-response (intentional steroid use) or clinical inertia (unintended prolonged steroid use without discontinuation) are both plausible explanations for our finding.
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