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Did Pharmacy Mix-Up Boost HIV Levels in Patient?

Lawsuit contends wrong dose led to drug resistance

FRIDAY, Dec. 28, 2001 (HealthDayNews) -- In a potentially precedent-setting lawsuit, a Boston man with AIDS is suing a nationwide pharmacy chain, claiming a botched prescription caused his body to become resistant to several of the life-saving drugs that treat his disease.

Adam Barrett, an intensive-care nurse, claims that a CVS pharmacist incorrectly gave him half the necessary dosage of a drug that helps keep the virus that causes AIDS from destroying the immune system. HIV-positive people must take their pills according to detailed instructions, or face the risk that the virus will mutate and become immune to the drugs.

CVS "just won't accept accountability for this error that they made," Barrett says.

A spokesman for CVS did not respond to a request for comment.

Barrett, 40, became infected with HIV, the virus that causes AIDS, in 1985. He later developed AIDS.

In 1989, he began taking the then-new drug AZT; in the mid-1990s, he moved on to the combination of drugs known as the AIDS "cocktail." Through this multi-pronged approach, he says, the drugs virtually eliminated the HIV in his body, bolstering his immune system.

Then in January 2001, Barrett got a refill at a CVS store for a drug called Crixivan and took it for three weeks. During that time, he noticed his lymph nodes became inflamed, which was a sign his immune system was overly active. He also felt tired, he says.

Then one day, he noticed he had been given 200-milligram Crixivan pills instead of the prescribed 400 milligrams. He'd been taking half the prescribed doses for almost a month, he says.

Barrett's doctor found that the level of HIV in his blood had increased rapidly from the almost indetectable amounts. Meanwhile, he had developed resistance not only to Crixivan, but to two other AIDS drugs, he says. He is now at least partially resistant to two more drugs, he says.

Barrett now takes a combination of five drugs and reports severe side effects, including nausea and stomach problems.

According to The Boston Globe, the CVS chain may claim in court papers that Barrett would have become immune to AIDS drugs anyway.

Indeed, researchers in San Diego reported recently that more than half the HIV and AIDS patients surveyed in 1996 had become resistant to at least one drug by 1998-99.

Barrett is asking for at least $257,000 to pay for lost wages from his job at Massachusetts General Hospital in Boston.

"As a medical professional, I'm responsible for my patients," he says. "And I expect the same from [CVS]."

Pharmacists use a variety of methods to double-check that their prescriptions are accurate, industry officials say.

Pharmacists generally check identification numbers on the labels of prescriptions and the pharmacy drug containers to make sure they match, says John Cronin, senior vice president and general counsel for the California Pharmacists Association.

Also, "a lot of pharmacies will actually open up the containers and show patients the contents so they can identify the drug and see if something looks unusual," he says.

But some pharmacists have no monitors but themselves. Although pharmacists must check the work of their employees who aren't certified to dispense drugs, states don't require that anyone double-check the pharmacists, says Kevin Kinkade, executive director of the Missouri Board of Pharmacy.

What to Do: Read more about drug resistance and AIDS from AIDSmeds.com, which is supported by drug companies. Learn about the basics of AIDS treatment at The Body.

SOURCES: Interviews with Adam Barrett, intensive-care nurse, Massachusetts General Hospital, Boston; John Cronin, PharmD, JD, senior vice president and general counsel, California Pharmacists Association, Valley Center, Calif.; Kevin Kinkade, RPH, executive director, Missouri Board of Pharmacy, Jefferson City
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