Adesão a terapia com efavirenz, tenofovir e lamivudina antes e após a alteração pelo regime em dose fixa combinada

Abstract

Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression in HIV treatment. In Brazil, the prescription of ART follows the recommendations of the Clinical Protocols and Therapeutic Guidelines (PCDT) of the Ministry of Health. Until March 2015, first-line therapy included three drugs, Efavirenz (EFZ) + Tenofovir (TDF) + Lamivudine (3TC), requiring multiple tablets. Since then, these drugs are available in fixed-dose combination (FDC) to simplify treatment and improve adherence. The objective of the study was to evaluate the adherence to ART of patients using EFZ, TDF, and 3TC before and after the exchange for the DFC in Belo Horizonte. Adherence is measured by the Proportion of days covered (PDC) which was calculated by the ratio of the tablets dispensed for the period corresponding to the prescribed treatment. The date of the exchange constituted the baseline of the study. The follow-up period was 18 months before and after the exchange, totaling 36 months. The PDC was calculated considering the complete period of follow-up, and a trajectory analysis was performed through the monthly PDC. Were included in the analysis HIV-infected individuals aged 17 years who were using EFZ, TDF, and 3TC for at least 18 months, who switched to CFD with the same drugs and remained in use for 18 months after the exchange. Among the 1206 patients selected, the majority of the patients were male (74%), aged 25-39 years (37.5%), with an upper course (27.5%), receiving ART for 49 months or more (53%) and were attended in only one Medication Dispensing Unit (MDU) during the follow-up time (82.2%). At the beginning of the cohort, 36.7% of the patients presented TCD4> 500 cells/µl. After the exchange, 45% of the patients presented CD4> 500 cells/µl, and 41.5% had an increase in TCD4 <30%. The viral load at the beginning of the cohort was undetectable for 54.3% of the patients and, after the exchange, 60.6% had an undetectable viral load. In the univariate analysis, before the exchange for FDC, they were positively associated with adherence, being> 60 years old and having a college degree. And they were negatively associated with adherence, using ART for a period of> 49 months and being linked to smaller MDUs. After the exchange for FDC, it was positively associated with adherence to have upper course and, negatively, to use ART for a period> 49 months. In the trajectory analysis, 55% (662) moved to a higher level of adherence after the exchange, 40% (484) remained at the same level, and only 5% (60) changed to a lower level. This result shows that there was an increase in the probability of adherence after the exchange with the strategy of reducing the number of tablets and that the investigation needs to intensify in other aspects related to adherence.