Adherence to Brazilian HIV-AIDS treatment guidelines: A 3-year retrospective analysis of dispensing data
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Universidade Federal de Minas Gerais
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Membros da banca
Resumo
Background: Brazilian HIV/AIDS therapeutic guidelines are reviewed regularly to provide updated guidance on antiretroviral treatment of people living with
HIV. Antiretroviral regimens are highly effective for
managing disease and preventing HIV dissemination.
Thus, to evaluate the appropriateness of their use is
crucial.
Objectives: Describe the profile of dispensing of antiretroviral regimens and the adherence to Brazilian
therapeutic guidelines for HIV treatment in adults.
Methods: Retrospective analysis of dispensing data of
antiretroviral drugs from HIV/AIDS public referral
centres in Minas Gerais state, Brazil. Data from the
Medication Logistics Control System from 2014 to
2016 were reviewed. Antiretroviral regimens were
classified into five categories according to 2014/2015
Brazilian guidelines: first line regimen – FLR, second
line regimen – SLR, salvage therapy – ST, other regimens – OR and non-recommended regimen – NRR.
Results: A total of 917,754 antiretroviral regimens
(equivalent to 696 different combinations and 42,302
patients) were dispensed: 60.3% FLR, 16.9% SLR,
3.2% ST, 19.3% OR and 0.3% NRR, being FLR,
SLR and ST in accordance with the guidelines. FLR
and SLR included most frequently combinations of
tenofovir (or zidovudine) + lamivudine + efavirenz (90.1%), and tenofovir (or zidovudine) + lamivudine +
boosted-atazanavir (87.1%), respectively. Raltegravir
and boosted-darunavir were the most frequent drugs
used in ST (89.3%). Roughly 67% (193/289 combinations) of the OR comprised tenofovir (or zidovudine) +
lamivudine + unboosted-lovinapir combinations. NRR
included tenofovir + didanosine associations (43.6%),
which could lead to pancreatitis and lactic acidosis.
Virologic effectiveness of darunavir- or saquinavirbased regimens would be prevented in 22.6% of
NRR as these antiretroviral drugs were contained in
unboosted preparations.
Conclusions: While demonstrating high agreement
with the national guidelines, the findings also showed
a considerable rate of OR and NNR. This highlights
the need for increased vigilance of dispensing of antiretroviral drugs in order to provide better clinical
outcomes.
Abstract
Assunto
HIV, AIDS, Tratamento
Palavras-chave
HIV, AIDS, Tratamento
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Departamento
Curso
Endereço externo
https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275