Objectives To assess the attitudes and opinions about generic antiretroviral drugs (ARVs) and single-tablet regimen (STR) de-simplification among physicians prescribing HIV treatment in the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods An online questionnaire with 27 structured questions was sent to all physicians (n = 199) who prescribed ARVs among the 45 centres participating in the cohort. Results A total of 169 (84.9%) physicians answered the questionnaire. Only 4.1% of the physicians would never prescribe generic ARVs, but 53.3% would not prescribe them if the number of pills per day increased and 89.3% would not prescribe them if the number of doses per day increased. However, 84.0% of the physicians agreed to prescribe generic ARVs if doing so would decrease costs for the public healthcare system. The percentages of physicians stating that generic ARVs (compared with branded ones) would be associated with worse adherence, more adverse effects or more probability of virological failure, provided that the number of pills and doses per day would not change, were low: 0.6%, 7.7% and 3.6%, respectively. However, these percentages were much higher if the generic ARV entailed breaking an STR: 63.9%, 18.9% and 42.0%, respectively. Most physicians stated that they needed more information about the effectiveness and safety of generic ARVs and the price difference compared with their branded equivalents. Conclusions Although most physicians were confident about prescribing generic ARVs, the majority had strong concerns about de-simplifying STR, and they also needed more information about generic drugs.
Objectives We compared 48 week effectiveness and safety of first-line antiretroviral regimens. Methods We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting the most commonly used antiretroviral regimens from 2014 to 2018. We used multivariable regression models to assess the impact of initial regimen on: (i) viral suppression (VS) (viral load <50 copies/mL); (ii) change in CD4 cell count; (iii) CD4/CD8 normalization (>0.4 and >1); (iv) CD4 percentage normalization (>29%); (v) multiple T-cell marker recovery (MTMR: CD4 > 500 cells/mm3 plus CD4 percentage >29% plus CD4/CD8 > 1); (vi) lipid, creatinine and transaminase changes; and (vii) discontinuations due to adverse events (AE). Results Among 3945 individuals analysed, the most frequently prescribed regimens were ABC/3TC/DTG (34.0%), TAF/FTC/EVG/CBT (17.2%), TDF/FTC + DTG (11.9%), TDF/FTC/EVG/CBT (11.7%), TDF/FTC/RPV (11.5%), TDF/FTC + bDRV (8.3%) and TDF/FTC + RAL (5.3%). At 48 weeks, 89.7% of individuals achieved VS with no significant differences by initial regimen. CD4 mean increase was 257.8 (249.3; 266.2) cells/mm3, and it was lower with TAF/FTC/EVG/CBT and TDF/FTC/RPV compared with ABC/3TC/DTG. CD4 percentage normalization was less likely with TAF/FTC/EVG/CBT, and MTMR was less likely with TAF/FTC/EVG/CBT and TDF/FTC + RAL. The proportion of discontinuations due to AE was higher with TDF/FTC + bDRV (9.7%), followed by TDF/FTC/EVG/CBT (9.5%) and TDF/FTC + DTG (7.9%). Compared with ABC/3TC/DTG, cholesterol and LDL mean increases were higher with TAF/FTC/EVG/CBT and lower with TDF/FTC + DTG, TDF/FTC/RPV and TDF/FTC + RAL. Higher mean increases in triglycerides were significantly associated with TAF/FTC/EVG/CBT. Regimens containing DTG showed higher creatinine increases. Conclusions The significantly greater immunological response and safety of some combinations may be useful for making decisions when initiating treatment.
Objectives To pinpoint factors associated with low‐level viraemia (LLV) and virological failure (VF) in people living with HIV in the era of high‐efficacy antiretroviral treatment (ART) and widespread use of integrase strand transfer inhibitor (INSTIs)‐based ART. Methods We included adults aged > 18 years starting their first ART between 2015 and 2018 in the Spanish HIV/AIDS Research Network National Cohort (CoRIS). Low‐level viraemia was defined as plasma viral load (pVL) of 50–199 copies/mL at weeks 48 and 72 and VF was defined as pVL ≥ 50 copies/mL at week 48 and pVL ≥ 200 copies/mL at week 72. Multivariable logistic regression models assessed the impact on LLV and VF of baseline CD4 T‐cell count, CD4/CD8 T‐cell ratio and pVL, initial ART classes, age at ART initiation, time between HIV diagnosis and ART initiation, gender and transmission route. Results Out of 4186 participants, 3120 (76.0%) started INSTIs, 455 (11.1%) started boosted protease inhibitors (bPIs) and 443 (10.8%) started nonnucleoside reverse transcriptase inhibitors (NNRTIs), either of them with two nucleos(t)ide reverse transcriptase inhibitors (NRTIs). Low‐level viraemia was met in 2.5% of participants and VF in 4.3%. There were no significant differences throughout the years for both virological outcomes. Baseline HIV‐1 RNA > 5 log10 copies/mL was the only consistent predictor of higher risk of LLV [adjusted odds ratio (aOR) = 9.8, 95% confidence interval (CI): 2.0–48.3] and VF (aOR = 5.4, 95% CI: 1.9–15.1), even in participants treated with INSTIs. Conclusions The rates of LLV and VF were low but remained steady throughout the years. Baseline HIV‐1 RNA > 5 log10 copies/mL showed a persistent association with LLV and VF even in participants receiving INSTIs.
RESUMENLa hepatitis por el virus C (HVC) representa hoy un desafío mundial para la salud pública. Algunos grupos de usuarios de drogas en la UE tienen una prevalencia del VHC elevada en todas las regiones y con niveles de infección 20 veces superiores a los estimados para la población general.Las medidas preventivas en relación con la hepatitis han de reforzarse ya que, aunque la incidencia de la infección por VHC pueda estar descendiendo, la prevalencia de la enfermedad hepática por esta causa está en aumento, debido al largo período que transcurre, a menudo 20 años ó más, entre el comienzo de la infección y la aparición de las manifestaciones clínicas secundarias a la enfermedad hepática establecida. Las predicciones sobre morbimortalidad (cirrosis, hepatocarcinoma, etc.) asociadas al VHC muestran incrementos que superan el 100% para los próximos 15 años. Sin duda alguna el colectivo de drogodependientes aportará una parte importante de los afectados por las negativas consecuencias de la cronificación de la Hepatitis C. Algunos factores como la coexistencia de una infección por el VIH participarán en gran medida en los problemas relacionados con la hepatitis por el virus C. Además de proporcionar el tratamiento adecuado cuando proceda habremos de esforzarnos por mantener activas todas las estrategias que han demostrado su eficacia para prevenir la transmisión de infecciones entre usuarios de drogas.Palabras clave: Hepatitis C, uso de drogas, prevalencia, prevención. 1 Hepatitis por virus C y drogodependencias. ABSTRACTNowadays hepatitis C virus (HCV) represents a worldwide challenge for public health. Some groups of drug users in the EU have a high HCV prevalence in all regions and levels of infection 20 times more than those estimated for the population in general.Hepatitis preventive measures have to be reinforced as although the incidence of HCV infection could be falling, the prevalence of the hepatic disease it causes is rising, due to the lengthy period -often 20 years or more-that passes between the onset of the infection and the appearance of clinical manifestations secondary to the established hepatic disease. The morbid mortality predictions (cirrhosis, hepatocarcinoma, etc) associated with HCV show rises that exceed 100% for the next fifteen years.There is no doubt that the drug dependent collective will contribute an important number of those affected by the negative consequences of the chronification of Hepatitis C. Certain factors such as the coexistence of an HIV infection will also figure, to a large extent, in the problems related to the Hepatitis C virus. In addition to providing the adequate treatment as necessary, an effort must be made to actively maintain all the strategies that have shown their efficacy in preventing the transmission of infections between drug users. Hepatitis C, drug use, prevalence, prevention. L a hepatitis por el virus C (HVC) representa hoy un desafío mundial para la salud pública. Con una prevalencia media mundial estimada en torno al 3%, se sitúa como la ...
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