Antiretroviral changes during the first year of therapy

Abstract

Introduction:The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD 4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. Method: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. Results: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD 4 lymphocytes since fifth month (p<0.001). Conclusion:The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.

Statistical comments on “Antiretroviral changes during the first year of therapy”

“…We read with great interest a recent article by Bandeira et al 1 entitled "Antiretroviral changes during the first year of therapy." In this study, the authors investigated the first year of highly active antiretroviral therapy (HAART) in patients from a reference center on HIV/AIDS management in Fortaleza.…”

Pattern of and reasons for antiretroviral therapy regimen change among adult HIV/AIDS patients at regional hospital in Eastern Ethiopia: A 10-year retrospective study

“…10 Among the regimens initiated, stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) is the regimen with the foremost experience of change. 3,10–12…”

“…2,7–9 Similarly, ART regimen change during the first year of initial therapy is mostly due to toxicities. 10 Among the regimens initiated, stavudine (d4T)/lamivudine (3TC)/nevirapine (NVP) is the regimen with the foremost experience of change. 3,10–12…”

Preditores de excesso de peso em pessoas que vivem com HIV em uso de TARV: aspectos nutricionais, clínicos, sociodemográficos e comportamentais

“…Os fármacos são divididos em seis classes de acordo com os seus mecanismos de ação: inibidores da transcriptase reversa análogos de nucleosídeos (ITRN), inibidores de transcriptase reversa não análogos de nucleosídeos (ITRNN), inibidores da protease (IP), inibidores de fusão (IF), inibidores da integrase (INI) e inibidores de entrada (IE) (BANDEIRA et al, 2017 (COSTA et al, 2018). Logo após o diagnóstico, devese iniciar com a terapia para evitar a progressão da doença, para se alcançar melhores resultados clínicos e a redução do risco de transmissão (GUNTHARD et al, 2016).…”

“…Durante o uso da TARV deve-se monitorar através de exames laboratoriais a carga viral (CV) e a contagem de leucócitos TCD4, a fim de verificar a eficácia do tratamento em atingir redução da CV e aumento de CD4 (BANDEIRA et al, 2017). A Diretriz Terapêutica para manejo da infecção pelo HIV em adultos de 2015 estabeleceu que para pacientes em TARV, assintomáticos, com carga viral indetectável e contagem de linfócitos CD4>350 células/mm³, em duas determinações consecutivas num intervalo de pelo menos 6 meses, não deve ser solicitado pelo médico novos exames de CD4 (BRASIL, 2018b), por não trazer nenhum benefício ao monitoramento da doença e para se evitar custos desnecessários (VOGLER et al, 2018).…”