Analysis of antiretroviral therapy modification in routine clinical practice in the management of HIV infection

Abstract

ObjectivesThe main goal was to assess the reasons for antiretroviral therapy (ART) change in patients with HIV in a hospital setting in routine clinical practice. The economic impact of ART modification was also analysed.MethodsPatients with HIV who changed their ART between 24 November and 24 December 2014 were registered. Length of initial therapy, type of ART before and after therapy modification, and reasons for the ART change were analysed. To assess the economic impact, antiretroviral drug costs at the time of the study were recorded.ResultsOf a cohort of 3850 patients with HIV, 1976 attended for pharmaceutical care consultation at Hospital Universitario La Paz during the study period. Ninety-two patients (4.7%) had their ART modified. The median length of the previous therapy was 26 months (range 1–144). The most common initial therapy regimen was 2 nucleoside reverse transcriptase inhibitors (NRTI)+1 non-nucleoside reverse transcriptase inhibitor (NNRTI) (29.4%), and the most common one after modification was 2 NRTI+1 integrase strand transfer inhibitor (INSTI) (40.2%). Forty-three modifications were made because of toxicity and adverse effects (46.7%), 25 because of therapy simplification (27.2%), 16 because of treatment failure (17.4%), and 8 because of drug–drug interactions (8.7%). ART costs increased by a mean of €14 (SD €216; range −€528 to +€831) per month per patient after therapy modification at the time of study.ConclusionsToxicity and adverse effects were the most common reason for ART alteration in patients with HIV in routine clinical practice in a hospital setting. Better knowledge about factors that motivate these changes may contribute to decreased toxicity and increased treatment success. ART modification had a variable but not very substantial economic impact.

A meta-analysis comparing 48-week treatment outcomes of single and multi-tablet antiretroviral regimens for the treatment of people living with HIV

“…Ten studies were summarized in the previous review [ 11 ]. Three additional studies were identified and are reported in this publication [ 23 , 44 , 45 ]. One study, evaluating overall ART changes in 3850 PLWH, found that modifying therapy resulted in a mean additional cost of €14 (SD €216; range −€528 to +€831) per month per patient [ 44 ].…”

“…Three additional studies were identified and are reported in this publication [ 23 , 44 , 45 ]. One study, evaluating overall ART changes in 3850 PLWH, found that modifying therapy resulted in a mean additional cost of €14 (SD €216; range −€528 to +€831) per month per patient [ 44 ]. Toxicity and therapy simplifications were cited as the leading causes for regimen changes [ 44 ].…”

“…One study, evaluating overall ART changes in 3850 PLWH, found that modifying therapy resulted in a mean additional cost of €14 (SD €216; range −€528 to +€831) per month per patient [ 44 ]. Toxicity and therapy simplifications were cited as the leading causes for regimen changes [ 44 ]. Economic outcomes have been modeled using simulations and insurance claims data including comprehensive computer-based microsimulation to compare the cost-effectiveness of STR to MTR for initial treatment and concluded that the ICER of STR to MTR is $26,383 per quality-adjusted life year [ 45 ].…”

Temporal evolution of antiretroviral therapy (2017-2021): analysis of treatment change and its economic impact

“…En este estudio retrospectivo describimos la evolución de la terapia antirretroviral en los últimos 5 años. Si analizamos estudios previos, como el de Korten et al [ 6 ] donde analizaban los motivos de cambio de TAR de 1ª línea (2011-2017), la interrupción por intolerancia/toxicidad fue la principal causa, mismo resultado que el obtenido en el estudio de SobrinoJiménez C. [ 7 ] durante diciembre del 2014. En ambos estudios el esquema ITIAN más frecuente era el que contenía tenofovir disoproxil en su forma de sal de fumarato (TDF), destacado por su toxicidad renal y ósea, y, a pesar de que estas toxicidades ya venían descritas en las guías, no fue hasta el 2018 cuando la guía geSIDA [ 8 ] menciona en sus recomendaciones de esquemas preferentes el uso únicamente de la forma tenofovir alafenamida (TAF).…”

Novel Delivery Systems for Oral Administration of Enfuvirtide: New Treatment Options for HIV/AIDS

“…The management of HIV predominantly revolves around a multifaceted approach, encompassing highly active antiretroviral therapy (HAART), consistent monitoring of viral load and CD4 cell count, and the implementation of lifestyle modifications conducive to overall health. [1][2][3][4] HAART stands as the established standard for managing HIV infection, a condition that currently remains without a definitive cure. [5][6][7] The concurrent administration of a combination of antiretroviral drugs, each targeting distinct viral components, serves to uphold the immune system's functionality and act as a deterrent against potentially fatal opportunistic infections.…”