Estimating the length of the first antiretroviral therapy regiment durability in São Paulo, Brazil

Abstract

Brazil was the first country to provide unrestricted, cost-free access to antiretroviral (ARV) medicine for AIDS treatment. However, there is little data about the benefits of such a policy for these patients. We evaluated the duration of benefit obtained with the introduction of ARVs, defined as the durability of the first ARV regiment. We reviewed the medical charts of patients attended from 1996-2000, at the outpatient clinics of the Federal University of São Paulo, Brazil. A total of 120 drug-naive HIV-1 infected patients were eligible to participate in the study. About half of the individuals (53%) presented with disease symptoms; 59% of them had CD(4) count below 200 cells/mm(3). Mean estimated duration of the benefit of therapy was 14.1 months. The most used regimen in this cohort was Zidovudine/3TC/Indinavir (26%), followed by Zidovudine/DDI (17%), and Zidovudine/3TC/Nelfinavir (13%). The most frequent cause of interruption of therapy was gastrointestinal intolerance. Use of treatment regimens with three drugs was more effective than with two drugs, but only for patients with CD(4)<200 cells/mm(3) or CV>100,000 copies RNA/mL. However, the use of triple therapy was associated with a significantly higher probability of reaching maximum viral suppression, during a longer period (p<0.05). The patients enrolled in the study benefitted from therapy for a limited time, after the introduction of double or triple antiretroviral therapy. The incidence of adverse events was significantly associated with loss of the benefits provided by the initial therapeutic regimen.

Characterization of virologic failure after an initially successful 48-week course of antiretroviral therapy in HIV/AIDS outpatients treated in Santos, Brazil

“…We found that patients in stable marital relationships maintain undetectable viral loads for a longer period of time, probably reflecting more propitious conditions for the use of this medication in patients with stable family relationships. We did not observe any difference among individuals of different educational levels in terms of viral suppression, a finding that is in contrast with those of other studies conducted in Brazil [21]. This suggests that despite the fact that, in Brazil, HIV tends to affect individuals of lower socioeconomic status, antiretroviral therapy can be used appropriately, provided these patients are properly instructed and motivated.…”

“…However, the results are similar to the findings reported for public and private urban clinics in the USA [2], Europe [9] and Brazil [20,21].…”

“…However, there are no sequential data regarding the maintenance of these values. Additional data reported that the median time to virologic failure was approximately 14 months among Brazilian treatment-naïve patients [21], and presumably, antiretroviral treatment failure rates are higher among those receiving sequential treatment.…”

Initial antiretroviral therapy in a 20-year observational cohort of patients followed at a reference center in the City of São Paulo, Brazil

“…A point that should be underscored is the duration of initial treatment, 30 days or less for 7.5% of individuals, and one year or more for 54.5% of patients. A study to estimate length of the first antiretroviral therapy regimen in an outpatient setting in São Paulo found that almost one third of patients were unable to maintain the same treatment for six months, and only 25% did not change their regimen during a one year follow-up 18 , which may be an indication of better adherence to treatment of CRT patients.…”

HIV-1 resistance testing influences treatment decision-making

“…1 In some developing countries where antiretrovirals are widely available, one study showed that the median time to loss of treatment benefi t was approximately 14 months among treatment-naïve patients. 2 As a result of antiretroviral failure, resistance has been increasingly detected, 3 even in developing countries. An analysis of 791 samples submitted for resistance testing in Brazil revealed that 96.6% of the samples had primary resistance-associated mutations present in the reverse transcriptase coding region, and 90.3% had mutations in the protease coding region.…”