Impact of Comorbidities on The Risk And Cost of Hospitalization In Hiv-Infected Patients: Real World Data From The Abruzzo Region

Abstract

To study the efficacy and safety of a specific first line antiretroviral (ART) regimen composed of tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV), which was used until recently as the preferred first line treatment for adults in Brazil and is still amongst the recommended by the World Health Organization. Methods: In April, 2017, we conducted a systematic search of the literature in MEDLINE via Pubmed, Cochrane CENTRAL, EMBASE and Lilacs for cohorts that reported on toxicity or CD4 lymphocyte count or viral load among HIV-1 infected adults on first line ART. Only reports on naïve patients were considered. One arm of treatment must have consisted of TDF+3TC+EFV. Results: Our search yielded 441 abstracts, of which 36 registries were read in full, resulting in 5 papers that met all eligibility criterion. The cohorts included comprised 7275 patients mostly from African countries. The most frequent backbone comparators were zidovudine+lamivudine and stavudine+lamivudine, and as for 3º agents, nevirapine and ritonavir boosted lopinavir were most common. The average follow-up was 1 year from the start of treatment. The median age at treatment initiation was 43.6 years and the median CD4 count at baseline was 179.6 cells/mm3. Only one study disclosed effects on viral load, just as only another one reported on CD4 final count. Regarding toxicity, adverse events associated to efavirenz were reported in 4 of 5 studies, mainly associated to the central nervous system and rash. Zidovudine based regimens appear to be safer compared to tenofovir based treatment. ConClusions: Recently, the preferred first line regimen in Brazil traded the 3º agent efavirenz to dolutegravir, which appears to be wise, considering the adverse events associated to the former. Nonetheless, efavirenz is still widely used. It is difficult to study the efficacy and safety of one regimen specifically, however, it is of importance in order to optimize therapy.