Background Currently, drugs for HIV treatment have an important financial impact in our hospital Pharmacy Department. Protease Inhibitor (PI) monotherapy is a useful tool that can be used for selected patients
Purpose To determine the proportion of patients on antiretroviral therapy (ART) who could benefit from simplification to Darunavir/Ritonavir (DRV/r) and evaluate its financial impact
Materials and Methods Retrospective study conducted in a primary hospital between September 2011 and September 2012. Patients included were those being treated for HIV infection. Simplification criteria  (CS) for DRV/r were the following: patients without a history of failure of Protease Inhibitors (PIs), undetectable viral load (VL < 50 c/mL) over the last 6 months, adherence to treatment >95% and/or intolerance to Nucleoside Reverse Transcriptase Inhibitors (NRTIs). We excluded HIV-2 patients, those co-infected with chronic hepatitis B virus or already treated with PI monotherapy (DRV/r). Clinical data were collected from medical and dispensing records from outpatients.
Results Patients on ART: 346. Of those, 34 patients met the CS. Their previous ARTs were: 18 with 2 NRTI+ 1 PI, 7 with 2 NRTI + 1 Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) and 9 with other ART. The most prevalent NRTIs, PIs and NNRTIs were tenofovir (76%), lopinavir (38%) and efavirenz (14%). There were 14 patients with no response to PIs, 68 with detectable VL, 89 with adherence <95% and 69 with intolerance to NRTIs. Average savings per patient/year: €3,246. Total savings: €110,378 per year (4.7% of the total HIV cost)
Conclusions Almost 10% of patients treated with HIV drugs could be on simplified treatment. 73% of previous ARTs were 2 NRTI plus 1 PI or NNRTI, which is consistent with reference clinical studies. Simplifying the treatment could improve adherence and tolerance in patients as well as cost effectiveness in the ambulatory management of these drugs.
EACS Clinical Guidelines, October 2011 (v.6).
No conflict of interest.
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