Background Adherence of HIV patients to antiretroviral treatment has increased over time. This has led the infection becoming chronic and fewer changes being made to antiretroviral treatment in these patients.
Purpose To analyse changes in antiretroviral treatment (ART) for HIV patients and the economic impact over six months in a tertiary hospital.
Materials and methods Descriptive and retrospective study on antiretroviral treatment changes from July 2012 to December 2012 in a tertiary hospital. The ART changes were analysed, evaluating the following parameters: ART before/after, adherence to ART prior to and following the change, reason for the change of ART, cost before/after. Adherence was calculated in an indirect way through dispensing records for external patients. The reasons for changing treatment were grouped as adverse reaction (AR), virological failure (VF) and interactions with concomitant medicines (IM). The cost associated with the ART was calculated through the difference in average/patient/month cost before and after the change. The data was collected from the Athos APD management and dispensing program and Diraya digital clinical history.
Results Of the 615 patients who came to receive ART, 20 (3.25%) needed to change their ART. The previous treatments were: NRTI 5% (1), NRTI + NNRTI 40% (8), NRTI + PIs 45% (9) and PIs 10% (2). The reasons for changing treatment were: AR 76.19% (16), of which 25% (4) improved adherence and 62.5% (10) maintained good adherence; VF 14.28% (3), with 66.66% (2) maintaining good adherence and 33.33% (1) improving it; IM 4.76% (1) who improved adherence after changing ART. Within the AR group, 35% (7) was due to lipid/metabolic changes associated to PIs and efavirenz, 15% (3) gastrointestinal changes associated with PIs and etravirine, 15% (3) bone and nephrotoxicity changes associated with tenofovir, 5% (1) change in the central nervous system associated with efavirenz and 5% (1) skin reaction associated with abacavir. ART distribution after the change was: NRTI 5% (1), NRTI + NNRTI 20% (4), NRTI + PIs 25% (5), PIs 10% (2) and NRTI + INTEGRASE INHIBITOR 40% (8). The cost of ART before/after went from 622.14 € ± 112 to 680.3 € ± 140, relating to an increase in average spending of 58.69 €/patient/month.
Conclusions The adverse reactions to ART were the main reason for the change in treatment in our patients, relating to an average monthly cost increase. No association was found between the reasons for changing ART and the adherence of the same patients.
No conflict of interest.
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