Background The arsenal of drugs available to antiretroviral therapy (ART) is extensive. It’s important to optimise HIV treatment basing on recommendations established by experts.
Purpose To analyse prescription profile, treatment changes, causes and financial impact of the changes in a first level hospital.
Material and methods Observational retrospective study from January 2013 to March 2014. The variables studied included: demographics (age, gender), clinical data (age at diagnosis, HCV/HBV co-infection, stage, HLAB5701 allele, viral load (VL) and CD4 cells before/after the change, reason for change) and financial analysis (cost per month before/after the change). Data were obtained from medical records and the electronic prescription programme.
GESIDA 2014 recommendations were considered as therapeutic strategies to improve efficiency and safety.
Results Out of the 178 patients receiving ART, 40 (22.5%) patients, who switched treatment were analysed.
The average age was 44.7 (22–57), 72.5% were male, 60% co-infected with HCV. The most frequent stage was C3 (40%). The average time since diagnosis was 14.6 years.
Before changing treatment 62.5% patients had undetectable VL (68% for at least six months) and the mean CD4 cell was 596.68 cells/mm3. HLAB5701 determination was available only in 15% (100% negative).
Reasons for change were: 52.5% adverse reactions (ADRs) (38% renal failure), 12.5% prevention of ADRs, 10% virological failure, 10% development of resistance, 7.5% reduction in the number of tablets, 2.5% immune failure, 2.5% unknown reason and only 2.5% therapeutic simplification.
These changes assumed an average cost increase of 21% per patient/month.
With these data 25% of our patients could be candidates for monotherapy and 17.5% for changing the combination of NRTI (Tenofovir/Emtricitabine for Lamivudine/Abacavir).
Conclusion ART has a high impact on the hospital budget. It is necessary to include efficiency strategies in changes of treatment and ART initiation.
We suggest developing with the infectious unit a protocol consistent with the existing recommendations, including an algorithm to support medical decision-taking in the light of safety and efficiency criteria.
References and/or Acknowledgements No conflict of interest.
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