Background The increase in life expectancy in patients receiving antiretroviral therapy (ART) and the incorporation of new drugs into the market, significantly increases the cost associated with the treatment of human immunodeficiency virus (HIV). Therefore, it would be a convenient optimisation of ART regimens.
Purpose To identify patients with HIV infection who are candidates for replacement of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) – Truvada® – with abacavir/lamivudine (ABC/3TC) generic-based ART. To estimate the theoretical savings that would result from modifying the ART.
Material and methods Observational cross-sectional descriptive study that included all patients with ART at the current date (July 2017). Candidate patients for substitution of TDF/FTC for ABC/3TC were considered to meet the following criteria: TDF/FTC-based ART, HLA-B*5701 negative, plasma viral load <50 copies/mL for at least the past 6 months, CD4+≥200 cells/µl, hepatitis B virus markers negative (DNA HBV and HBAgS), absence of mutations in abacavir resistance, adherence ≥95%, absence of diagnosis of cardiovascular disease and percentage of cardiovascular risk in 10 years (Regicor equation)<10%. The data were extracted from a dispensing module of the hospital pharmacy programme and electronic health record. The theoretical savings were calculated as the difference between the current cost and the ABC/3TC substitution.
Results Four hundrd and eighteen patients were receiving ART. A total of 80 patients were on treatment with TDF/FTC, of whom 58 were males, mean age was 49.1±8.8 years. We identified 51/80 patients who met the criteria for ABC/3TC substitution, 20/80 patients who did not meet the criteria and 9/80 patients with no data were identified. The estimated theoretical economic savings of ART replacement for candidates to switch was €195,590/year.
Conclusion More than half of the patients are candidates to switch to the ART regimen (TDF/FTC to ABC/3TC). Consolidation of this strategy could lead to a saving of approximately 7.5% in annual expenditure on ART.
No conflict of interest
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