Background and importance Antiretroviral therapy (ART) has evolved over the years, leading to a change in initial therapy strategies.
Aim and objectives To describe and compare the profile of patients who started ART in 2014 and 2018. To assess chosen treatment schemes and cost per patient.
Material and methods A retrospective, observational, descriptive study was conducted in HIV patients who started ART in 2014 and in 2018 in a second level hospital. Data collected from the electronic medical history and prescription programme were demographic data, transmission route, viral load (VL) and CD4 lymphocytes at the beginning and after 4 weeks of treatment, chosen ART and treatment cost/patient/year.
ResultsCombination ART therapy chosen in 2014: two nucleoside reverse transcriptase inhibitors (NRTIs) (87% tenofovir–disoproxil/emtricitabine (TDF/FTC) and 13% abacavir/lamivudine (ABC/3TC)), a non-nucleoside reverse transcriptase inhibitor (NNRTI) (13.3% efavirenz and 20% rilpivirine) or a protease inhibitor (PI) (46.7% darunavir–ritonavir (DRV/r)) or an integrase inhibitor (INSTI) (20% raltegravir).
Combination ART therapy chosen in 2018: two NRTIs (26.7% TDF/FTC and 53.3% ABC/3TC, 20% tenofovir–alafenamide (TAF)/FTC)) and a PI (20% DRV–cobicistat) or an INSTI (60% dolutegravir, 20% elvitegravir–cobicistat (ELV/c)). One patient initiated TAF/FTC+DRV+ELV/c due to a restrictive resistance profile. The cost of ART per patient/year was 8632€ in 2014 and 7405€ in 2018.
Conclusion and relevance The demographic profile of patients changed little over the study period. Sexual transmission continued to be the main route of infection despite official prevention strategies. The new recommendations for early initiation of ART in all HIV patients leads to better results than deferred treatment (higher values of CD4 at baseline and at 4 weeks, and more patients with indetectable VL). Our study reflected a decrease in the use of TDF/FTC as starting ART and TAF/FTC was introduced, a fact attributable to its better bone and renal safety profile. In turn, the use of INSTI associated with initial ART has increased due to its power and good tolerance. The cost/patient decreased slightly despite commercialisation of generics due to the appearance of INSTI and TAF.
References and/or acknowledgements No conflict of interest.
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