Background and importance Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) cause a significant economic impact on health systems worldwide. Guidelines and treatments are constantly renewing, and for this reason it is crucial to optimise these therapies.
Aim and objectives To identify and propose patients who could benefit from ART simplification, from dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) to dual therapy dolutegravir/lamivudine (DTG/3TC), and to analyse the economic impact of simplifying the regimen.
Material and methods A prospective study was conducted in a second level hospital in March 2020. All HIV patients with active ART (>6 months) with DTG/ABC/3TC were included. Patients who were candidates for simplification had to meet the following criteria: treatment with DTG/ABC/3TC for at least 6 months, absence of failure prior to another ART, undetectable plasma viral load (VL) for at least 6 months (undetectable being <50 copies/mL) and optimal adherence. Adherence was indirectly calculated by scoring the days that treatment was collected on time; 95% score or more was considered optimal. Adverse effects (AE) related to ART therapy were also recorded and taken into account, but they were not an indispensable requirement for simplification. Candidates were proposed to their doctor. The annual economic impact was evaluated by analysing laboratory sales prices in Spain and the number of patients who had a simplified ART.
Results 64 patients were included, 52(83%) were men, with a mean age of 48 (27–77) years. 38 (59%) patients had at least one prior ART and 10 (26%) of these patients failed on previous ART and consequently were excluded for simplification. Of the total number of patients receiving DTG/ABC/3TC, 50 (78%) presented undetectable VL, 44 (69%) had optimal adherence and 27 (42%) had some type of mild AE: 10 (37%) patients presented with neurological symptoms, 10 (37%) with dyslipidaemia and 7 (26%) with gastrointestinal upset. 31 (48%) patients met the criteria for simplification to DTG/3TC and 27 (87%) treatments were changed. This gave a saving of 49 288€ per year.
Conclusion and relevance The hospital pharmacist’s role is fundamental in ensuring the correct use of these therapies and identifying patients whose ART could be improved. The impact of simplifying ART not only contributes to economic sustainability but could also reduce possible AEs from the treatment. In this case, dyslipidaemia was a common AE. Removing abacavir from the therapeutic regimen could reduce the cardiovascular risk.
Conflict of interest No conflict of interest
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