Adherence to Brazilian HIV-AIDS treatment guidelines: A 3-year retrospective analysis of dispensing data

• Autor(a) principal: Cassia Cristina Pinto Mendicino
• Data de Publicação: 2017
• Outros Autores: Leticia Penna Braga, Leonardo Vinicius Dias da Silva, Menezes de Padua
• Tipo de documento: Artigo de conferência
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: https://doi.org/10.1002/pds.4275; http://hdl.handle.net/1843/46344
• topic: HIV; AIDS; Tratamento; HIV; AIDS; Tratamento

Background: Brazilian HIV/AIDS therapeutic guidelines are reviewed regularly to provide updated guidance on antiretroviral treatment of people living with HIV. Antiretroviral regimens are highly effective for managing disease and preventing HIV dissemination. Thus, to evaluate the appropriateness of their use is crucial. Objectives: Describe the profile of dispensing of antiretroviral regimens and the adherence to Brazilian therapeutic guidelines for HIV treatment in adults. Methods: Retrospective analysis of dispensing data of antiretroviral drugs from HIV/AIDS public referral centres in Minas Gerais state, Brazil. Data from the Medication Logistics Control System from 2014 to 2016 were reviewed. Antiretroviral regimens were classified into five categories according to 2014/2015 Brazilian guidelines: first line regimen – FLR, second line regimen – SLR, salvage therapy – ST, other regimens – OR and non-recommended regimen – NRR. Results: A total of 917,754 antiretroviral regimens (equivalent to 696 different combinations and 42,302 patients) were dispensed: 60.3% FLR, 16.9% SLR, 3.2% ST, 19.3% OR and 0.3% NRR, being FLR, SLR and ST in accordance with the guidelines. FLR and SLR included most frequently combinations of tenofovir (or zidovudine) + lamivudine + efavirenz (90.1%), and tenofovir (or zidovudine) + lamivudine + boosted-atazanavir (87.1%), respectively. Raltegravir and boosted-darunavir were the most frequent drugs used in ST (89.3%). Roughly 67% (193/289 combinations) of the OR comprised tenofovir (or zidovudine) + lamivudine + unboosted-lovinapir combinations. NRR included tenofovir + didanosine associations (43.6%), which could lead to pancreatitis and lactic acidosis. Virologic effectiveness of darunavir- or saquinavirbased regimens would be prevented in 22.6% of NRR as these antiretroviral drugs were contained in unboosted preparations. Conclusions: While demonstrating high agreement with the national guidelines, the findings also showed a considerable rate of OR and NNR. This highlights the need for increased vigilance of dispensing of antiretroviral drugs in order to provide better clinical outcomes.