Patterns of antiretroviral drug prescripcion in 997 Colombian patients

Jorge Machado, John Alexander Alzate, .

Keywords: Acquired immunodeficiency syndrome/therapy, antiretroviral therapy, highly active, drugs, prescription, Colombia

Abstract

Introduction. Antiretroviral therapy for treatment of human immunodeficiency virus type 1 (HIV-1) infection has improved steadily since the advent of combination therapy in 1996.
Objective. The pharmacological therapies of the infection by HIV/AIDS were documented in order to determine if effective treatment regimes were prescribed.
Materials and methods. Pharmacological therapies of the human immunodeficiency virus infection were compared in 997 patients affiliated with the health security system, of both sexes and all ages. All had been in treatment for more than three months (July-September 2006) and were distributed in 15 Colombian cities. The data were retrieved from medication consumption files which were maintained by the institutions that had distributed medications to the selected patients.
Results. The average age of patients was 37.7±13.2 and 82.6% were men. All the patients received between three to five antiretrovirals.  The medications most commonly prescribed were nucleoside reverse transcriptase inhibitors (96.4%), nonnucleoside reverse transcriptase inhibitors (54.9%), protease inhibitors (39.8%) and others (0.4%). All of the doses were at recommended levels.The most common combinations were lamivudine-zidovudine-efavirenz (35%), lamivudine-zidovudine+lopinavir/ritonavir (8.4%), abacavir+lamivudine-zidovudine (5.5%), lamivudine-zidovudine+nevirapine (5.2 %) and others (45.9%), consisting of  65 different combinations.
Conclusions. All agents were used at internationally recommended doses and rational prescription patterns prevailed in the initial therapy. However, the use of 69 different associations suggested that after the beginning of treatment, clinicians do not have adequate criteria to prescribe in accordance with international guidelines of antiretroviral therapy; they adopt a variety of options that may be outside of established recommendations.

Downloads

Download data is not yet available.
  • Jorge Machado Grupo de Investigación de Farmacoepidemiología y Farmacovigilancia, Departamento de Ciencias Básicas, Universidad Tecnológica de Pereira, Pereira, Colombia Departamento de Farmacoepidemiología, Audifarma S.A., Pereira, Colombia
  • John Alexander Alzate Grupo de Investigación de Farmacoepidemiología y Farmacovigilancia, Departamento de Ciencias Básicas, Universidad Tecnológica de Pereira, Pereira, Colombia

References

1. Gottlieb MS, Schroff R, Schanker HM, Weisman JD, Fan PT, Wolf RA et al. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency. N Engl J Med. 1981;305: 1425-31.
2. Masur H, Michelis MA, Greene JB, Onorato I, Stouwe RA, Holzman RS et al. An outbreak of community-acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. N Engl J Med. 1981;305:1431-8.
3. Grenen WC. The molecular biology of human immunodeficiency virus type 1 infection. N Engl J Med. 1991;324:308-17.
4. Beyrer C. HIV epidemiology update and transmission factors: risk and risk contexts-16th International AIDS Conference epidemiology plenary. Clin Infect Dis. 2007;44:981-7.
5. Simon V, Ho DD, Abdool Karim Q. HIV/AIDS epidemiology, pathogenesis, prevention and treatment. Lancet. 2006;368:489-504.
6. Ministerio de Protección Social. Modelo de Gestión Programática en VIH/SIDA Colombia. Bogotá: Ministerio de Protección Social; 2006.p.11-3.
7. Hammer SM. Clinical practice. Management of newly diagnosed HIV infection. N Engl J Med. 2005;353: 1702-10.
8. Egger M, Pauw J, Lopatatzidis A, Medrano D, Paccaud F, Smith GD. Promotion of condom use in a high-risk setting in Nicaragua: A randomized controlled trial. Lancet 2000;355:2101-5.
9. Cogen M, Dellabeta G, Laga M, Holmes KK. A new deal in HIV prevention: Lessons from the global approach. Ann Intern Med. 1994;120:340-1.
10. Wegbreit J, Bertozzi S, DeMaria L, Padian NS. Effectiveness of HIV Prevention strategies in resource-poor countries: tailoring the intervention to the context. AIDS. 2006;20:1217-35.
11. Carpenter CJ, Fischl MA, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA et al. Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the International AIDS Society-USA Panel. JAMA. 1997;277:1962-9.
12. Hogg RS, OShaughnessy MV, Gataric N, Yip B, Craib K, Schechter M et al. Decline in deaths from AIDS due to new antiretrovirals. Lancet. 1997;349:1294.
13. Clavel F, Hance A. HIV drug resistance. Engl J Med. 2004;350:1023-35.
14. Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R et al. Positive effects of combined anti-retroviral therapy on CD4+ T cell homeostasis and func-tion in advanced HIV disease. Science. 1997;277:112-6.
15. Powderly WG, Landay A, Lederman MM. Recovery of the immune system with antiretroviral therapy: the end of opportunism? JAMA. 1998;280:72-7.
16. Sethi AK, Celentano DD, Gange SJ, Moore RD, Gallant JE. Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clin Infect Dis. 2003;37:1112-8.
17. Condra JH, Schleif WA, Blahy OM, Gabryelski LJ, Graham DJ, Quintero JC et al. In vivo emergence of HIV-1 variants resistant to multiple protease inhibitors. Nature. 1995;374:569-71.
18. Jacobsen H, Hanggi M, Ott M, Duncan IB, Owen S, Andreoni M et al. In vivo resistance to a human immunodeficiency virus type 1 proteinase inhibitor: mutations, kinetics, and frequencies. J Infect Dis. 1996; 173: 1379-87
19. Shafer RW, Winters MA, Palmer S, Merigan TC. Multiple concurrent reverse transcriptase and protease mutations and multidrug resistance of HIV-1 isolates from heavily treated patients. Ann Intern Med. 1998;128:906-11.
20. Erice A, Mayers DL Strike DG, Sannerud KJ, McCutchan F, Henry K et al. Primary infection with zidovudine resistant human immunodeficiency virus type 1. N Engl J Med. 1993;328:1163-5.
21. Murphy EL, Collier AC, Kalish LA, Assmann SF, Para MF, Flanigan TP et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med. 2001;135:17-26.
22. Lorenzi P, Yerly S, Abderrakim K, Fathi M, Rutschmann O, Overbeck J et al. Toxicity, efficacy, plasma drug concentrations and protease mutations in patients with advanced HIV infection treated with ritonavir and saquinavir. AIDS 1997;11:F95-9.
23. DAmato RM, DAquila RT, Wein LM. Management of antiretroviral therapy for HIV infection: Analyzing when to change therapy. Manage Sci. 2000;46:1200-13.
24. Gallant JE, DeJesus E, Arriba JR, Poznia AL, Gazzar B, Campo RE et al. Tenofovir DF, emtricitabine and efavirenz vs. zidovudine, lamivudine and efavirenz for HIV. N Engl J Med. 2006;354:251-60.
25. Richman D, Bozette S, Morton S Chien S, Wrin T, Dawson K et al. The prevalence of antiretroviral drug resistance in the US. AIDS. 2004;18:1393-401.
26. Ministerio de Salud de Colombia. Consejo Nacional de Seguridad Social en Salud. Acuerdo 228 de 2002. Bogotá D.C.: Ministerio de Salud; 2002.
27. Ministerio de Salud de Colombia. Consejo Nacional de Seguridad Social en Salud. Acuerdo 282 de 2004. Bogotá D.C.: Ministerio de Salud; 2004.
28. Ministerio de Salud de Colombia. Consejo Nacional de Seguridad Social en Salud. Acuerdo 336 de 2006. Bogotá D.C.: Ministerio de Salud; 2006.
29. D´Aquila RM, Wein LM. Management of antiretroviral therapy for HIV Infection: Modeling when to change therapy. Antivir Ther. 1998;3:147-58.
30. Isaza CA, Osorio FJ, Mesa G, Moncada JC. Patrones de uso de antihipertensivos en 11.947 pacientes colombianos. Biomédica 2002;22:476-85.
31. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, El-Sadr WM, Lundgren JD, Neaton JD, Gordin F, Abrams D et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355:2283-96.
32. Gebo K. HIV and aging: implications for patient management. Drug Aging. 2006;23:897-913.
33. Chen LF, Hoy J, Lewin SR. Ten years of highly active antiretroviral therapy for HIV infection. Med J Aust. 2007;186:146-51.
34. Ministerio de Protección Social. Guía para el manejo del VIH/SIDA basada en la evidencia. Diario Oficial. Bogotá D.C.: Ministerio de Protección Social; 2006.p. 245-57.
35. Shafer RV, Smeaton LM, Robbins GK, De Gruttola V, Snyder SW, DAquila RT et al. Comparison of four-drug regimens and pairs of sequential Three-drug regimens as initial therapy for HIV-1 infection. N Engl J Med. 2003;349:2304-15.
36. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents-A Working Group of the Office of AIDS Research Advisory Council (OARAC). Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Baltimore: OARAC; 2006.p.11-8.
37. Isaza CA, Moncada JC, Mesa G, Osorio FJ. Efectividad del tratamiento antihipertensivo en una muestra de pacientes colombianos. Biomédica. 2004; 24:273-81.

 

How to Cite
1.
Machado J, Alzate JA. Patterns of antiretroviral drug prescripcion in 997 Colombian patients. biomedica [Internet]. 2008 Mar. 1 [cited 2024 May 19];28(1):78-86. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/110

Some similar items:

Published
2008-03-01
Section
Original articles

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code