Journal Information
Vol. 16. Issue 1.
Pages 27-33 (January - February 2012)
Share
Share
Download PDF
More article options
Vol. 16. Issue 1.
Pages 27-33 (January - February 2012)
Open Access
Durability of the first combined antiretroviral regimen in patients with AIDS at a reference center in Belo Horizonte, Brazil, from 1996 to 2005
Visits
2754
Flávia Andrade Ribeiro
Corresponding author
flaviar@hc.ufmg.br

Corresponding author at: Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil.
, Unaí Tupinambás, Marise Oliveira Fonseca, Dirceu Bartolomeu Greco
Medical School, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
This item has received

Under a Creative Commons license
Article information
Abstract

Finding a better first antiretroviral regimen is one of the strategies used to improve span and quality of life of HIV/AIDS patients. 891 patients were followed during 24 months or until interruption/abandonment of treatment, changing regimen or death. At the end of 6 months, 69% of the patients were still being treated with the first regimen, 54% at 12 months, 48% at 18 months and 39% at 24 months. AZT-3TC-EFV was the most prescribed regimen and with the lesser discontinuation. NNRTI regimens showed high effectiveness and durability compared to PI regimens. Irregular medication dispensation was the only risk factor for failure/interruption of treatment in multivariate analyses. Intolerance/adverse effects were mainly responsible for first regimen discontinuation, followed by abandonment/non-adherence and virologic failure. Results showed significant difference between causes of interruption of first HAART with higher percentage of intolerance/adverse effects with PI regimens and higher immunologic failure with NNRTI regimens. Even with the availability of more potent and tolerable drugs, lack of adherence to HAART and high level of adverse effects are still the most important barriers to prolonged success of treatment. This study adds relevant information about durability and effectiveness of HAART in the first decade of its use in Brazil.

Keywords:
HIV
AIDS
HAART
Durability
Efficacy
Full text is only aviable in PDF
References
[1.]
D. Nash, M. Katyal, M.W.G. Brinkhof, et al.
Long-term immunologic response to antiretroviral therapy in low income countries: a collaborative analysis of prospective studies.
[2.]
The ART-LINC Collaboration of the International Databases to Evaluate AIDS (IeDEA).
Antiretroviral theray in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens ans monitoring in sub-Saharan Africa, Asia and Latin America.
Trop Med Int Health, 13 (2008), pp. 870-879
[3.]
L. Ferradini, D. Laureillard, N. Prak, et al.
Positive outcomes of HAART at 24 months in HIV infected patients in Camboja.
[4.]
The Strategies for Management of Antiretroviral Therapy (SMART) Study Group.
Major Clinical Outcomes in antiretroviral therapy (ART)-naïve participants and in those not receiving ART at bseline in the SMART study.
J Infect Dis, 197 (2008), pp. 1133-1144
[5.]
E.S. Daar.
Potency and durability of antiretroviral therapy.
J Acquir Immune Defic Syndr, 34 (2003), pp. S111-S117
[6.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2006),
[6.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2008),
[8.]
Centers for Disease Control and Prevention – CDC. National Center for Infectious Diseases. Division of HIV/AIDS. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992; 41(RR-17), 1992. Available at: <www.cdc.gov/mmwr/> Acessed on: 26 Jan 2006.
[9.]
National Program of STD/AIDS. Boletim epidemiológico AIDS/DST, ano III, no. 1, 1a - 26a Semana Epidemiológica, janeiro-junho. Brasília; 2006.
[10.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (1996),
[11.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (1997),
[12.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (1999),
[13.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2000),
[14.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2001),
[15.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2002),
[16.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2003),
[17.]
National Program of STD/AIDS. Consensus for the treatment of adults and adolescents with HIV infection.
National Program of STD/AIDS.
Brazilian Ministry of Health, (2004),
[18.]
P.R.B. Souza Jr., C.L. Szwarcwald, E.A. Castilho.
Delay in introducing antiretroviral therapy in patients infected by HIV in Brazil, 2003–2006.
Clinics, 62 (2007), pp. 579-584
[19.]
P.F. Bonolo, C.C. César, F.A. Acúrcio, et al.
Non-adherence among patients initiating antiretroviral therapy: a challenge for health professional in Brazil.
AIDS, 19 (2005), pp. S5-S13
[20.]
L. Lignani Junior, D.B. Greco, M. Carneiro.
Avaliação da aderência aos anti-retrovirais em pacientes com infecção pelo HIV/AIDS.
Rev Saúde Pública, 35 (2001), pp. 495-501
[21.]
M. Dorrucci, P. Pezzotti, B. Grisorio, for the Italian Cohort of Antiretroviral-Naive Patients Study Group, et al.
Time to discontinuation of the first highly active antiretroviral therapy regimen: a comparison between protease inhibitor-and non-nucleoside reverse transcriptase inhibitor containing regimens.
AIDS, 15 (2001), pp. 1733-1736
[22.]
M.E. O’Brien, R.A. Clark, C.L. Besch, et al.
Patterns and correlates of discontinuation of the initial HAART regimen in a urban outpatient cohort.
J Acquir Immune Defic Syndr, 34 (2003), pp. 407-414
[23.]
K. Tashima, S. Staszewski, M. Nelson, et al.
Efficacy and tolerability of long term efavirenz plus nucleoside reverse transcriptase inhibitors for HIV-1 infection.
[24.]
J.R.P. Marins, L.F. Jamal, S.Y. Chen, et al.
Dramatic improvement in survival among adult Brazilian AIDS patients.
[25.]
M.B. Klein, P. Willemot, T. Murphy, et al.
The impact of initial highly active antiretroviral therapy on future treatment sequences in HIV infection.
AIDS, 18 (2004), pp. 1895-1904
[26.]
J.A. Bartlett, M.J. Fath, R. DeMasi, et al.
An update systematic overview of triple combination therapy in antiretroviral-naïve HIV-infected adults.
AIDS, (2006), pp. 2051-2064
[27.]
V. Montessori, N. Press, M. Harris, et al.
Adverse effects of antiretroviral therapy for HIV infection.
CMAJ, 170 (2004), pp. 229-238
[28.]
B. Ledergerber, M. Egger, M. Opravil, et al.
Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study.
Lancet, 353 (1999), pp. 863-868
[29.]
M. Egger, M. May, G. Chêne, et al.
Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies.
Lancet, 360 (2002), pp. 119-129
[30.]
A.C. Brito, C.L. Szwarcwald, E.S. Castilho.
Fatores associados à interrupção de tratamento antirretroviral em adultos com AIDS. Rio Grande do Norte, Brasil, 1999-2002.
Rev Assoc Med Bras, 52 (2006), pp. 86-92
[31.]
A.C. Brito, E.A. Castilho, C.L. Szwarcwald.
AIDS e infecção pelo HIV no Brasil: uma epidemia multifacetada.
Rev Soc Bras Med Trop, 34 (2001), pp. 207-217
[32.]
R. Medeiros, R.S. Diaz, A. Castelo Filho.
Estimating the length of the first antiretroviral therapy regiment durability in São Paulo, Brazil.
Braz J Infect Dis, 6 (2002), pp. 298-304
[33.]
G.M. Lucas, R.E. Chaisson, R.D. Moore.
Comparison of initial combination antiretroviral therapy with a single protease inhibitor, ritonavir and saquinavir, or efavirenz.
AIDS, 15 (2001), pp. 1679-1686
[34.]
A.C. Friedl, B. Ledergerber, M. Flepp, et al.
Response to first protease inhibitor-and efavirenz-containing antiretroviral combination therapy The Swiss Cohort Study.
AIDS, 15 (2001), pp. 2001
[35.]
The Antiretroviral Therapy in Lower Income Countries (ART-LINC) Collaboration, ART Cohort Collaboration (ART-CC) groups.
Mortality of HIV-1 infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries.
Copyright © 2011. Elsevier Editora Ltda.. All rights reserved
The Brazilian Journal of Infectious Diseases
Article options
Tools