Suchergebnisse

Despite the increasing optimization of combined antiretroviral therapy (cART) regimens in the last decades, a significant percentage of patients still do not achieve viral replication control. We present a retrospective analysis focusing on human immunodeficiency virus (HIV)‐infected population on cART, followed at our ambulatory care clinic between 1st January and 31st December 2011, in order to identify the causes of virological failure. From the 1895 patients in our population we included 1854 in the study. Ten percent (187) of the included patients had detectable HIV RNA (≥40 cp/mL) at the time of last laboratory evaluation: 70,1% were males, mean age was 46 years and 72,7% were Portuguese. Patients with detectable HIV RNA were divided into group A (HIV RNA <200 cp/mL) ‐ 78 (41,7%) patients and group B (HIV RNA ≥200 cp/mL) 109 (58,3%) patients. The comparison of both groups revealed an higher mean count of TCD4+ (568 vs 334 cells/mm3; p<0,001) in group A, although similar mean TCD4+ count at time of cART initiation (276 vs 262 cells/mm3; p=0,412). Group A patients experienced longer exposure to cART (10 vs 8 years; p<0,05) and have undergone, on average, 3 previous regimens (p<0,05). With regard to cARV current regimen: 32,1% patients in group A and 30,3% in group B were prescribed non‐nucleoside reverse transcriptase inhibitors based regimes and 51,3% patients in Group A and 59,6% in group B were under cARV based on Protease inhibitors. The identified causes of virologic failure for patients with detectable HIV RNA were: poor adherence (54%); unsuccessful retention in care (14,4%); sporadic detectable HIV RNA (40≤viral load<200), "blips" (14,4%); mutations of resistance to ARVs (13,4%); intolerance to the current regimen (2,1%) and pharmacokinetics drug interactions (1,6%). The estimated rate of virological failure was 10,1% in this population. Insufficient adherence and unsuccessful retention in care were identified in 68,4% of treatment failed patients as main causes of virological failure. Failure of therapy due to intolerance or adverse effects was reported in 2,1% of cases, reflecting a better safety profile and tolerability of recent prescribed regimens. Early identification of causes of virologic failure, timely adjustment of therapeutic regimens, and the adoption of measures to promote adherence and retention in care are key factors for successful treatment of HIV‐infected patients.

Comparison of hospital admission causes for previously known (group A) and HIV‐infected patients diagnosed during in‐ward stay (group B), from 2009 to 2011. Retrospective evaluation of demographic, epidemiologic, clinical, immunologic, virologic and treatment parameters at time of admission. 1167 patients were admitted; of those 617 (52,9%) were HIV‐infected: 92% HIV‐1 and 8% HIV‐2. 83% had previously known HIV infection and 15% were diagnosed during hospital stay (missing data in 2%). 66% were male, mean age was 46 years and 52% were Portuguese. The most frequent transmission routes were heterosexual exposure (36%) and iv drug use (29%). Mean length of hospital stay was 17 days (group A) and 28 days (group B) (p = 0,004). At admission, the mean TCD4+ count was 280 cells/mm3 in group A, and 132 cells/mm3 in group B (p<0,001). The majority of group B patients had clinical or immunological AIDS criteria at admission (84%) while group A presented a 71% rate for the same parameter (p=0,011). In group A, 52% of patients were on antiretroviral therapy but of those only 33% presented undetectable HIV plasma RNA, non‐adherence being an important cause of therapeutic failure identified in 40% of cases. Respiratory infection was the principal cause of hospital admission in both groups (33% in group A vs. 35% in group B). The most prevalent nosological entities were community acquired pneumonia in group A (18,1% vs. 11,5%‐p=0,118) and Pneumocystis jirovecii pneumonia in group B (4% vs. 18%‐p<0,001). Mycobacterium tuberculosis was frequently identified as an agent of opportunistic infection (10% in group A vs. 24% in group B‐p=<0,001). HCV coinfection was a comorbidity found in 37% in group A vs. 11% in group B (p<0,001). Other relevant comorbidities were psychiatric disturbances (16% vs. 3%‐p=0,001) and neoplastic conditions (11% vs. 0%‐p=0,001), mostly present in group A. Mortality rate was not significantly different between groups (10% group A vs. 11% group B) (p=0,773). This analysis evidenced that, a significant percentage of HIV patients diagnosed at admission were late presenters. Slightly a half of patients with previous known HIV infection were prescribed cARV and only a third presented undetectable HIV viral load. Non‐adherence was a major concern in this population. Respiratory infections had a significant clinical impact in both groups, justifying the importance of vaccination prevention strategies in immunocompromised individuals.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK