Abstract
ABSTRACTObjective To describe antiretroviral treatment regimens prescribed and their compliance with the Clinical Protocol and Therapy Guidelines of the Ministry of Health for the management of HIV infection.Methods Observational and descriptive study. Secondary data of the state of Paraná (Brazil) on drugs, treatment regimens, lines of treatment and number of individuals on treatment, from January to June 2018, were accessed at the Antiretroviral Agents Logistic Control System. Combinations of antiretroviral drugs (treatment regimens) were compared according to the current Clinical Protocol and Therapy Guidelines and non-compliances were classified and quantified.Results In Paraná, 35,127 individuals with HIV were treated with 253 different treatment regimens. Of the prescribed regimens, 19.1% were first-line, 27.4% second-line and 48.5% third-line. Among non-compliances, the most prevalent were absence of association of protease inhibitors and ritonavir (42.8%), low efficacy triple therapy (36.9%), double therapy (26.1%), monotherapy (20.3%), and triple therapy of nucleoside analog reverse transcriptase inhibitors (17.1%).Conclusion Most individuals receiving HIV treatment in the state of Paraná are on treatment regimens established in the current Clinical Protocol and Therapy Guidelines, which contributes to successful therapy. However, associations not provided by the current Clinical Protocol and Therapy Guidelines were identified in the initial treatment lines, which could lead to ineffectiveness, virologic failure and viral resistance.
Highlights
The infection caused by the human immunodeficiency virus (HIV) is a major issue for community health in Brazil and worldwide, due to morbidity and mortality, and the consequent impact on public health policies.[1]In 1996, federal law 9.313 was enacted and guaranteed access to antiretroviral therapy through the Unified Health System (SUS - Sistema Único de Saúde).(2) Studies have shown that this HIV infection control-oriented public policy contributed significantly to the reduction in mortality and hospitalizations due to HIV/AIDS in Brazil.[3,4]Currently, the SUS has 21 drugs available for controlling HIV infection
The SUS has 21 drugs available for controlling HIV infection. They are distributed into six distinctive pharmacological classes: nucleoside analog reverse-transcriptase inhibitors (NRTI) and nonnucleoside reverse-transcriptase inhibitors (NNRTI), which prevent replication of viral RNA inside TCD4+ cells; protease inhibitors (PI), which block the enzyme that breaks viral proteins synthetized in host cells; integrase inhibitors (INI), which inhibit the enzyme that integrates viral RNA to the DNA of host cells; fusion inhibitors (FI), which prevent the fusion of the viral membrane to the human cell membrane; and CCR5 inhibitors, which inhibit membrane proteins that bind to the HIV and prevent the infection in host cells.[5]
In the period from January to June 2018, 235 different treatment regimens prescribed to 35,127 individuals living with HIV/AIDS in Paraná were identified
Summary
In 1996, federal law 9.313 was enacted and guaranteed access to antiretroviral therapy through the Unified Health System (SUS - Sistema Único de Saúde).(2) Studies have shown that this HIV infection control-oriented public policy contributed significantly to the reduction in mortality and hospitalizations due to HIV/AIDS in Brazil.[3,4]. The SUS has 21 drugs available for controlling HIV infection They are distributed into six distinctive pharmacological classes: nucleoside analog reverse-transcriptase inhibitors (NRTI) and nonnucleoside reverse-transcriptase inhibitors (NNRTI), which prevent replication of viral RNA inside TCD4+ cells; protease inhibitors (PI), which block the enzyme that breaks viral proteins synthetized in host cells; integrase inhibitors (INI), which inhibit the enzyme that integrates viral RNA to the DNA of host cells; fusion inhibitors (FI), which prevent the fusion of the viral membrane to the human cell membrane; and CCR5 inhibitors, which inhibit membrane proteins that bind to the HIV and prevent the infection in host cells.[5]. If viral suppression and restoration of immunity is unsuccessful, second line
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