Abstract
ABSTRACTOBJECTIVE To evaluate the effectiveness of antiretroviral therapy and the associated factors according to the type of regimen used: Single Tablet Regimen or Multiple Tablet Regimen.METHODS Prospective cohort of 440 patients (male, 74.3%, median age, 36 years old) who initiated antiretroviral therapy between Jan/14 and Dec/15 at a referral service in Belo Horizonte. Efficacy was defined as viral suppression (viral load, VL < 50 copies/ml) and evaluated after six and twelve months of treatment. Sociodemographic, clinical and behavioral data were collected from clinical charts and from Information Systems. Multivariate analysis of overall effectiveness was performed by logistic regression.RESULTS Most patients initiated Multiple Tablet Regimen antiretroviral therapy (n = 255, 58%). At six months, overall viral suppression was 74.6%, being higher among patients who used Single Tablet Regimen (80.6%, p = 0.04). At twelve months, 83.2% of patients reached viral suppression, with no difference between groups (p = 0.93). Factors independently associated with viral suppression at six and twelve months varied, being negatively associated with effectiveness: VL ≥ 100,000 copies/ml, symptoms of AIDS, longer interval time between diagnosis and initiation of antiretroviral therapy, antiretroviral switching, smoking or current illicit drugs usage (p < 0.05). Factors positively associated with viral suppression included adherence to antiretroviral therapy and category of risk/exposure of men who have sex with men (p < 0.05). Reaching viral suppression at six months was the main predictor of effectiveness at one year (OR = 8.96 and p < 0.01).CONCLUSIONS Viral suppression was high and better results were achieved for patients who used Single Tablet Regimen regimens at six months. Clinical, behavioral, and antiretroviral therapy -related factors influence viral suppression and highlight the need for interventions to increase early diagnosis and initiation of antiretroviral therapy, patient’s adherence, and to reduce illicit drugs and cigarette smoking in this population.
Highlights
An estimated 830,000 people were living with HIV in Brazil by the end of 2016, a prevalence of 0.4% in the general population
Factors independently associated with viral suppression at six and twelve months varied, being negatively associated with effectiveness: viral load (VL) ≥ 100,000 copies/ml, symptoms of AIDS, longer interval time between diagnosis and initiation of antiretroviral therapy, antiretroviral switching, smoking or current illicit drugs usage (p < 0.05)
Factors positively associated with viral suppression included adherence to antiretroviral therapy and category of risk/exposure of men who have sex with men (p < 0.05)
Summary
An estimated 830,000 people were living with HIV in Brazil by the end of 2016, a prevalence of 0.4% in the general population. This prevalence is higher among sex workers, injecting drug users, men who have sex with men (MSM), and persons deprived of libertya,b. Of this total, about 498 thousand people use antiretroviral therapy (ART), a coverage rate of 60%b. 22 antiretroviral drugs (ARV) are provided for HIV control, including the single-tablet regimen (STR) of tenofovir, lamivudine and efavirenz, listed in 2015c. Several clinical protocols, in agreement with the recommendations of the World Health Organization, favor the use STR as initial therapy2,d
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