DI-029 Analysis of the modifications in antiretroviral treatment

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Abstract

Background

There are several circumstances for changing antiretroviral therapy (ART), such as drug toxicities, new comorbidities, pharmacological interactions, virologic failure, suboptimal regimen, difficulty adhering to the regimen or simplifications of the regimen.

Purpose

The object of the study was to describe the reasons of ART modifications during 2015 and 2016 and to determine whether treatment of hepatitis C virus (HCV) has had an influence.

Material and methods

ART modifications during 2015 and from January to September 2016 were revised. Baseline treatments, causes of changes in treatment and new schemes were analysed.

Results

During 2015, 113 ART modifications were detected. There were 32 changes (28.3%) because of drug toxicities; 18 (56.3%) were CNS toxicities (insomnia, abnormal dreams, dizziness, etc) and most were due to efavirenz. 16 ART changes (14.2%) were regimen simplifications and there were another 15 ART modifications (13.3%) due to virologic failure. 35 of the changes (31%) were because of interactions with prioritised direct antivirals in our hospital for the treatment of HCV. From January to September 2016, 56 changes were reported. 13 (23.2%) were because of a variety of drug toxicities, such as lipid abnormalities, CNS toxicity, gastrointestinal intolerance, hypophosphataemia and hyperbilirubinaemia, none of which were particularly prevalent. There were 8 simplifications of the ART (14.3%) and 4 changes because of virologic failure (7.1%). With respect to HCV, 23 changes (41.1%) were necessary owing to interactions with direct antivirals for HCV. In both periods, pregnancy, renal impairment, immunologic failure and other interactions were also documented as reasons for modifying ART.

Conclusion

All changes were well documented in the literature. During 2015, Eviplera (emtricitabine/rilpivirine/tenofovir) was included as an option in our hospital which may be the reason why many patients with intolerance to Atripla (emtricitabine/efavirenz/tenofovir) or ART combinations, including efavirenz, were switched to Eviplera. This implies more changes due to CNS toxicity and overall due to toxicity during 2015, compared with 2016. Coinfection with HCV is another reason for ART modification, at least during HCV therapy.

Conclusion

No conflict of interest

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