JAC Advance Access published online on June 21, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn252
Original research |
Trends in the prescription of antiretroviral drugs and impact on plasma HIV-RNA measurements
1 Service of Pharmacy, Pharmacokinetics and Pharmacogenetics, Hospital Carlos III, Calle Sinesio Delgado 10, Madrid 28029, Spain 2 Service of Pharmacy, Hospital Severo Ochoa, Carretera de Madrid s/n, Leganés 28045, Spain 3 Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, Madrid 28029, Spain
Received 14 March 2008; returned 21 April 2008; revised 24 May 2008; accepted 26 May 2008
* Corresponding author. Tel: +34-91-4532500; Fax: +34-91-7336614; E-mail: vsoriano{at}dragonet.es
Background: The choice of antiretroviral drugs has evolved over the last decade. Recognition of trends and determinants of changes may help to make predictions on prescription patterns.
Methods: Longitudinal analyses were performed every 6 months from 1996 to 2006, of all HIV-infected individuals who attended at one HIV/AIDS referral centre located in Madrid, Spain.
Results: A total of 2602 different individuals attending during the study period were examined over 23 consecutive time-points. The number and proportion of patients under antiretroviral therapy significantly increased in the period 1996–99, with a plateau since then around 1100 patients, which represented around two-thirds of the patients seen at each time-point after the year 2000. The proportion of patients under antiretroviral therapy having undetectable viraemia significantly increased from 34.5% in 1996 to 80% in 2006. The relative use of nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) has risen in recent years, while prescription of non-nucleoside reverse transcriptase inhibitors has declined compared with the period 1999–2001, when it peaked. Among NRTIs, the use of zalcitabine, stavudine and didanosine has dramatically declined or vanished, while zidovudine, lamivudine, abacavir and tenofovir have gained relevance. Among PIs, indinavir and nelfinavir have almost disappeared, being replaced by ritonavir-boosted PIs, mainly atazanavir and lopinavir. After its first introduction in the year 1999, efavirenz has been generally preferred over nevirapine.
Conclusions: The choice of antiretroviral drugs has evolved during the last decade, with safety and convenience issues driving most changes in prescription patterns, while antiviral success has dramatically increased.
Key Words: antiretroviral therapy , protease inhibitors , non-nucleoside reverse transcriptase inhibitors , nucleoside reverse transcriptase inhibitors