ABSTRACT
The Perfil-es study demonstrated that, while non-nucleoside reverse transcriptase inhibitor (NNRTI)-based initial antiretroviral therapy (ART) is more frequently used in human immunodeficiency virus (HIV)-infected naïve patients, ritonavir-boosted protease inhibitors (PI/r)-based regimens are the preferred option in patients with advanced infectious stages or high baseline viral load. The present analysis focused on the second phase of the Perfil-es study, where sociodemographic and clinical data were retrospectively collected from patients starting NNRTI- or PI/r-based regimens in order to identify factors that could influence the choice of initial ART. Patients' characteristics were compared by both bivariate and multivariate analyses. A total of 642 patients were evaluated. The main transmission group was men who have sex with men (MSM) (48%), and 24% of patients were coinfected with hepatitis B or C. Patients with cardiovascular risk accounted for 56%, and 15% had a neuropsychiatric history. Anxiolytics (29%), antidepressants (18%) and methadone (18%) were the most frequent concomitant medications. The use of PI/r-based regimens was more frequent in older patients, childbearing potential women patients coinfected with hepatitis B or C, and those with cardiovascular risk and a neuropsychiatric history. The presence of a neuropsychiatric disorder (OR: 1.912; CI 95%: 1.146-3.191; p < .05) and the use of concomitant medication (OR: 1.736; CI 95%: 1.204-2.502; p < .01) were identified as independent factors associated with the selection of PI/r-based regimens. MSM sexual conduct was the only independent factor related to the selection of NNRTI-based ART (OR: 0.699; CI 95%: 0.504-0.970; p < .05). Neither the physicians' characteristics nor the geographical area where HIV patients were attended influenced the choice of ART. In conclusion, patients' comorbidity, pregnancy potential and lifestyle seem to influence the choice of ART. Neuropsychiatric comorbidity and concomitant medication, mainly related to this condition, appear to be associated with the use of PI/r-based initial ART while MSM seem more likely to receive NNRTI-based regimens in Spain.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Protease Inhibitors/therapeutic use , Practice Patterns, Physicians' , Reverse Transcriptase Inhibitors/therapeutic use , Adult , Cardiovascular Diseases/complications , Coinfection/complications , Female , HIV Infections/complications , Hepatitis B/complications , Hepatitis C/complications , Humans , Male , Mental Disorders/complications , Mental Disorders/drug therapy , Middle Aged , Pregnancy , Retrospective Studies , Risk Factors , SpainABSTRACT
INTRODUCCIÓN: El objetivo del estudio Perfil-es era conocer, en la práctica clínica, la proporción de TARV de inicio basado en ITINAN o IP/r e identificar los factores implicados en la decisión terapéutica. Métodos Estudio observacional, retrospectivo en 65 hospitales. Resultados Se iniciaron 1.687 TARV: un 53% basado en ITINAN y un 42% en IP/r. Se analizaron 642 pacientes. El 72% presentaba un recuento de CD4 < 350 células/μl. Conclusión En España el TARV de inicio sigue siendo tardío. Los ITINAN son la elección más frecuente aunque los IP/r desempeñan un importante papel
INTRODUCTION: The purpose of Perfil-es study was to identify the proportion of patients starting ARV treatment based on NNRTIs or PI/r, and to identify the variables involved in the therapeutic decision-makingin standard clinical practice. METHODS: An observational restrospective study performed in 65 Spanish hospitals. RESULTS: Was a total of 1,687 starts: 53% with NNRTI-based regimen and 42% with PI/r, and of the642 patients analyzed, 72% had a CD4 count < 350 cells/l. CONCLUSION: The initiation of ARV treatment is still late in Spain. NNRTIs are the more frequent choice, although PI/r plays an important role
Subject(s)
Humans , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active/methods , Anti-Retroviral Agents/administration & dosage , AIDS-Related Complex/drug therapy , Retrospective Studies , Reverse Transcriptase Inhibitors/administration & dosage , Ritonavir/administration & dosage , HIV Protease Inhibitors/administration & dosage , Practice Patterns, Physicians'ABSTRACT
INTRODUCTION: The purpose of Perfil-es study was to identify the proportion of patients starting ARV treatment based on NNRTIs or PI/r, and to identify the variables involved in the therapeutic decision-making in standard clinical practice. METHODS: An observational retrospective study performed in 65 Spanish hospitals. RESULTS: Was a total of 1,687 starts: 53% with NNRTI-based regimen and 42% with PI/r, and of the 642 patients analyzed, 72% had a CD4 count<350 cells/µl. CONCLUSION: The initiation of ARV treatment is still late in Spain. NNRTIs are the more frequent choice, although PI/r plays an important role.
