Use of new antiretroviral therapy in Brazil: preliminary analysis of physicians prescribers adherence to the therapeutic recommendations for multiexperienced people at Brazil Ministry of Health
R. Oliveira1, J. Monteiro2, R. Scapini2
1Ministry of Health of Brazil, Brazil's National Department of STD/AIDS and Hepatitis, Brasília, Brazil, 2Ministry of Health of Brazil, STD/AIDS and Hepatitis National Department, Brasília, Brazil
Background: Nowadays Brazil has a group of people living with aids who is multiexperienced in antiretroviral therapy (ART), of which genotypic profiles shows the need of new classes to support viral suppression and best quality of life. Brazil has policy of universal ART free access and introduced new classes to optimize ART regimens: enfuvirtide (fusion inhibitor,at 2005), darunavir (protease inhibitor, 2008) and raltegravir (integrase inhibitor, 2009). The number of people using raltegravir, since january to july (2009) was about 2000.
Methods: Researchers accessed the database of ART from the states with centralized authorization at STD/AIDS and hepatitis Department at Brazil's Ministry of Health about four months after the beginning of the use to obtain the reasons of raltegravir prescriptions, at this preliminary step. The actual recommendations from the advisory committee of experts say that this one could to be at the regimens of multiexperienced people , which have evidences of: failure in three classes (NRTI, NNRTI, PI), activity at protease inhibitors; or switch of enfuvirtide.
Results: At ten states, excluding São Paulo and others, the number of authorizations was 263, of which 197 presented evidence of failure at the three classes, and 66 for switch of enfuvirtide to raltegravir. 47 people used enfuvirtide at past regimens. At this preliminary sample the number of people who had failure of two classes (any combination above) was two, of which had kidney failure. No treatment was discontinued for adverse events.
1. Preliminarily observed that incorporate and disclose the criteria set of a new class by an expert committee makes easier the following recommendations for prescribers.
2. Even with control of variables a normative document can not address all the needs of one new drug.
3. Brazil needs to implement tool for monitoring and evaluation of the use of new corporate ART, in the current context.
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