Experience of a National Advisory Board for the prescription of an optimal salvage ARV regimen in heavily treatment-experienced patients in Mexico
Y.A. Vargas-Infante1, L. Soto-Ramirez2, J. Andrade-Villanueva3, J. Sierra-Madero2, J.A. Mata Marin4, J. Gaytan-Martinez4, J. Casillas-Rodriguez5, S. Treviño6, L. Pérez Saleme7, F. Ortiz Luna1, J. Calva-Mercado1
1Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Clinical Epidemiology Unit, Mexico, Mexico, 2Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Infectious Diseases, Mexico, Mexico, 3Antiguo Hospital Civil de Guadalajara, HIV Clinic, Guadalajara, Mexico, 4Centro Medico Nacional La Raza, Infectious Diseases, Mexico, Mexico, 5Clinica especializada Condesa, HIV Clinic, Mexico, Mexico, 6Hospital Regional no.1 del IMSS, Internal Medicine, Mexico, Mexico, 7Centro Médico Nacional Siglo XXI, Infectious Diseases, Mexico, Mexico
Background: An advisory board (CORESAR) was created in 2008 by the Mexican Ministry of Health aimed at assuring the prescription of salvage ARV regimen with at least 2 fully active drugs and optimizing the use of the third line-ARV drugs in heavily treatment-experienced patients seen across the country. This is a descriptive analysis of the advisory board´s performance.
Methods: CORESAR is an interinstitutional group of 10 clinicians with known experience in ARV usage and an administrative team. This committee evaluates cases on individual-bases (based on history and resistance testing), distributes and regulates the newest ARV drugs, and follow-up all assessed cases.
Results: From Nov-08 to Jan-2010, CORESAR evaluated 393 cases treated in 30 states of Mexico. Three hundred and thirty two (84%) cases were men with a median age of 41 yrs-old (IQR 33.5,47) and with a 9-year period (IQR 5.5,11) since the diagnosis of HIV-infection. Twenty four (6%) had hepatitis B and 11(3%) hepatitis C coinfection. At the time of this analysis 223/266(84%) pts started therapy as recommended. Median time from case assessment and the shipment of the drug was 4 weeks (IQR 3,6). In 331(84%) cases a recommendation containing a third-line agent was given: raltegravir (RAL) 277(70%), darunavir (DRV) 254(65%), etravirine (ETR) 86(29%), enfuvirtide 40(10%), and tipranavir 11(3%). The most frequently prescribed combinations were: tenofovir (TDF) with or without emtricitabine (FTC)+ boosted DRV +RAL 94/393(24%); ETR+DRV/r+RAL 39(10%); and TDF (with or without FTC)+lopinavir/ritonavir+RAL 31(8%). Mortality was 14/393(3.5%) and the median cost by case in antiretroviral treatment was $1,213 USD/month IQI(907,1248) vs. $1,183 USD/month IQI(839,1552) for the regimen proposed by their physicians.
Conclusions: A centralized panel of experts has succeeded in advising salvage regimens likely to lead to maximal virologic suppression. Follow-up of these patients is underway to assess the virologic, immunologic and clinical impact of this strategy.
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