Assuntos
Dicetopiperazinas/uso terapêutico , Infecções por HIV/prevenção & controle , Inibidores de Integrase de HIV/uso terapêutico , Piridonas/uso terapêutico , Custos e Análise de Custo , Dicetopiperazinas/economia , Inibidores de Integrase de HIV/economia , Equidade em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Piridonas/economiaAssuntos
Dicetopiperazinas/administração & dosagem , Infecções por HIV/prevenção & controle , Inibidores de Integrase de HIV/administração & dosagem , Piridonas/administração & dosagem , Dicetopiperazinas/efeitos adversos , Dicetopiperazinas/economia , Dicetopiperazinas/farmacologia , Interações Medicamentosas , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/economia , Inibidores de Integrase de HIV/farmacologia , HIV-1 , Humanos , Profilaxia Pré-Exposição , Piridonas/efeitos adversos , Piridonas/economia , Piridonas/farmacologiaAssuntos
Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Oxazinas/uso terapêutico , Piperazinas/uso terapêutico , Piridonas/uso terapêutico , Criança , Inibidores de Integrase de HIV/economia , Compostos Heterocíclicos com 3 Anéis/economia , Humanos , Oxazinas/economia , Piperazinas/economia , Piridonas/economiaRESUMO
With the second-generation integrase inhibitors (dolutegravir and bictegravir) extending the attributes of earlier integrase inhibitors, three-drug regimens containing integrase inhibitors plus two nucleos(t)ide reverse transcriptase inhibitors are now widely recommended for first-line (initial) treatment of human immunodeficiency virus-1 infection. Led by dolutegravir plus lamivudine, two-drug therapy is emerging as a way to reduce antiretroviral therapy cost and adverse effects without compromising treatment options should virologic failure occur. Initial two-drug therapy has limitations, including the relative incompatibility with the coemerging concept of same-day antiretroviral therapy initiation.
Assuntos
Antirretrovirais/administração & dosagem , Antirretrovirais/farmacologia , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/administração & dosagem , Inibidores de Integrase de HIV/farmacologia , Antirretrovirais/efeitos adversos , Antirretrovirais/economia , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/economia , HIV-1/efeitos dos fármacos , Humanos , Resultado do TratamentoAssuntos
Darunavir/administração & dosagem , Farmacorresistência Viral/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/administração & dosagem , Inibidores da Protease de HIV/administração & dosagem , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Carga Viral/efeitos dos fármacos , Adulto , Darunavir/economia , Darunavir/uso terapêutico , Esquema de Medicação , Feminino , Inibidores de Integrase de HIV/economia , Inibidores de Integrase de HIV/uso terapêutico , Inibidores da Protease de HIV/economia , Inibidores da Protease de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/economia , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Masculino , Oxazinas , Piperazinas , Piridonas , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: To evaluate the cost-effectiveness of an integrase inhibitor (INI), dolutegravir (DTG), in combination with abacavir (ABC)/lamivudine (3TC) in France, in treatment-naive (TN) HIV adult patients. METHODS: The ARAMIS microsimulation Markov model, evaluates costs and effects of DTG vs. first-line ARVs options including INIs (raltegravir, elvitegravir/c), protease inhibitors (PIs) (darunavir/r, atazanavir/r, lopinavir/r), non-nucleoside reverse transcriptase inhibitors (efavirenz and rilpivirine). Efficacy and safety data were derived from phase III studies and network meta-analysis. Treatment algorithms were based on French guidelines and experts opinion. Costs included routine HIV and opportunistic infection care, and death. RESULTS: The model showed the fixed-dose combination DTG/ABC/3TC was more effective than all other recommended regimens: patients stayed longer on first-line, and lived longer and healthier. With the exception of EFV, DTG/ABC/3TC was more efficacious and less costly compared to all strategies. The cost per QALY gained (ICER) for DTG compared to EFV was 6,939. DTG/ABC/3TC was more efficacious and less costly compared to INIs and PIs in all deterministic sensitivity analyses. CONCLUSION: DTG/ABC/3TC was cost-effective in the management of HIV TN patients in France. These results are mainly explained by its lower price compared to other INIs and PIs, DTG's superior efficacy and high barrier to resistance.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Didesoxinucleosídeos/administração & dosagem , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Lamivudina/administração & dosagem , Adulto , Algoritmos , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/economia , Análise Custo-Benefício , Didesoxinucleosídeos/efeitos adversos , Didesoxinucleosídeos/economia , Combinação de Medicamentos , França , Infecções por HIV/economia , Inibidores de Integrase de HIV/administração & dosagem , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/economia , HIV-1 , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/economia , Humanos , Lamivudina/efeitos adversos , Lamivudina/economia , Cadeias de Markov , Oxazinas , Piperazinas , Guias de Prática Clínica como Assunto , Piridonas , Anos de Vida Ajustados por Qualidade de Vida , Resultado do TratamentoRESUMO
BACKGROUND: There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. METHODS: The HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year. FINDINGS: A transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost. INTERPRETATION: A future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in low-income settings in sub-Saharan Africa at any prevalence of pre-ART NNRTI resistance. The urgency of the transition will depend largely on the country-specific prevalence of NNRTI resistance. FUNDING: Bill & Melinda Gates Foundation, World Health Organization.
Assuntos
Análise Custo-Benefício/métodos , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/economia , Compostos Heterocíclicos com 3 Anéis/economia , Adolescente , Adulto , África Subsaariana , Inibidores de Integrase de HIV/uso terapêutico , Política de Saúde , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Pessoa de Meia-Idade , Modelos Econômicos , Oxazinas , Piperazinas , Saúde Pública , Piridonas , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Recommended human immunodeficiency virus (HIV) treatment regimens in the United States contain 3 antiretroviral agents, costing >$30 000/person/year. Pilot studies are evaluating the efficacy of dual therapy with dolutegravir (DTG) and lamivudine (3TC). We examined the potential cost-effectiveness and budget impact of DTG + 3TC regimens in the United States. METHODS: Using a mathematical model, we projected the clinical and economic outcomes of antiretroviral therapy (ART)-naive patients under 4 strategies: (1) no ART (for modeling comparison); (2) 2-drug: initial regimen of DTG + 3TC; (3) induction-maintenance: 48-week induction regimen of 3 drugs (DTG/abacavir [ABC]/3TC), followed by DTG + 3TC maintenance if virologically suppressed; and (4) standard of care: 3-drug regimen of DTG/ABC/3TC. Strategy-dependent model inputs, varied widely in sensitivity analyses, included 48-week virologic suppression (88%-93%), subsequent virologic failure (0.1%-0.6%/month), and Medicaid-discounted ART costs ($15 200-$39 600/year). A strategy was considered cost-effective if its incremental cost-effectiveness ratio (ICER) was <$100 000/quality-adjusted life-year (QALY). RESULTS: The 3 ART strategies had the same 5-year survival rates (90%). The ICER was $22 500/QALY for induction-maintenance and >$500 000/QALY for standard of care. Two-drug was the preferred strategy only when DTG + 3TC 48-week virologic suppression rate exceeded 90%. With 50% uptake of either induction-maintenance or 2-drug for ART-naive patients, cost savings totaled $550 million and $800 million, respectively, within 5 years; savings reached >$3 billion if 25% of currently suppressed patients were switched to DTG + 3TC maintenance. CONCLUSIONS: Should DTG + 3TC demonstrate high rates of virologic suppression, this regimen will be cost-effective and would save >$500 million in ART costs in the United States over 5 years.
Assuntos
Fármacos Anti-HIV/economia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Inibidores de Integrase de HIV/economia , Compostos Heterocíclicos com 3 Anéis/economia , Lamivudina/economia , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/economia , Contagem de Linfócito CD4 , Análise Custo-Benefício , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Lamivudina/uso terapêutico , Modelos Estatísticos , Oxazinas , Piperazinas , Piridonas , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To evaluate the cost-effectiveness of a new generation integrase inhibitor (INI), dolutegravir (DTG), in France, in treatment-experienced (TE) and INI-naïve HIV-infected adults with at least two classes resistance compared to raltegravir (RAL), by adapting previously published Anti-Retroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model. METHODS: ARAMIS is a microsimulation Markov model with a lifetime time horizon and a monthly cycle length. Health states are defined as with or without opportunistic infection and death. In the initial cohort, efficacy and safety data were derived from a phase III study comparing DTG to RAL. Antiretroviral treatment algorithms, accounting for patient history, were based on French guidelines and experts opinion. Costs are mainly including treatment costs, routine HIV and opportunistic infection care, and death. Utilities depend on CD4+ cell count and the occurrence of opportunistic infections. RESULTS: The ARAMIS model indicates in the TE population that DTG compared to RAL over a life time is associated with 0.35 additional quality-adjusted life years (QALY; 10.75 versus 10.41) and additional costs of 7,266 (390,001 versus 382,735). DTG increased costs are mainly related to a 9.1-month increase in life expectancy for DTG compared with RAL, and consequently a longer time spent on ART. The incremental cost-effectiveness ratio (ICER) for DTG compared with RAL is 21,048 per QALY gained. About 83% and 14% of total lifetime costs are associated with antiretroviral therapy and routine HIV care respectively. Univariate deterministic sensitivity analyses demonstrate the robustness of the model. CONCLUSION: DTG is cost-effective in the management of TE INI naive patients in France, from a collective perspective. These results could be explained by the superior efficacy of DTG in this population and its higher genetic barrier to resistance compared to RAL. These data need to be confirmed with longer-term real life data.
Assuntos
Análise Custo-Benefício , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/economia , Inibidores de Integrase de HIV/farmacologia , HIV-1/fisiologia , Compostos Heterocíclicos com 3 Anéis/economia , Compostos Heterocíclicos com 3 Anéis/farmacologia , Adulto , Farmacorresistência Viral , França , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Método de Monte Carlo , Oxazinas , Piperazinas , Piridonas , Anos de Vida Ajustados por Qualidade de VidaAssuntos
Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/economia , Compostos Heterocíclicos com 3 Anéis/economia , Custos de Medicamentos , Infecções por HIV/economia , Inibidores de Integrase de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Oxazinas , Piperazinas , PiridonasRESUMO
Since the discovery of HIV as the cause for AIDS 30 years ago, major progress has been made, including the discovery of drugs that now control the disease. Here, we review the integrase (IN) inhibitors from the discovery of the first compounds 20 years ago to the approval of two highly effective IN strand transfer inhibitors (INSTIs), raltegravir (Isentress) and elvitegravir (Stribild), and the promising clinical activity of dolutegravir. After summarizing the molecular mechanism of action of the INSTIs as interfacial inhibitors, we discuss the remaining challenges. Those include: overcoming resistance to clinical INSTIs, long-term safety of INSTIs, cost of therapy, place of the INSTIs in prophylactic treatments, and the development of new classes of inhibitors (the LEDGINs) targeting IN outside its catalytic site. We also discuss the role of chromatin and host DNA repair factor for the completion of integration.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/farmacologia , Inibidores de Integrase de HIV/uso terapêutico , HIV/efeitos dos fármacos , Farmacorresistência Viral , HIV/enzimologia , Infecções por HIV/virologia , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/economia , Humanos , Modelos Biológicos , Replicação Viral/efeitos dos fármacosRESUMO
PURPOSE OF REVIEW: There are at least seven million people eligible for antiretroviral treatment but not receiving it. An additional 19 million people will need to start treatment in the future, as their HIV disease progresses. Funding for Universal Access to HIV treatment has been restricted by the Global Financial Crisis. RECENT FINDINGS: There are three large randomized trials ongoing, designed to establish the efficacy of lower than approved doses of antiretrovirals. If successful, the results of these trials could lower costs of antiretrovirals and improve the safety profiles. Clinical trials evaluating efavirenz, atazanavir, ritonavir and stavudine are discussed. The costs of these and other antiretrovirals are presented. SUMMARY: The results of these trials could significantly lower the costs of Universal Access. Assuming 15 million people on antiretroviral treatment, the reduction in unit costs of tenofovir (TDF)/3TC/efavirenz from dose optimization of efavirenz to 400âmg once daily would save US$16 per person, leading to an overall saving of US$192 million per year. The switch from zidovudine (ZDV)/3TC/atazanavir (ATV)/r 300/100 once daily to dolutegravir along with ATV/r 200/50 once daily would save US$267 per person, leading to an overall saving of US$801 million. The combined saving in costs from first- and second-line treatment would therefore be US$993 million per year.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/economia , Custos e Análise de Custo , Infecções por HIV/economia , Inibidores de Integrase de HIV/administração & dosagem , Inibidores de Integrase de HIV/economia , Humanos , Nucleosídeos/administração & dosagem , Nucleosídeos/economia , Inibidores de Proteases/administração & dosagem , Inibidores de Proteases/economiaRESUMO
Raltegravir is a first-in-class HIV-1 integrase inhibitor with established antiviral efficacy in treatment-naive and treatment-experienced patients with multidrug-resistant HIV-1 infection. In this article, we summarize pharmacoeconomic evaluations of raltegravir-based treatment regimens, compared with alternative therapies, in the treatment of patients with HIV infection and/or AIDS. Cost-effectiveness evaluations of raltegravir in treatment-experienced patients conducted using a continuous-time, state-transition Markov cohort model suggest that raltegravir, combined with optimized background therapy, falls within the range that would generally be considered cost effective compared with optimized therapy alone in Spanish, Swiss and UK health systems. In treatment-naive populations, raltegravir was evaluated using a three-stage continuous-time state-transition cohort model. Raltegravir-based initiation treatment strategies (first-line raltegravir) were compared with protease inhibitor and non-nucleoside reverse-transcriptase inhibitor initiation strategies, in which raltegravir was retained for salvage therapy. First-line raltegravir was cost-effective versus retaining raltegravir for salvage therapy in several European populations. A separate economic model was used to evaluate first-line raltegravir against two alternative initiation regimens representing standard clinical practice in Australia; raltegravir proved to be cost effective in both scenarios. In all studies examined, results were sensitive to factors including treatment duration, mortality rate, analytic time horizon, health utility weights, cost of raltegravir and optimized therapy, incidence of opportunistic infection and discount rates. Nonetheless, raltegravir remained cost effective under most scenarios.
Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Inibidores de Integrase de HIV/economia , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Pirrolidinonas/economia , Pirrolidinonas/uso terapêutico , Austrália , Análise Custo-Benefício , Custos de Medicamentos , Farmacorresistência Viral , Europa (Continente) , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Inibidores de Integrase de HIV/efeitos adversos , HIV-1/patogenicidade , Humanos , Cadeias de Markov , Modelos Econômicos , Pirrolidinonas/efeitos adversos , Anos de Vida Ajustados por Qualidade de Vida , Raltegravir Potássico , Terapia de Salvação/economia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: Raltegravir, a novel integrase inhibitor, has shown great efficacy in reducing HIV viral load among treatment-experienced patients. A cohort state-transition model was used to assess the long-term effect of raltegravir treatment on costs and quality-adjusted life expectancy from a Swiss perspective. METHODS: Patients were stratified into health states according to opportunistic infection status, HIV RNA level, and CD4 count, with each group assigned a treatment cost and utility (quality of life) score. Model inputs came from published studies, clinical trials, and database analyses. Results were used to calculate incremental cost-effectiveness ratio (ICER) of raltegravir use, expressed in Swiss francs (CHF) as incremental cost/quality-adjusted life-year (QALY) gained. Future costs and QALYs were discounted at 3% per year. RESULTS: Five years of raltegravir treatment increased discounted quality-adjusted life expectancy by 3.73 years over placebo, with additional discounted cost of CHF 170,347, resulting in an ICER of CHF 45,687/QALY. ICERs ranged from CHF 42,751 to 53,478/QALY for treatment duration of 3 and 10 years, respectively. Results were most sensitive to changes in raltegravir treatment duration, source of estimated quality of life weights, and raltegravir price. CONCLUSIONS: Adding raltegravir to optimized background therapy was a cost-effective strategy for treatment-experienced patients in Switzerland.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/crescimento & desenvolvimento , Modelos Econômicos , Pirrolidinonas/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Contagem de Linfócito CD4 , Estudos de Coortes , Simulação por Computador , Análise Custo-Benefício , Feminino , Infecções por HIV/economia , Infecções por HIV/microbiologia , Infecções por HIV/virologia , Inibidores de Integrase de HIV/economia , HIV-1/genética , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Pirrolidinonas/economia , Anos de Vida Ajustados por Qualidade de Vida , RNA Viral/sangue , Raltegravir Potássico , SuíçaRESUMO
Raltegravir, a novel HIV-1 integrase inhibitor, has superior efficacy with optimized background treatment (OBT) vs. placebo + OBT in treatment-experienced HIV-1 patients. This study assessed the long-term cost effectiveness of raltegravir from a Spanish National Healthcare System perspective. A cohort-state-transition model was used to estimate clinical and economic outcomes associated with raltegravir + OBT vs. OBT alone. Subjects were stratified into health states according to HIV RNA level, CD4 count, and opportunistic infection (OI) history, and could transition into different health states over time based on projected long-term efficacy. Each health state was associated with a distinct treatment cost and utility (QoL) score. Model inputs for mortality, resource utilization, unit costs, OI risk, and long-term durability of viral suppression were obtained from clinical trials, published studies, and database analyses. Model outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2007 Euros per quality-adjusted life-year (euro/QALY) gained. Costs and QALYs were discounted at 6% per year based on Spanish cost-effectiveness guidelines. Extensive sensitivity analyses were conducted. Five years of treatment with raltegravir + OBT resulted in an additional 4.5 years of undiscounted life expectancy vs. OBT alone. The ICER of raltegravir + OBT vs. OBT alone was euro22,908/QALY and euro31,431/QALY for 3- and 5-year use, respectively. Lower ICERs were observed with lower discount rates (3%) for costs and benefits, lower raltegravir price (20%), and shorter treatment duration (3 years). ICER was also sensitive to analytical time horizon and alternative sources of QoL scores. In treatment-experienced Spanish patients, raltegravir was projected to provide survival benefits and be cost effective.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/economia , HIV-1/efeitos dos fármacos , Pirrolidinonas/economia , Adulto , Análise Custo-Benefício , Feminino , Infecções por HIV/economia , Inibidores de Integrase de HIV/uso terapêutico , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Programas Nacionais de Saúde , Pirrolidinonas/uso terapêutico , Qualidade de Vida , Raltegravir Potássico , EspanhaAssuntos
Cicloexanos/uso terapêutico , Inibidores da Fusão de HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Compostos Orgânicos/uso terapêutico , Triazóis/uso terapêutico , Administração Oral , Antagonistas dos Receptores CCR5 , Cicloexanos/administração & dosagem , Cicloexanos/efeitos adversos , Cicloexanos/economia , Esquema de Medicação , Custos de Medicamentos , Interações Medicamentosas , Farmacorresistência Viral , Inibidores da Fusão de HIV/administração & dosagem , Inibidores da Fusão de HIV/efeitos adversos , Inibidores da Fusão de HIV/economia , Infecções por HIV/virologia , Inibidores de Integrase de HIV/administração & dosagem , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/economia , HIV-1/enzimologia , Humanos , Maraviroc , Compostos Orgânicos/administração & dosagem , Compostos Orgânicos/efeitos adversos , Compostos Orgânicos/economia , Pirrolidinonas , Raltegravir Potássico , Resultado do Tratamento , Triazóis/administração & dosagem , Triazóis/efeitos adversos , Triazóis/economiaRESUMO
Because raltegravir inhibits a novel viral target, even HIV that is resistant to other antiretroviral-medication classes is sensitive to this drug.