[Antiretroviral therapy of HIV infection: duration and reasons for changing the first therapeutic regimen in 518 patients]. / Tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana: duración y motivos de cambio del primer esquema terapéutico en 518 pacientes.

BACKGROUND AND OBJECTIVE: Different combinations of antiretroviral drugs are used as initial HIV therapy but comparative studies between them are not frequent. The objectives of this study are to determine the median duration of different therapy combinations in naive patients between 1998-2000 and the main reasons for changing or stopping this first antiretroviral therapy (ARVT). PATIENTS AND METHOD: This study included a total of 518 naive patients who began antiretroviral therapy patients from 1998-2000. Using a Kaplan-Meier analysis the median duration of different combinations was determined. In addition, the main reasons for changing or stopping this first treatment were analysed. RESULTS: First ARVT median duration was 427 days (IQR: 114-890). 47% of patients stopped their first therapy due to adverse effects, 6% voluntarily withdrew from it, in 9% of patients the therapy was not effective and 15% of them were lost of follow up. Only 9% of them continued with the same ARVT at the end of the study but if we add 7% of treatment simplifications we can consider 16% of first ARVT successful. CONCLUSIONS: A median duration of 427 days, similar to other studies, is shorter than we would prefer for HIV, a condition that requires continuous treatment. On the other hand, the study corroborates that secondary effects are the principal problem associated with ARVT.

Tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana: duración y motivos de cambio del primer esquema terapéutico en 518 pacientes / Antiretroviral therapy of VIH infection: duration and reasons for changing the first therapeutic regimen in 518 patients

Fundamento y objetivo: Las combinaciones de fármacos antirretrovirales utilizadas como pautas de inicio de tratamiento de la infección por el virus de la inmunodeficiencia humana (VIH) son diversas y hay pocos datos comparativos entre ellas. El objetivo de este estudio es conocer la mediana de duración de las distintas combinaciones utilizadas como inicio del tratamiento antirretroviral (TAR) en pacientes naïve entre los años 1998-2000 y cuáles fueron los motivos más frecuentes de cambio o finalización de éste. Pacientes y método: En el estudio se incluyó a 518 pacientes naïve infectados por el VIH que iniciaron TAR durante el período 1998-2000. Se determinó la duración mediana de las distintas combinaciones mediante un análisis de la supervivencia de Kaplan-Meier. Paralelamente, se realizó un análisis descriptivo de los principales motivos de finalización del tratamiento de estos pacientes. Resultados: La mediana de duración del primer TAR fue de 427 días (intervalo intercuartil, 114-890). Los principales motivos de finalización del primer TAR fueron efectos secundarios (47%), fracaso terapéutico (9%) y abandono voluntario (6%). En un 15% de los pacientes fueron pérdidas de seguimiento y tan sólo el 9% continuaba con el primer tratamiento al final del estudio, que, junto con un 7% que pudo simplificar su TAR, pueden considerarse como un 16% de «éxitos del primer TAR». Conclusiones: La mediana de duración obtenida, similar a la descrita por otros autores, es relativamente corta para una infección como la producida por el VIH que requiere un tratamiento continuado. Por otro lado, se confirma que los efectos secundarios son el principal problema del TAR

Background and objective: Different combinations of antiretroviral drugs are used as initial HIV therapy but comparative studies between them are not frequent. The objectives of this study are to determine the median duration of different therapy combinations in naive patients between 1998-2000 and the main reasons for changing or stopping this first antiretroviral therapy (ARVT). Patients and method: This study included a total of 518 naive patients who began antiretroviral therapy patients from 1998-2000. Using a Kaplan-Meier analysis the median duration of different combinations was determined. In addition, the main reasons for changing or stopping this first treatment were analysed. Results: First ARVT median duration was 427 days (IQR: 114-890). 47% of patients stopped their first therapy due to adverse effects, 6% voluntarily withdrew from it, in 9% of patients the therapy was not effective and 15% of them were lost of follow up. Only 9% of them continued with the same ARVT at the end of the study but if we add 7% of treatment simplifications we can consider 16% of first ARVT successful. Conclusions: A median duration of 427 days, similar to other studies, is shorter than we would prefer for HIV, a condition that requires continuous treatment. On the other hand, the study corroborates that secondary effects are the principal problem associated with ARVT