AEGiS-15IAC: Significantly different profile of antiretroviral prescription (AP) in the two HIV outpatient units of Bologna, Italy.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Significantly different profile of antiretroviral prescription (AP) in the two HIV outpatient units of Bologna, Italy.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. D10411)

Manfredi R, Calza L, Chiodo F
Infectious Diseases, University of Bologna, Bologna, Italy

BACKGROUND: The knowledge of profile and trend of AP is needed to allocate treatment resources.

METHODS: Comparison of electronic databases of AP in the 2 linked HIV outpatient centres of Bologna (Italy),where ~1900 HIV-infected patients (p) are followed,and 86.5% received AP during 2003.

RESULTS: Combinations of 2 nucleoside analogues (NA) and 1 protease inhibitor (PI) or 1 non-nucleoside inhibitor (NNRTI),or 3 NA,were given to 68.2% of p,while 18.2% of p took 2 NA,and 13.6% of p had >3 drugs. The PI-based AP prevailed over the NNRTI one,and the NA one (38%,31%,and 10%). Among NA,3TC,AZT,d4T,and TDP were prescribed with a greater frequency at the 1st unit (p<.001 to<.03),while ABC and co-formulated AZT-3TC-ABC were used more frequently at the 2nd unit (p<.02 to<.05). Among PI,SQVhg and NFV were more common at the 1st unit (p<.001),and SQVsg at the 2nd unit (p<.04). Since AP comes by the same medical equipe,reasons for differences are linked to p features: higher prevalence of sexually-transmitt ed HIV at the 1st unit, vs greater iv drug abuse at the 2nd unit (p<.01),and longer history of AP with more frequent changes at 1st unit (p<.004).

CONCLUSION: Among HAART regimens,significantly different costs are evident,with d4T-TDP-LPV/r as the most expensive PI-based AP (870[ a]/month),vs AZT-3TC-SQVsg/r (547 [ a]/month). Among NNRTI-based AP,d4T-TDP-EFZ is more expensive (642 [ a]/month),vs AZT-3TC-NVP (452 [ a]/month). The fixed AZT-3TC-ABC combination has comparable costs (515 [ a]). A wide spectrum of variables influence the choice of AP for each treated p: therapeutic background,resistance,toxicity,compliance,pill burden,and also costs. Even between the 2 city HIV outpatient services followed by the same medical staff,significant differences in AP occur. Given the availability of 18 anti-HIV drugs,a correct balance of expected efficacy-tolerability should be tailored according to every single p need,but also weighted against scheduled costs,to allow better allocation of health care resources.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Anti-HIV Agents, Zidovudine, Lamivudine, Stavudine, Antiretroviral Therapy, Highly Active, Italy, Humans

040711
D10411