CP-150 Reasons for switching effectiveness antiretroviral therapy

Abstract

BackgroundThe main objective of antiretroviral therapy (ART) is to maintain undetectable viral load (VL) and preserve immune function. But nowadays reduction in morbidity and improvements in patient quality of life appear to be as important therapy goals, encouraging clinicians to change ART although VL and immune function are controlled.PurposeThe aim of our study was to assess the reasons for ART switches in patients with effective previous treatment (undetectable VL) and to analyse if these switches had been done according to the GESIDA (Grupo de Estudio del SIDA, AIDS Study Group) 2015 guidelines.Material and methodsAn observational retrospective study was carried out from June 2014 to January 2015. All patients with ART during this period were included, and patients who underwent treatment switching were analysed. Previous and actual treatments, pre-switch VL, and reasons for the switch were recorder in a database. Pregnant patients and those with detectable VL were excluded from the final analysis in relation to its adaptation to the GESIDA 2015 guideline recommendations.Results781 patients were included. 120 treatments were switched (15.4): 103 patients had undetectable VL, 13 patients had detectable VL and 4 patients were pregnant. The reasons for switching in patients with undetectable VL are shown in table 1.Abstract CP-150 Table 1Reasons for switching in patients with undetectable VL (n = 103)Side effects (56%):· Gastrointestinal disorders 26% · Impaired renal function 24%· Metabolic disorders 21% · Neurologic disorders 21% · Skin reactions 5%· Osteopenia 3%Simplification (23%):· Minor number of tablets 56%· Improve adherence 44%Relevant interactions 8%New comorbidities appearance 3%Changes in patients’ lifestyle 2%Improve immune response 2%Unknown reason 6%Analysing our clinicians reasons for switching according to the GESIDA recommendations (excluding unknown reasons), we found that 32% of switches had no defined level of evidence; 17% had a level of evidence BII; 2% BI; 10% AIII; 20% AII; and 19% AI.ConclusionThe main reason for ART switching in patients with undetectable VL was side effects. Nearly one-third of all switches did not correspond to any level of evidence, according to the GESIDA 2015 guidelines. Among the switches that followed the recommendation, 71% had a level of evidence of A.No conflict of interest.