Indicación de uso de los antirretrovirales de última generación en la práctica clínica actual

Objective: To describe the indications for use, in medical practice, of next-generation antiretroviral drugs (NGA): darunavir, raltegravir, maraviroc and etravirine. Method: An observational, transversal and descriptive study conducted in adult patients who have started to receive a NGA between May 2008 and April 2009. The variables associated with the use of NGA were defined as follows: a) Variables related to efficacy: resistance confirmed by geno/phenotype tests or potencial resistance as a result of extensive exposure to antiretroviral agents, and/or severe immunological deterioration (CD4 less than 200 cells/mcl). b) Variables related to safety: prior toxicity to classic antiretroviral drugs and/or comorbidity which compromises their use. c) Combined efficacy and safety variable (main variable): prioritizing the variables which were detected, the patients were classified into three groups: multiresistant geno/phenotype (multi-G/P), multiresistant as a result of treatment history and other situations. Data was obtained from electronic medical records, laboratory tests, and records of interviews and drugs dispensed by the Pharmacy Service. Results: Seventy three patients, 40% of whom had an undetectable viral load and 38.4% who showed severe immunological deterioration, were included in the study. Multi-G/P occurred in 45% and multiresistance as a result of treatment history was found in 33% of patients. Patients classified as belonging to the ‘‘other situations’’ category were characterized by having a greater viral load and a poorer immunological status. In 90% of the patients without multi-G/P two or more variables associated with the use of NGA were detected. Discussion: The medical reality of using NGA shows that they play a role in clinical situations which are very different, specific and difficult to manage.