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Caracterização de esquemas terapêuticos de antirretrovíricos em doentes com idade igual ou superior a 65 anos
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Objetivos: Contribuir para o conhecimento dos esquemas terapêuticos prescritos num centro hospitalar português a doentes de idade igual ou superior a 65 anos com infeção VIH/ Sida.
Métodos: Realizou-se um estudo retrospetivo transversal com dados provenientes de um centro hospitalar português. Recolheu-se a informação sobre a idade e os esquemas terapêuticos prescritos aos doentes com idade igual ou superior a 65 anos, no ano de 2016.
Resultados: Do total de 22 doentes, 50% enquadra-se na classe etária entre os 65 e os 70 anos de idade; 5 doentes (23%) têm idade compreendida entre os 71 e os 75 anos e 6 doentes (27%) possuem idade superior a 75 anos.
Em 41% dos casos foi prescrito um esquema terapêutico de comprimido único (Dolutegravir + Abacavir + Lamivudina); a 32% um esquema terapêutico de 2 comprimidos; a 18% foram prescritos esquemas terapêuticos de 3 comprimidos e em 9% dos casos, os doentes apresentaram um esquema terapêutico de 4 comprimidos.
Um regime recomendado preferencial é seguido por 64% dos doentes e 9% seguem um regime recomendado alternativo.
64% dos doentes têm um regime contendo Abacavir + Lamivudina e 27% apresentam regimes com Tenofovir disoproxil fumarato + Emtricitabina.
O esquema terapêutico por classe de fármaco apresentado em 64% dos doentes foi de 2 N(t)RTI+ITI.
Em 64% dos doentes a terapêutica instituída não interage com o Citocromo P450 3A4 (CYP3A4). 36% dos doentes seguem terapêutica com potencial para interação com os fármacos mais comuns prescritos a idosos.
Conclusões: Num centro hospitalar português no ano de 2016 o regime mais comum nos indivíduos com mais de 65 anos e com VIH foi o esquema de comprimido único (41%), verificando-se a tendência para a prescrição de esquemas terapêuticos com menos comprimidos.
À maioria dos doentes (73%) foi prescrito um regime recomendado, preferencial ou alternativo (64% e 9%, respetivamente) para início da terapêutica antirretrovírica combinada, de acordo com as recomendações da Direção Geral de Saúde em doentes adultos e adolescentes com infeção crónica por VIH-1.
Verificou-se um maior n.º de doentes com esquemas terapêuticos contendo Abacavir + Lamivudina possivelmente devido ao facto de o Abacavir, ao contrário do Tenofovir disoproxil fumarato, não precisar de ajuste na dose em situações de patologia renal e também por ter menos efeitos negativos na densidade mineral óssea, características consideradas relevantes na população idosa.
A maioria dos doentes apresenta no regime terapêutico um Inibidor da Integrase (Dolutegravir ou Raltegravir), que poderá estar relacionado com o facto de esta classe de fármacos originar menos interações medicamentosas.
Objectives: this study aims to contribute to the knowledge of the therapeutic regimens prescribed in a portuguese hospital center for patients aged ≥ 65 years with HIV / AIDS infection. Methods: A transversal retrospective study was conducted with data from a portuguese hospital center. Information on the treatment regimens prescribed for patients of age igual or greater than 65 in the year of 2016 was collected. Results: of the 22 patients, 50% were in the age group between 65 and 70 years of age; with 5 patients (23%) between the ages of 71 and 75 and 6 patients (27%) over 75 years of age. It was found that in 41% of cases a single tablet therapeutic regimen (Dolutegravir + Abacavir + Lamivudine) was prescribed; 32% had a therapeutic regimen of 2 tablets, 18% were prescribed therapeutic regimen of 3 tablets and 9% of patients have a therapeutic regimen of 4 tablets. A preferential recommended regimen is followed by 63% of the patients and 9% are on an alternative recommended regimen. 64% had a regimen containing Abacavir + Lamivudine, 27% of patients had Tenofovir disoproxil fumarate + Emtricitabine regimens. The most common (64%) drug class association was 2 N(t)RTI + ITI. Most of the patients (64%) have therapy that does not interact with Cytochrome P450 3A4 (CYP3A4). 36% of patients follow a regimen which has the possibility to interact with the most common prescribed medication among the elderly. Conclusions: In a Portuguese hospital in the year 2016, the most common regimen among individuals over 65 years old and with HIV was the single tablet therapeutic regimen (41%), which agrees with the trend to prescribe therapeutic regimens with fewer tablets. Most patients (73%) are on a recommended or alternate recommended regimen (64% and 9%, respectively) for initiation of combination antiretroviral therapy in adult and adolescent patients with chronic HIV-1 infection as recommended by the Portuguese health department. The largest number of patients are undergoing therapeutic regimens containing Abacavir + Lamivudine possibly because Abacavir, unlike Tenofovir disoproxil fumarate, does not require dose adjustment in renal pathology situations and also because it has fewer negative effects on bone mineral density, characteristics which are relevant on the elderly. Most patients have an integrase strand transfer inhibitor (Dolutegravir or Raltegravir) in the therapeutic regimen, possibly due to the fact that this Dlass of drugs causes fewer drug interactions.
Objectives: this study aims to contribute to the knowledge of the therapeutic regimens prescribed in a portuguese hospital center for patients aged ≥ 65 years with HIV / AIDS infection. Methods: A transversal retrospective study was conducted with data from a portuguese hospital center. Information on the treatment regimens prescribed for patients of age igual or greater than 65 in the year of 2016 was collected. Results: of the 22 patients, 50% were in the age group between 65 and 70 years of age; with 5 patients (23%) between the ages of 71 and 75 and 6 patients (27%) over 75 years of age. It was found that in 41% of cases a single tablet therapeutic regimen (Dolutegravir + Abacavir + Lamivudine) was prescribed; 32% had a therapeutic regimen of 2 tablets, 18% were prescribed therapeutic regimen of 3 tablets and 9% of patients have a therapeutic regimen of 4 tablets. A preferential recommended regimen is followed by 63% of the patients and 9% are on an alternative recommended regimen. 64% had a regimen containing Abacavir + Lamivudine, 27% of patients had Tenofovir disoproxil fumarate + Emtricitabine regimens. The most common (64%) drug class association was 2 N(t)RTI + ITI. Most of the patients (64%) have therapy that does not interact with Cytochrome P450 3A4 (CYP3A4). 36% of patients follow a regimen which has the possibility to interact with the most common prescribed medication among the elderly. Conclusions: In a Portuguese hospital in the year 2016, the most common regimen among individuals over 65 years old and with HIV was the single tablet therapeutic regimen (41%), which agrees with the trend to prescribe therapeutic regimens with fewer tablets. Most patients (73%) are on a recommended or alternate recommended regimen (64% and 9%, respectively) for initiation of combination antiretroviral therapy in adult and adolescent patients with chronic HIV-1 infection as recommended by the Portuguese health department. The largest number of patients are undergoing therapeutic regimens containing Abacavir + Lamivudine possibly because Abacavir, unlike Tenofovir disoproxil fumarate, does not require dose adjustment in renal pathology situations and also because it has fewer negative effects on bone mineral density, characteristics which are relevant on the elderly. Most patients have an integrase strand transfer inhibitor (Dolutegravir or Raltegravir) in the therapeutic regimen, possibly due to the fact that this Dlass of drugs causes fewer drug interactions.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2017
Palavras-chave
Vírus da imunodeficiência humana (VIH) Síndrome da imunodeficiência humana adquirida (SIDA) Terapêutica Antirretrovírica (TAR) Idoso Mestrado Integrado - 2017