Authors' objectives:

The aims of this report are:

1. To summarise the main policies or recommendations of the anti-retroviral treatment at international level, as well as the appropriateness of this type of therapeutical in HIV patients according to the current scientific evidence.

2. To summarise the prescription pattern of anti-retroviral agents in different hospital centres of Catalonia during the years 1997 and 1998, and to identify the possible sources of variability.

Authors' results and conclusions: There is a ample agreement internationally regarding the fact that the anti-retroviral treatment in individuals with VIH infection should be started early to be able to preserve the immune system. Viral replication damages the immune system, and contributes decisively to the progression towards AIDS, so the objective of the anti-retroviral treatment is to obtain the highest suppression of viral replication for the longest time possible. On the other hand, there is quality evidence supporting that the combination of three anti-retroviral drugs, especially that combining two inverse-transcriptase inhibiting nucleosides and a third agent, enables to obtain the highest therapeutical efficacy, while minimising the risk of resistances. Catalonia is one of the European regions with the highest rates of AIDS patients, actually the first cause of death in the Catalan population aged between 20 and 39 years. The number of alive persons in the different stages of the HIV infection is increasing. Self-stated clinical practice for a sample of health care professionals in Catalonia does not show any important differences between them, and it shows high correspondence with international recommendations on retroviral treatment. According to the assessment of interviewed specialists, the degree of treatment compliance does not reach 75%. This fact influences not only the effectiveness of the therapy -due to the therapeutical failure it entails- but it may also compromise its efficiency at a longer term, since non-compliance favours resistances, which in turn require more complex, aggressive and expensive therapeutical strategies. According to the pharmacy registers of a sample of hospitals in Catalonia, in 1998 there was an approximate increase of 11% in the number of patients receiving anti-retroviral treatment compared to the previous year. According to this source, the number of prescriptions of this drug increased 28% in that period of time. A similar prescription pattern of anti-retroviral agents has been observed for all hospitals considered. This pattern agrees with the self-stated clinical practice, and with the recommendations of national and international guidelines; therefore, it can be said that Catalan professionals use this group of drugs appropriately, according to the available evidence on its efficacy, effectiveness and safety.

Authors' recommendations: New epidemiological factors may reasonably explain altogether the higher cost of anti-retroviral treatments in recent years: a lower mortality associated to AIDS, life expectancy increases in these patients, or the increase in the number of alive patients with AIDS, an earlier detection, the benefit derived from new therapies, the advent of new anti-retroviral agents quickly incorporated into these patients' treatment, and the high drug treatment costs. This setting takes place not only in Catalonia, but it has been identified in the literature as common to most countries in our context. It is thus foreseeable that the number of subjects requiring anti-retroviral treatment keeps to increase. On the other hand, an increase in the percentage of patients switching from double to triple therapy, and from triple to quadruple therapy is likely to increase as well, mainly due to therapeutical failure. Therefore, a strong increase in the use of anti-retroviral agents should be expected in next years. Finally, although the utilisation of anti-retroviral agents will be influenced in the years to come by the different items mentioned, two main aspects may be underlined. First, a great effort should be undertaken to limit the number of new infections, that is, insisting on and fostering the most effective preventive and health promoting measures should be noted. Second, serious steps should be taken to improve treatment compliance. Both alternatives require necessarily multi-disciplinary and multi-centric approaches, since the nature of this clinical condition and the social problem often carried with it are far from the competencies of the strictly health care context.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)