Promjene početnog antiretrovirusnog liječenja u osoba zaraženih HIV-om liječenih u Hrvatskoj u razdoblju od 2012. do 2016.

master's thesis

• Title (english): Initial antiretroviral therapy change in HIV positive individuals treated in Croatia between 2012 and 2016
• Author: Adam Galkovski
• Mentor: Maja Ortner Hadžiabdić (mentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Lidija Bach-Rojecky (član povjerenstva)
• Committee member: Josip Begovac (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2018-10-20, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

HIV infekcija je neizlječiva bolest koja ako se ne liječi dovodi do AIDS-a i smrti od neke oportunističke bolesti. Antiretroviralni
lijekovi sprečavaju replikaciju virusa i na taj način sprečavaju progresiju bolesti. Zbog brzog razvoja rezistencije na lijekove
kada se koriste u monoterapiji, najčešće se koriste režimi s tri lijeka: 2 NRTI koji čine nukleozidnu osnovu i NNRTI ili PI ili II.
Cilj ovog istraživanja bilo je pokazati postoje li razlike u učestalosti i razlozima promjena početnog antiretrovirusnog liječenja u
odnosu na sociodemografske (dob, spol, mjesto stanovanja, vjerojatni način zaraze) i čimbenike koji pokazuju uznapredovalost
infekcije (početna viremija, broj CD4+ limfocita i prisutstvo AIDS-a) te početni ART režim i nukleozidnu osnovu kod osoba
koje su počele s liječenjem u razdoblju izmedu 2012. i 2016. u Hrvatskoj. Promatrani ishodi su bili promjena ART-a koja je
definirana kao zamjena lijekova ili prekid liječenja. Vrijeme praćenja je bilo godina nakon početka liječenja ili do promjene.
Od 508 ispitanika promjenu je imalo njih 181 (35,6%). Statistička analiza je uključivala analizu doživljenja i Coxovu regresiju
s modelima za ukupno vrijeme praćenja, prvih 30 dana i vremenom praćenja nakon prvih 30 dana. Rezultati su pokazali da
ART režimi koji sadrže II imaju manju vjerojatnost promjene u odnosu na druge režime. Najznačajnija povezanost s rizikom
promjene nakon prvih 30 dana praćenja je za nukleozidnu osnovu koja sadrži ZDV3TC (p < 0,001). Takvi rezultati idu u prilog
novim smjernicama koje preporučaju režime s II kao početne režime i više ne preporučaju ZDV za početnu terapiju.

Abstract (english)

HIV infection is a disease that can not be eradicted which, if left untreated, leads to AIDS and death from an opportunistic
infection. Antiretroviral drugs stop viral replication thus preventing disease progression. Due to the fast emergence of drug
resistance if used in monotherapy, regimes containing three drugs are most common. Two drugs in the regime are NRTI, which make the nucleoside backbone, and the other is either NNRTI, PI, or II. The aim of this research was to determine if there are differences in frequency and reasons for change of the first line antiretroviral therapy taking into consideration sociodemographic factors (age, sex, residence, probable route of transmission), factors that indicate severity of the disease (viral load, CD4 cell count, AIDS), and the ART combination and nucleoside backbone. The studied population is treatment naive patients who started ART between 2012 and 2016 in Croatia. The main outcome was ART change which was defined as either switch or discontinuation with the follow-up period being 1 year after the start of ART or until the first change. Out of 508 subjects 181 (36.5%) of them had a change in initial ART. Statistical analysis included survival analysis, and Cox regression with models for the whole time of follow-up, the first 30 days of follow-up, and all days past the first 30. The results show that ART regimes containing II had less risk of change compared to other regimes. The most significant correlation with the risk of change was found for regimes that contained ZDV3TC as a nucleoside backbone (p < 0.001). These results support new guidelines that reccomend II based regimes as first line therapy and no longer recommend ZDV as a part of the initial ART.

• Keywords: HIV; AIDS; antiretrovirusni lijekovi; ART promjene; inhibitori integraze; zidovudin
• Keywords (english): HIV; AIDS; ART switch; ART change; integrase inhibitors; zidovudine
• Language: croatian
• URN:NBN: urn:nbn:hr:163:941090
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-04 09:12:13