Factors determining changes in initial antiretroviral therapy

SummaryObjectiveTo investigate factors determining changes in initial antiretroviral therapy (ART) in patients attended to in an AIDS tertiary care hospital in Ceará, Brazil.MethodsThis descriptive and exploratory study used the analysis of request to initiate or change treatment forms in the year of 2008, and the changes in therapy were followed through the first year of treatment. Data were analyzed with SPSS and EpiInfo by using ANOVA and the exact test of the coefficient of contingency, with significance at p<0.05.ResultsFrom 301 patients initiating ART, 22.1% (n=68) needed a change in the first year. These patients were mostly males, aged 20 to 39 years; with only one ART changed needed in 86.8% of the cases (n=59). Reports of two or three changes in regimen were observed. Zidovudine was the drug most often changed, followed by lopinavir/ritonavir and efavirenz. A significant association was found between changes in initial regimens and the report of adverse reactions (p<0.001).ConclusionThe main factor determining changes in the initial ART was an adverse reaction report. Most patients had one change in the initial ART over the first year of treatment. ART monitoring contributed to a better control of the specific drug therapy

Interleukin-10 gene polymorphism (−1082G/A) and allergy to efavirenz in patients infected with human immunodeficiency virus

The aim of the present study was to investigate the association between polymorphism in the interleukin-10 gene promoter at position −1082 in human immunodeficiency virus-infected patients who had presented allergic reaction due to efavirenz. The study included 63 patients treated at the Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil. Twenty-one patients who had presented allergic reaction to efavirenz were compared to 42 patients with no allergic reaction following exposure to this drug. Blood samples were collected for DNA extraction and submitted to the restriction fragment length polymorphism – polymerase chain reaction technique. The −1082AA genotype was significantly more frequent in allergic patients as compared to non-allergic patients (p = 0.019; χ2 = 5.534; OR = 3.625; 95% CI = 1.210–10.860). Likewise the allele IL-10 −1082A was identified significantly more often among efavirenz allergic patients than in the non-allergic group (p = 0.009; χ2 = 6.787; OR = 3.029; 95% CI = 1.290–7.111). These findings suggest that the polymorphism in the interleukin-10 gene promoter −1082G/A can be related to the development of allergic reactions to efavirenz. Keywords: HIV, Drug allergy, Polymorphism, IL-1