국내 3차 병원에서 HIV 환자의 약물치료요법 관리와 추적 관찰

Abstract

The use patterns of human immunodeficiency virus (HIV) drugs had been rapidly evolved due to new antiretroviral drugs and recently revised HIV/AIDS guidelines. However, there are limited studies regarding their prescription patterns, efficacy, and safety according to the new guidelines in Korea. The aims of this study were to analyze the prescription patterns of medications for HIV and to perform follow-up evaluation. This study was retrospectively conducted through electronic medical records (EMR). HIV patients who visited the tertiary hospital between October 2011 to September 2017 were included in the study. One hundred and eighty-three HIV patients were selected for the analysis. The mean age was 47.3 ± 12.4 years, and 159 (86.9%) were males. The combination of nucleoside reverse transcriptase inhibitors (NRTIs)/protease inhibitors (PIs) was most frequently prescribed during the study period; however, its frequency had been gradually decreased from 54.6% at baseline to 41.6% at month 72. The second most commonly prescribed combination was NRTIs/PIs/integrase strand transfer inhibitors (INSTIs) which had been gradually increased. Specifically, ABC/3TC and TDF/FTC were used most frequency during the whole study period. ZDV/3TC use had been gradually declined from 19.7% at baseline to 8.7% at month 72, whereas TAF/FTC use had been gradually increased from 2.7% at baseline to 21.7% at month 72. At the beginning of follow-up, the success rate of HIV suppression (HIV-1 RNA < 50 copies/mL) was 86.7% in ART-experienced patients and 65.7% in ART-naive patients, but there was no difference after 12 months and showed an average success rate of HIV suppression exceeding 80% (excluding 30 month). Among study patients, 126 (68.9%) experienced adverse drug reactions. Skin reactions (23%), such as rash, itching, and pigmentation, most commonly occurred followed by vomiting (10.9%), fatigue (9.8%) and diarrhea (9.3%). Total cholesterol level was 167.5 ± 40.4 mg/dL at baseline, but was 189.3 ± 43.3 mg/dL at month 72. Glucose level was also 117.2 ± 43.4 mg/dL at the beginning of treatment, but was increased to 186.4 ± 177.7 mg/dL at month 72. The number of CD4+ T cells increased from 316 ± 22 cells/μL at baseline to 687 ± 340 cells/μL at month 72. Gastrointestinal and metabolic drugs were co-prescribed more commonly with ART in patients ≥ 50 years (72.2%) than those < 50 years (46.2%) (p<0.001). Dermatologic drugs (p=0.008), cardiovascular drugs (p=0.023), blood and hematopoietic drugs (p=0.023), and genitourinary and sex hormone drugs (p=0.009) were also more frequently used with statistical significance in patients ≥ 50 years than those < 50 years. In conclusion, it was confirmed that single tablet regimen (STR) formulation and new drug were changed according to the new guidelines. It is considered that a study should be needed to confirm the efficacy and safety of new HIV drugs on Korean. Further related studies in multicenters are needed to confirm this study. Also, it is necessary to expand the roles of pharmacists to monitor appropriate drug selection, drug interaction, and side effects.