title: Analysis of the discontinuation of protease inhibitor therapy in routine clinical practice.
abstract: We evaluated the frequency of and reasons for discontinuation of protease inhibitor therapy in a cohort of HIV-infected patients in a prospective observational study. We included 230 HIV-infected patients who had started protease inhibitor therapy between November 1996 and July 1997. Mean baseline CD4 count was 138 cells/microl and HIV-RNA 4.5 log10. Forty-five percent of patients had prior AIDS and 77% had been treated with nucleoside analogues. Saquinavir-treated patients were at a less advanced stage of HIV disease. Overall, 41.3% of patients discontinued therapy, and their last HIV-RNA measured higher than that of patients who continued therapy: 4.07 vs. 2.70 log10 (p < 0.0001). Reasons for discontinuation of therapy were poor adherence (including abandonment) (18.6%), drug intolerance (12.1%), virological failure (7%) and physician decision (3.5%). In a multivariate model, factors associated with drug discontinuation were not taking indinavir (OR 0.26, 95% CI 0.12-0.59) and being pretreated with nucleoside analogues (OR 3.42, 95% CI 1.58-7.42). We concluded that in routine clinical practice a high proportion of patients discontinued protease inhibitors during the first 6 months of therapy, the main reason being the patient's own decision (abandonment or poor adherence). Psychological support and counselling are warranted in patients when initiating protease inhibitor therapy.
authors.affiliation: Infectious Diseases Service, Ciutat Sanitaria de Bellvitge, University of Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ferrer
authors.forename: E
authors.initials: E
authors.lastname: Consiglio
authors.forename: D
authors.initials: D
authors.lastname: Podzamczer
authors.forename: I
authors.initials: I
authors.lastname: Grau
authors.forename: J M
authors.initials: JM
authors.lastname: Ramon
authors.forename: J L
authors.initials: JL
authors.lastname: Perez
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D003376:Counseling; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects; D019258:Saquinavir / Q000008:administration & dosage / Q000009:adverse effects; D016312:Treatment Refusal; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors; D019469:Indinavir; D019258:Saquinavir; D019438:Ritonavir