[Spanish recommendations for proper use of enfuvirtide].
Enfuvirtide is a high-cost, parenterally administered drug commonly used in late phases of HIV infection, when its efficacy may be compromised. To optimize enfuvirtide use, consensus recommendations for this purpose have been formulated by 247 physicians attending patients with HIV infection in Spain. A literature review was performed in which grades of evidence and recommendations were defined according to the origin of the data (randomized clinical trials, non-randomized studies, expert opinion). Twenty-eight local consensus meetings were held between May and September 2005 to discuss the most important aspects related to the use of enfuvirtide, following a pre-established system used in all the meetings. The main conclusions were as follows: a) enfuvirtide use is often excessively delayed and is given to patients with little chance of treatment success; b) enfuvirtide is indicated in patients who require antiretroviral treatment and for whom an optimum treatment with three other fully effective drugs cannot be designed; c) the most important prognostic factor is the availability of at least one other completely active drug; d) there is no infallible method to avoid the development of local reactions, but measures are available to decrease their incidence and severity; and e) patient counseling and training for correct administration of the drug are essential to improve adherence, the repercussions of local reactions and, of course, the efficacy of the treatment.
Ribera
Esteban
E
Hospital Vall d'Hebron, Barcelona, España. eribera@vhebron.net
Moreno
Santiago
S
Viciana
Pompeyo
P
Echevarría
Santiago
S
Flores
Juan
J
Francés
Adela
A
Gómez-Sirvent
Juan Luis
JL
González
Juan
J
Hernández-Quero
José
J
Lozano
Fernando
F
Mallolas
Josep
J
Muñoz
Agustín
A
Ocampo
Antonio
A
Portilla
Joaquín
J
Pulido
Federico
F
Rivero
Antonio
A
Santos
Jesús
J
Soriano
Vicente
V
Antela
Antonio
A
Arazo
Piedad
P
Arribas
José Ramón
JR
Cervantes
Manel
M
Domingo
Pere
P
D000077560:Enfuvirtide; D015700:HIV Envelope Protein gp41 / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D023581:HIV Fusion Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D010349:Patient Compliance; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011379:Prognosis; D016879:Salvage Therapy
D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D010446:Peptide Fragments; D000077560:Enfuvirtide