The Successful Application of a National Peer Advisory Committee for Physicians Who Provide Salvage Regimens to Heavily Antiretroviral-Experienced Patients in Mexican Human Immunodeficiency Virus Clinics

This cohort study shows the effect of prudent usage of expanded-activity antiretroviral agents in a resource-limited country. The strategy applied in Mexico is based on an expert advisory board that recommends optimal salvage regimens to clinicians who care for patients with extensive prior antiretr...

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Published in:Open forum infectious diseases 2014-09, Vol.1 (2), p.ofu081-ofu081
Main Authors: Calva, Juan J., Sierra-Madero, Juan, Soto-Ramírez, Luis E., Aguilar-Salinas, Pedro
Format: Article
Language:English
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Summary:This cohort study shows the effect of prudent usage of expanded-activity antiretroviral agents in a resource-limited country. The strategy applied in Mexico is based on an expert advisory board that recommends optimal salvage regimens to clinicians who care for patients with extensive prior antiretroviral exposure. This intervention led, in most cases, to a reversal of the predicted unfavorable clinical prognoses of these patients. Background.  Designing optimal antiretroviral (ARV) salvage regimens for multiclass drug-resistant, human immunodeficiency virus (HIV)-infected patients demands specific clinical skills. Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients. Methods.  We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Adults infected with HIV were assessed for a median of 33 months (interquartile range [IQR] = 22–43 months). These patients had experienced the virologic failure of at least 2 prior ARV regimens and had detectable viremia while currently being treated; their physicians had received therapeutic advice, by a panel of experts, regarding the ARV salvage regimen. The primary endpoint was the incidence of loss of virologic response (plasma HIV-RNA levels of
ISSN:2328-8957
2328-8957
DOI:10.1093/ofid/ofu081