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OBJECTIVE: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the co-formulation of abacavir, lamivudine and zidovudine (ABC-3TC-AZT). METHOD: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients withdrawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. RESULTS: In all, 114 patients (85 males, 74.6%) received this therapy - 25.4% of them were naïve patients - and 34.2% (39/114) withdrew from this regimen, amongst them 44.8% (13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). CONCLUSIONS: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented.

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Objetivo: Identificar y analizar las causas más frecuentes de discontinuación de la terapia antirretroviral que incluye la co-formulación: abacavir, lamivudina y zidovudina (ABC-3TC-AZT). Método: Estudio retrospectivo observacional de los pacientesen tratamiento antirretroviral con ABC-3TC-AZT, atendidos en la unidad de pacientes externos del servicio de farmacia durante el periodo comprendido entre febrero de 2002 y junio de 2004. Se analizó la causa de discontinuación en aquellos pacientes que no siguieron con esta terapia. Se evaluó la adherencia mediante los registros informáticos de dispensación. Se diseñó un análisis de supervivencia de Kaplan-Meier para identificar factores predictivos de discontinuación. Resultados: Un total de 114 pacientes (85 hombres, 74,6%) fueron tratados con esta terapia. Un 25,4% era naïve. El 34,2% (39/114) de los pacientes discontinuó el tratamiento. Entre ellos, el 44,8% (13/29) de los sujetos naïve. En el 92,3% del total de casos esto ocurrió antes de alcanzar las 48 semanas en tratamiento. Las causas de discontinuación fueron: reacciones adversas (46,1%), abandono voluntario (33,3%), decisión clínica (15,4%) y otros motivos (5,1%). Posible reacción de hipersensibilidad a ABC fue descrita en 9 pacientes. Se relacionó tener carga viral detectable al inicio del tratamiento, ser ex-ADVP, y paciente naïve, con mayor probabilidad de discontinuación (p < 0,05). Conclusiones: Se encontró un alto porcentaje de discontinuación debido a efectos adversos y abandono voluntario, principalmente al inicio del tratamiento. Es necesario identificar a aquellos pacientes a los cuales este esquema les puede aportar un beneficio terapéutico, especialmente los sujetos naïve, y realizar intervenciones para mejorar la adherencia y optimizar así los parámetros de recuperación

Objective: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the coformulation of abacavir, lamivudine and zidovudine (ABC-3TCAZT). Method: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department’s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients with drawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. Results: In all, 114 patients (85 males, 74.6%) received this therapy – 25.4% of them were naïve patients – and 34.2% (39/114) with drew from this regimen, amongst them 44.8%(13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). Conclusions: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented

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