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Introduction: HIV treating physicians in the Netherlands follow the guidelines of the Department of Health and Human Services (DHHS). Most of these recommended initial regimens are single-tablet regimens (STRs), which incur higher costs. By the end of 2017, generic NRTI backbones had become widely available, offering a potentially cheaper multi-tablet regimen. This study aimed to evaluate guideline compliance in people with HIV who started antiretroviral therapy (ART), the uptake of generic multi-tablet regimens (gMTRs), and associated medication costs. Methods: This retrospective cohort study used data from the Dutch HIV Monitoring Foundation to determine the proportion of treatment-naïve people entering care who initiated ART according to the DHHS and type of ART regimens prescribed between January 2016 and December 2020. We analyzed ART prescriptions, both at the national level and per individual HIV treatment centers. We calculated the monthly ART costs based on Dutch medicine prices listed on www.medicijnkosten.nl for each calendar year. Results: In 2016, an integrase inhibitor-containing regimen was initiated in 77.3% which increased to 87.8% in 2020. The compliance rate to DHHS-recommended initial regimens ranged from 82.8% in 2016 to 90.9% in 2020. Most patients received single-tablet regimens, 81.3% in 2016 to 60.3% in 2020. After the introduction the gMTRs showed a steady increase from 17.8% in 2018 to 37.8% in 2020. The cost of the first-line regimen per patient decreased by 22.9% in 2020 compared with 2017. The decrease was larger in centers where treatment-naïve individuals with HIV were preferentially initiated on a gMTR. Conclusions: There was a high compliance to the "DHHS-recommended initial regimens for most people with HIV" in the Netherlands. Most people who initiated ART received STRs, although the percentage of people who started on STRs gradually decreased over time. The use of gMTRs increased over time and was associated with lower medication costs. [ABSTRACT FROM AUTHOR]

Objective: Lower urinary tract symptoms (LUTS) are becoming more prevalent in the ageing population of males living with HIV. Drugs to treat LUTS are known for both their potential role as victims in drug–drug interactions (DDIs) and their side effects. We aimed to evaluate the current use of drugs to treat LUTS and to assess potential DDIs in our cohort of adult males living with HIV. Design: This was a retrospective review of pharmacy records. Methods: We recorded the combination antiretroviral therapy (cART) regimen and any use of drugs to treat LUTS (anatomical therapeutic chemical codes G04CA/CB/CX and G04BD). Potential DDIs were assessed using the interaction checker developed by the University of Liverpool (https://www.hiv-druginteractions.org/checker). Results: A total of 411 adult males living with HIV were included in this analysis. The median (interquartile range [IQR]) age was 53 (41–62) years. Nineteen (4.6%) patients used one or more drugs to treat LUTS. As expected, older patients were more likely to be receiving treatment for LUTS: Q1 (20–40 years) = 0%; Q2 (41–52 years) = 2%; Q3 (53–61 years) = 7%; Q4 (62–79 years) = 10%. Seven potential DDIs between cART and LUTS treatment were noted in six of the 19 (32%) patients. Following medication reviews of these six patients, the following interventions were proposed: evaluate safe use of alpha‐blocker (n = 4), change in cART (n = 2), and dose reduction of the anticholinergic agent (n = 1). Conclusion: Treatment for LUTS coincided with cART in 7%–10% of patients aged above the median age of 53 years in our cohort. Improvements in DDI management appeared to be possible in this growing cohort of males living with HIV and with LUTS. [ABSTRACT FROM AUTHOR]

BACKGROUND and METHODS HIV infection has become a chronic infection due to the high efficacy and good tolerability of combination antiretroviral therapy (cART). In contrast to earlier days, cART is now recommended to all HIV-positive persons, for their own health and to prevent transmission of the virus to other persons (“treatment as prevention"). RESULTS More recently introduced anti-hiv agents have more favorable pharmacokinetics than older ones. First line regimens usually consist of a backbone of two nucleoside reverse transcriptase inhibitors to which an integrase inhibitor is added as a third drug. Pre-exposure prophylaxis by using two antiretroviral agents (tenofovir DF/emtricitabine) is receiving increased interest for use in hiv-negative people who are at risk for hiv infection. CONCLUSION Generic forms of widely-used antiretroviral agents have been introduced in the Netherlands, and make considerable cost savings possible. Drug-drug interactions remain an important safety risk for hiv-positive patients on cART. [ABSTRACT FROM AUTHOR]