Latin American Journal of Pharmacy

(formerly Acta Farmacutica Bonaerense)

Lat. Am. J. Pharm. 30 (9): 1749-54 (2011)

Regular Article
Received: March 10, 2011
Revised version: September 17, 2011
Accepted: September 18, 2011

Evaluation of the Pharmacotherapeutic Profile of HIV/AIDS Bearers

Matheus M. de O. MONTEIRO 1, Jorge E.G. SANTANA 1,
Carlos H.T.B. VICENTE 1, Valter BESSA FILHO 1, Everton R. BEZERRA 1,
Alusio M. FERREIRA 2, Daniele I. JANEBRO *2 & Maria do S.R. QUEIROZ 1
Departamento de Farmcia, Universidade Estadual da Paraba,
CEP 58429-600, Campina Grande, PB, Brasil.
2 Faculdade Maurcio de Nassau, CEP 58410-050, Campina Grande, PB, Brasil.
1

SUMMARY. In this work was evaluated the pharmacotherapeutic profile of HIV/AIDS bearers registered
in the Service of Specialized Attendance located in Campina GrandePB, Brazil. The research was of the
type traverse, documental, descriptive and analytical and was realized in the period of August to October
2010. Were appraised the patient records of 188 people being 66 % males and 34% females. The most part
(36 %) just studied the education fundamental level and presented age group between 40-49 years old. Antiretrovirals more prescribed were nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside
reverse-transcriptase inhibitors (NNRTIs). Schemes no recommended by the Ministry of Health also were
evidenced. The Negative Results associated to the use of medicine was registered in the three supra-categories. It is necessary a larger integration of the multidisciplinary team of prescribers (physicians and dentists) and pharmacists in the evaluation of the pharmacotherapy to guarantee the reduction of the morbidity and the presence of opportunists infections, guaranteeing so a better surviving for the seropositive patients.

INTRODUCTION
The Acquired Immunodeficiency Syndrome
(AIDS) is the loss or severe decrease in the immune systems ability to defend the body itself
due to the action of the Human Immunodeficiency Virus (HIV) 1.
The AIDS epidemic in the world is a matter
that must be constantly debated, especially
when it comes to improving the response to
treatment and care for HIV bearers. Brazil was
one of the first countries to adopt meaningful
policies to improve health care for this population. Among those policies, there is universal
and free access of the population to medicines
used in AIDS treatment, with the publication of
Law 9313 of November 13, 1996 2,3. Approximately 197,000 patients are treated with the 19
antiretroviral (ARV) medicines distributed by the
National Health System (SUS). As a result of
such access, significant reduction it is observed
in the country in mortality, the number of hospitalizations and opportunistic infections (OIs),

which are those that occur as a result of attenuation of the immune system, caused by HIV 3.
A quality pharmaceutical care for HIV bearers represents a major challenge for health systems and should be realized through monitoring
pharmacotherapy which is a component of
pharmaceutical care that sets up a process
where the professional is responsible for
medicines-related needs of the patient through
the detection, prevention and resolution of the
Negative Results to the Use of Medicines
(RNMs).
The RNMs are the patients health outcomes,
not suitable for the purpose of drug therapy and
associated with medicines use. May be caused
by different causes, such as those related to
health care, and the user aspects bio-psycho-social, health professionals and medicines4,5. The
pharmacist to detect and identify the RNMs
should act to bring the patient to the drawn first
line therapy, in order to achieve the desired
therapeutic result.

KEY WORDS: Acquired Immune Deficiency Syndrome (AIDS), antiviral, Human Immunodeficiency Virus
(HIV).
*Author to whom correspondence should be addressed. E-mail: dijanebro@yahoo.com.br

ISSN 0326-2383

1749

MONTEIRO M.M. de O., SANTANA J.E.G., VICENTE C.H.T.B., BESSA FILHO V., BEZERRA E.R., FERREIRA A.M. , JANEBRO D.I. &
QUEIROZ M. do S.R.

Knowing that the number of medicines used

for treating HIV-positive is high, continued use
as is the case of ARVs and may result in RNMs
it is necessary to outline the profile of patients
with a Service Specialized Attendance (SAE) in
order to know pharmacotherapy and to identify
possible adverse reactions to facilitate the work
of the multidisciplinary team, so monitoring the
response to ARV therapy contributing to more
effective treatment to ensure the achievement of
defined and measurable results, aimed at improving the quality of life.
MATERIALS AND METHODS
The research was of the type traverse, documental, descriptive and analytical and was realized in the period of August to October of 2010
in Campina GrandePB, involving 188 patients
corresponding to 25 % of registered service. The
data were collected through the register records
or the Patient records and soon afterwards transcribed for two forms, the first to register the
patients personal data and the second, information on the prescribed medicines.
The evaluation of RNMs was accomplished
in agreement with the criteria of the Third Consensus of Granada in three supra - categories
and in six categories 4,5: I) Necessity; Ia) Problem
of health no treated, the patient suffers a problem of health associated to the fact of not receiving a medicine that needs; Ib) Effect of unnecessary medicine, the patient suffers a problem of health associated to the fact of receiving
a medicine that doesnt need; II) Effectiveness;
IIa) Ineffectiveness no quantitative, the patient
suffers a problem of health associated to an ineffectiveness no quantitative of the medicine,
IIb) Quantitative Ineffectiveness, the patient suffers a problem of health associated to a quantitative ineffectiveness of the medicine; III) Safety;
IIIa) Insecurity no quantitative, the patient suffers a problem of health associated to an insecurity no quantitative of the medicine; IIIb) Quantitative insecurity, the patient suffers a problem
of health associated to a quantitative insecurity
of the medicine 6,7.
It was also evaluated socio-demographic data regarding gender, age, marital status and education level. The IO were classified according to
the International Classification of Diseases (CID
10) 6,7 and the control of medicines followed the
same Anatomical Therapeutic Chemical Classification (ATC) 8. All the obtained data were submitted to the evaluation through EPI-INFO version 3.4.1.
1750

The development of the study had beginning

after approval of the Committee of Ethics of the
Universidade Estadual da Paraba, number
3338.0.000.133-07. Participants knowledged the
scientific character of the objectives, the
methodology of the research and possible discomforts and/or benefits that the same could result. It was explained about the refusal possibility of his participation, even after having included in the study, also was informed regarding the
secrecy of the information. After these explanations the people signed the Statement of Consent.
It was also presented a term of the researchers commitment and a request term to
the manager of the service of public health that
it made possible the accomplishment of that research. This way, this project was in agreement
with the ethical guidelines of the research with
human, recommended by the National Commission of Ethics in Research (CO-NEP), expressed
in the Resolution 196/96 of National Council of
Health 9.
RESULTS AND DISCUSSION
It was accompanied 188 bearers of HIV, being most males (n = 124), single, whose age
group of larger incidence corresponded to 40-49
years and the incomplete degree of fundamental
education (Table 1).
The discoveries of this work are in agreement with the literature, because the difference
of males bearers of HIV was not significant in
relation to females. In Brazil, second some authors, AIDS initially was predominant in the
male population in 1985 (male to female infected proportion of 24:1) 10. A more recent study
presented the relationship 1,5 males to 1 females infected, showing tendency of feminization of the epidemic 11.
In Paraba of 1985 to August 2010, according
to raise data for the Management of STD/AIDS,
were notified more than 3,500 cases of the disease. Only among the years of 2006 to August
of 2010, 1,024 cases were registered, pointing
the growth tendency mainly inside the state, besides, there was increase of cases among the
women. In the period of 1985 and 2006 they
were 1,887 cases between men and 761 among
women; from 2007 to 2010, were informed 340
new cases of HIV between women and 578
among men 12.
As for the patients distribution for education
level, the standard found in the study, shown
similar to the general for Brazil, that is, charac-

Latin American Journal of Pharmacy - 30 (9) - 2011

Characteristic

Gender
Age

Marital Status

Education

Categories

No

Types of Opportunistic Infections (OI)

Males
Females

124
64

66
34

0-09
10-19
20-29
30-39
40-49
50-59
60-69
80-89

4
3
18
65
70
21
6
1

Single
Married
Widowed
Divorced
Analphabet
Fundamental incomplete
Fundamental complete
Medium incomplete
Medium complete
Superior

None

135

67

Tuberculosis (Cid 10 A15.0)

17

3
2
9
34
36
11
4
1

Vaginal Candidiasis (Cid 10 B37.3)

10

Oral Candidiasis (Cid 10 B37.0)

Herpes Zoster (Cid 10 B02.2)

Pneumonia (Cid 10 J15.0)

128
43
7
10

68
23
3
5

18
99
22
5
33
11

9
54
12
3
16
6

Table 2. Types of OI for CID registered by the seropositives accompanied.

Table 1. Data social-demographic of research partici-

pants.

terized by a larger frequency among people that

has low level of education 13.
A great part of patients (n = 135) didnt present any type of OI, however the most frequent
cases were: Tuberculosis (Tb) and Vaginal Candidiasis being registered also some associations
(Table 2).
The medicines used for the treatment of OI
were also evaluated and among them the more
prescribed belonged to the groups pharmacological sulphonamide and antifungal drug
(Table 3).
Besides the pharmacotherapy for OI the
bearers of HIV use in association ARV. In agreement with the Brazilian Consensus, the treatment ARV is indicated for all the patients infected by HIV, symptomatic or asymptomatic, that
present counting of lymphocytes T-CD4+ below
200 cells/mm 3, the beginning of the therapy
should be considered according to the evolution
of the immunological parameters, virological
and the other patients characteristics. The recommended preferential scheme are constituted
by two nucleoside analogue reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor (NNRTI); the use of
Protease inhibitors (PIs) started to have a more
restricted indication, being just recommended
only for patients with serious immunodeficiency

Cytomegalovirus (Cid 10 B25.0)

Kaposi's Sarcoma (Cid 10 C46.0)

Trichomoniasis (Cid 10 A59.9)

Herpes Zoster, Tuberculosis, Vaginal

Candidiasis (Cid 10 B02.2; Cid 10
A15.0; Cid 10 B37.3)

Vaginal Candidiasis And Cytomegalovirus

(Cid 10 B37.3; Cid 10 B25.0)

Medicines prescribed for OI

No

Sulfamethoxazole + Trimethoprim

58

34

Ketoconazole

30

18

Isoniazid + Rifampicin + Ethambutol

+ Pyrazinamide (J04AC01 + J04AB30
+ J04AK02 + J04AK01)

18

11

Fluconazole (J02AC01)

16

Metronidazole (J01XD02)

12

Amoxicillin (J01CA04)

11

Azithromycin (J01FA10)

Aciclovir (J05AB01)

Nystatin (G01AA01)

Secnidazole (P01AB07)

Sulfadiazine (D06BA01)

Table 3. Percentile of medicines prescribed for the

treatment of OI.

and rescue therapeutic 14. Table 4 makes reference to the outlines prescribed in SAE that were
extolled by Ministry of Health and those that the
seropositives made use, but were not recommended.
The schema more prescribed and that it is
accepted by MS was the 2NRTIs + 1NNRTI that
corresponded to the following substances: AZT
+ 3TC + EFZ (zidovudine + lamivudine +
efavirenz) and 3TC + D4T + EFZ (lamivudine +
stavudine + efavirenz). In agreement with the
literature is chosen preferentially, for the great
effectiveness, easiness posologic and better adhesion, besides smaller risk of adverse effects 4.
Also justified that IP can be alternative to NNRTI

1751

MONTEIRO M.M. de O., SANTANA J.E.G., VICENTE C.H.T.B., BESSA FILHO V., BEZERRA E.R., FERREIRA A.M. , JANEBRO D.I. &
QUEIROZ M. do S.R.

Recommended by the Ministry of Health

TYPES

2NRTIs + 1IP
2NRTIs + 2IP
2INTR + 1INNTR

22
58
81

11
30
42

Not recommended by the Ministry of Health

2IP
3IP
1NRTIs
3NRTIs
4NRTIs
1NRTIs
3NRTIs
4NRTIs
2NRTIs
2NRTIs
1NRTIs
3NRTIs

+
+
+
+
+
+
+

2IP
IP
1IP
3IP
1NNRTI + 2IP
1NNRTI
1NNRTI

1
1
1
2
1
6
1
1
4
1
2
1

1
1
1
2
1
4
1
1
2
1
2
1

Table 4. Outlines of ARV prescribed in SAE.

dada registered also in this work. The use of the

3TC should be avoided with pharmaco that produce peripheral neuropathy, as the d4T data
registered in many patient records 15.
Some prescribed schema were evidenced
and excused for the patients in disagreement
with what extols Ministry of Health, may be noted 2NRTIs: AZT + D4T; three or more IP: IDV +
LPV + RTV (Indinavir + Lopinavir + Ritonavir);
five or more ART: D4T + 3TC + IDV + LPV +
RTV; D4T + 3TC + SQV (Saquinavir) + LPV +
RTV; AZT + 3TC + EFZ + LPV + RTV.
According to orientations of Ministry of
Health the schema should be double with 2NRTIs, triples with 2 NRTIs + 1 NNRTI or 2 NRTIs
+ 1 IP, quadruple with 2 NRTIs + 1 NNRTI + 1
IP, or 2 NRTIs + 2 IP 16,17.
152 RNMs were evidenced among ARV and
among ARV and medicines for IO and the Insecurity no quantitative was the most representative category (Fig. 1).

Figure 1. Percentile of RNMs presented in the pre-

scriptions of SAE.

1752

Among RNMs can be mentioned:

Necessity
Medicine effect no necessary: The patient
made use of RTV in double dose, in other
words, the schema was SQV + D4T + 3TC +
RTV + Kaletra (RTV + LPV), it was also evidenced with AZT and the 3TC: IDV + AZT +
3TC + Biovir (AZT + 3TC).
Effectiveness
Ineffectiveness no quantitative. It was observed in cases of associations of the (didanosine) ddI with ATV, the first pharmaco provokes
decrease of the absorption of the second; some
bearers used benodiazepinic with ARV, according to the literature the association of the diazepam with pharmaco biotransformed for the
enzyme CYP3A4 or UGT1A1 as it is the case of
ATV can provoke increase of the plasmatic concentration of ARV resulting in risks to the health
15.
Ineffectiveness quantitative. It had been registered through ARV ATVS concomitant use +
RTV, RTV increases the plasmatic concentration
of ATV and dose should be decreased.
Safety
Insecurity no quantitative. The more present
was the peripheral neuropathy, that it corresponds an inflammation of the peripheral
nerves, showing with numbness in the feet and
in the hands. That type of RNM is considered an
Adverse Reaction to Medicine (ARM) and it
might have happened due to the existent interaction between ATV and 3TC, as well as D4T
with the metronidazole and D4T and 3TC. The
use associated of the 3TC with sulfonamides
(Sulfadiazine and Sulfamethoxazole and
Trimethoprim) was registered in this study, it is
important to guide the patients better because
the united action of these pharmaco can take a
clinical pictures of pancreatitis. The sulfamethoxazole and Trimethoprim increase the
area under the curve of the 3TC in 44 % and it
reduces renal purification of 30 %, therefore the
accompanied patients can be susceptible to a
clinical pictures of Nephrotoxicity 15,18. With regard to the fluconazole was confirmed the use
associated to AZT, this ARV is capable to reduce
the concentration of the antifungal, reducing
like this the therapeutic effectiveness, dado evidenced also with ddI and ketoconazole.
During the ARV therapy some bearers accomplished by treatment for Tuberculosis
through: Rifampicin, Isoniazid, Ethambutol and
Pyrimethamine, could have a smaller absorption

Latin American Journal of Pharmacy - 30 (9) - 2011

of ARV, being necessary a better evaluation of

the load viral avoiding like this the aggravation
of the clinical picture.
Insecurity quantitative. Some participants
made use of the ketoconazole with IDV, however in agreement with some accomplished studies the antifungal is capable to increase the plasmatic concentration of this ARV should be done
the reduction of IDV for 600 mg to each eight
hours 15.
The necessity of a pharmaco in the treatment
is sustained in the search by the best therapeutic
result, as well as in the quality of the users life,
in that the absence or the use no necessary of
the medicine can bring serious risks and to
commit in a significant way his health 19.
When the patient receives an appropriate
and designate medicine, however doesnt reach
the stipulated therapeutic mark, Problem of
qualitative therapeutic ineffectiveness can happened and (not depend on the amount of the
active ingredient and of the action place). It was
what told in the found results, once time that,
all of the medicamental interactions were related only with the pharmaco and not with the
posologic 13.
As for the safety, the sample in study, is susceptive the some types of ARMs, as peripheral
neuropathy and other. The safety of a medicine
is a process no static, that changes as advance
the knowledge on pharmacology, being also altered along the time by the disastrous situation
that affect the use of the pharmaco 19,20.
RNM constitutes a true problem of public
health with important economical repercussion.
About 80 % of RNMs are avoidable or preventable, so that precocious detection can prevent and to reduce problems of health and as
consequence, to improve the quality of the patients life. This situation offers an opportunity
to the pharmacist to participate in active and coresponsible form with the other members of the
health care team, in the care and the patients
individualized prosecution, in a systematic way,
with purpose of identifying, to prevent and to
solve RNMs that can interfere in the obtaining
of results therapeutic positives 21.
Because of the great number of medicines
used daily by the bearers of HIV is necessary a
better integration of the multidisciplinary team
of SAE to avoid that happen RNM in the medical
prescriptions as well as to motivate to the adhesion of the patient to the treatment. If there is a
work humanized among the users, with certainty the therapeutics will be obtained with success.

CONCLUSIONS
The bearers have been getting to maintain a
control of the load viral, evidenced fact because
most of them didnt present any type of OI. In
SAE of Campina Grande-PB are made available
all the medicines prescribed for the bearers of
HIV/AIDS, however, were identified schema of
ARV no recommended by MS and also RNMs
that can result in the aggravation of the patients
clinical picture. It is necessary that happens a
larger integration among prescribers (physicians
and dentists) and pharmacists in the best intention to evaluate the prescription and of motivating the adhesion to the treatment, fact that will
contribute to a more effective pharmacotherapy,
capable to improve the a better surviving for the
seropositive patients.

REFERENCES

1. Lima, A.C. de, R.F. Sturion & L.M. Franco

(2004) Rev. Sade 14(6): 61-6.
2. Brasil, Ministrio da Sade (1996) Lei n 9.313,
de 13 de novembro de 1996. Dirio Oficial da
Unio, Poder Executivo, Braslia, DF, 14 nov.
1996
3. Brasil, Ministrio da Sade (2010) Protocolo
de assistncia farmacutica em DST/HIV/AIDS:
recomendaes do Grupo de Trabalho de Assistncia Farmacutica. Braslia: MS.
4. Dader, M.J., P.A. Muoz & F.M. Martinez
(2008) Ateno Farmacutica: Conceitos, processos e casos prticos. So Paulo: RCN.
5. Comit de consenso (2007) Ars. Pharm. 48: 512.
6. Organizao Mundial da Sade (1997) CID-10
Classificao Estatstica Internacional de
Doenas e Problemas Relacionados Sade.
10a rev. So Paulo: Universidade de So
Paulo. v. 1.
7. Organizao Mundial da Sade (1997) CID-10
Classificao Estatstica Internacional de
Doenas e Problemas Relacionados Sade.
10a rev. So Paulo: Universidade de So
Paulo, v. 2.
8. World Health Organization, Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) index with
Defined Daily Doses (DDDs). Availabe at
<http://www.whocc.no/atcddd>.
9. Brasil, Conselho Nacional de Sade (1996).
Resoluo n 196 de 10 de outubro de 1996.
Available
at
<http://conselho.saude.gov.br/docs/Resolucoes/Reso196.doc>.
10. Dias, P.R.T.P. &, F.F. Nobre (2001) Cad. Sade
Pbl. 17: 1173-87.
1753

MONTEIRO M.M. de O., SANTANA J.E.G., VICENTE C.H.T.B., BESSA FILHO V., BEZERRA E.R., FERREIRA A.M. , JANEBRO D.I. &
QUEIROZ M. do S.R.

11. Barbosa, A.N. &, L. do R. Souza (2007) Rev

Racine. So Paulo. 99: 42-50.
12. Brasil, Secretaria Estadual da Sade do Estado
da Paraba (2010) Aids j est em 76,2% dos
municpios da Paraba. Available at
<http://hivempauta.wordpress.com/2010/10/03
/aids-ja-esta-em-762-dos-municipios-da-paraiba/>.
13. Nogueira, I.A.L., , A.B.B. Leo, , R.R. Bueno, ,
A.Q. Soares & .F. Carvalho (2007) Rev Eletrn.
Farm. 4: 104-12.
14. Brasil, Ministrio da Sade, Coordenao Nacional DST/AIDS (2002) Recomendaes para
terapia antiretroviral em adultos e adolescentes
infectados pelo HIV - 2002/2003. Braslia.Available at <http: www.aids.gov.br/final/tratamento/adulto>.
15. Korolkovas, A. & F.F. de A.C Frana (20092010) Quimioterpicos Antivirais. In: Dicionrio Teraputico Guanabara (A.Korolkovas
& F.F. de A.C. Frana, eds.). 15ed. Rio de Ja-

1754

neiro: Guanabara Koogan S/A. pp 18.41-18.60.

16. Brasil, Secretaria Municipal da Sade de Belm
(1999) Teraputica antiretroviral uma conquista da Secretaria Municipal de Sade.
17. Brasil, Secretaria Estadual da Sade do Estado
de Mina Gerais (2008) Manual de boas prticas para unidades dispensadoras de Medicamentos anti-retrovirais do estado de Minas Gerais. Minas Gerais: Autntica Editora LTDA.
18. Barros, E., C.A. Bittencourt, M.L. Caramori &
A. Machado (2002) Antimicrobianos. 3ed. Porto Alegre: Artmed. pp. 234-52.
19. Gonalves, S.J.E., F.C.B. Barbosa, M. do S.R.
Queiroz, D.I. Janebro &, I.R. Queiroz (2009)
Rev. Bras. Farm. 90: 344-8.
20. Rosa, M.B. & E. Perini (2003) Rev. Assoc. Md.
Bras. 49: 335-41.
21. Andrade, E.M., Cesana, E.S., Ferreira, N.G., Vitria, E.L. & Andrade, T.U. (2008) Rev. Cinc.
Farm. Bs. Apl. 28: 291-9.