Optimizing HIV therapy. A consensus project on differences between cytidine analogues and regime compactness

Objectives. The identification of the most effective HAART regimens in different clinical settings is still an issue. The aim of the study was to analyze how the compactness of HAART regimens is perceived and if differences between lamivudine (3TC) and emtricitabine (FTC) do exist according to a panel of Italian HIV/AIDS clinicians, using the Delphi method. Methods. The Delphi technique relies on a structured group of participants to reach a consensus on debated topics. Issues related to the compactness of HAART and to 3TC / FTC features were identified and proposed to randomly- selected 80 HIV/AIDS Italian clinicians by questionnaires. Questionnaires were administered in two rounds. The steering board of the project discussed the answers after each round to reformulate or to draw conclusions, respectively. Results. Participants agreed that the compactness of HAART may influence adherence and outcome in many clinical conditions. Moreover, differences between FTC and 3TC were acknowledged with respect to pharmacokinetics, genetic barrier, antiviral potency, and resistance mutations arising at virologic failure. Conclusions. The Delphi method proved useful to focus on and gauge the relevance of issues such differences between the two cytidine analogues (FTC and 3TC) and the overall compactness of HAART combinations in HIV/ AIDS therapy.