OBJECTIVES: To assess current clinical practice and estimate future treatment algorithm for people living with Human Immunodeficiency Virus type 1 (PLHIV) in Portugal during 2018 and 2019.

METHODS: A panel with five infectious diseases specialists highly experienced on HIV treatment was implemented to derive 2018 and 2019 clinical practice for PLHIV in Portugal. Experts, who were geographically and institutionally representative of the national clinical practice, replied independently to an electronic questionnaire and were individually interviewed. Responses allowed to estimate the number of PLHIV on each regimen. The prevalence of diagnosed PLHIV in 2018 and 2019 was based on previous projections from official national data.

RESULTS: In 2018, it is estimated that 35,491 PLHIV are on treatment, of which 43% on first line, 36% on second line and 21% on subsequent lines. Amongst those on first line, 45% are on integrase strand transfer inhibitors (ITI), 27% on non-nucleoside reverse transcriptase inhibitors (NNRTI) and 28% on protease inhibitors (PI) as third agents. Amongst those on second line, the respective proportions are 47%, 9% and 39%, being 5% on nucleosides sparing regimens. In 2019, it is estimated that 35,899 PLHIV will be treated, of which 32%, 39% and 28% on first, second and subsequent lines. The distribution by third agent remains almost unchanged. In both years, the two most used agents on both lines of therapy are darunavir and dolutegravir; in 2019 the newly introduced single tablet regimen darunavir/cobicistate/tenofovir alafenamida/emtricitabine will represent 10% of darunavir utilisation. Switching from tenofovir disoproxil fumarate/emtricitabine to tenofovir alafenamida/emtricitabine is the main reason for backbone change.

CONCLUSIONS: Portuguese official sources do not include treatment algorithms or updated distribution by regimen. The analysis developed allowed to fulfill those gaps and estimate the most used regimens by therapeutic line. The estimates are in line with the most recent treatment guidelines.