An audit of antiretroviral treatment use in HIV‐infected patients in a London clinic: the limitations of observational databases when auditing antiretroviral treatment use

Sabin, Caroline; Lampe, Fiona; Chaloner, Clinton; Madge, S; Lipman, Marc; Youle, Michael; Phillips, Andrew; Johnson, Margaret

doi:10.1046/j.1468-1293.2003.00141.x

Cited by 31 publications

(23 citation statements)

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Section: Patient Populationmentioning

confidence: 99%

“…The information is audited every 6-9 months by a trained research assistant who updates and cross-checks the information in the notes with that on the database. The Royal Free Cohort has been described previously [23].For the purpose of this study, HAART is defined as any regime containing a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI). Normal haemoglobin was defined as haemoglobin 413.5 g/dL for men and 411.5 g/dL for women, while anaemia was defined as values below these cut-offs.…”

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confidence: 99%

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Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender^*

et al. 2007

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The aims of the study were to describe gender differences in haemoglobin and albumin and to investigate the prognostic value of these measurements in relation to highly active antiretroviral therapy (HAART). MethodsAnaemia was defined as haemoglobin o13.5 g/dL for men and o11.5 g/dL for women. Albumin o35 g/L was defined as hypoalbuminaemia. Proportional hazards models were used to describe relationships between these markers and HIV progression and death. ResultsA total of 291 patients had pre-HAART and 1-year measurements. Mean haemoglobin and albumin levels pre-HAART were lower in women than in men (haemoglobin: 11.2 vs 13.2 g/dL, respectively, Po0.0001; albumin: 37.4 vs 40.2 g/L, respectively, Po0.0001), and a higher proportion of women were anaemic and hypoalbuminaemic compared with men. Despite a rise in both markers in the first year on HAART, mean haemoglobin levels remained lower by 2.08 g/dL (Po0.0001) and albumin by 2.88 g/L (Po0.0001) in women. In the 495 patients included in this analysis, haemoglobin and albumin levels were both significantly related to short-term risk of AIDS and death independently of CD4 count [hazards ratio (HR) 5 0.73/g/dL higher haemoglobin, 95% confidence interval (CI) 0.55-0.82, Po0.0001 and HR 5 0.87/g/L higher albumin, 95% CI 0.83-0.91, Po0.0001]. The prognostic value did not differ by gender. ConclusionsWomen were more likely to be anaemic and/or hypoalbuminaemic pre-HAART, but post-HAART increases were similar to those in men. Both haemoglobin and albumin were strong independent prognostic factors for risk of AIDS and death, regardless of gender.Keywords: albumin, disease progression, gender, haemoglobin, highly active antiretroviral therapy Received: 23 February 2006, accepted 18 September 2006 IntroductionThe management of patients with HIV-1 infection is dependent on the use of markers of disease progression such as the CD4 count and HIV-1 RNA concentration [1,2]. While these remain the main markers in clinical use, they do not fully explain an individual's prognosis [3]. In addition, their measurement requires sophisticated and often expensive laboratory equipment [4,5]. Additional markers of disease progression are therefore required, particularly in resource-poor settings.Many alternative markers have been proposed, including total lymphocyte count, white blood cell count, packed cell *This work has previously been presented as Abstracts at the 10th Anniversary Conference of the British HIV Association (BHIVA), Cardiff, UK, 15-17 April 2004 (The effect of gender on haemoglobin as a marker of HIV disease progression in the HAART era) and at the 3rd International AIDS Society (IAS) conference on HIV pathogenesis and treatment, Rio de Janeiro, Brazil, 24-27 July 2005 (Albumin as a marker of HIV disease progression and prognosis in women and men following initiation of HAART). [4,5,[7][8][9][10][11][12][13][14][15][16][17]. Anaemia is frequently experienced by HIV-positive individuals and has been shown to be a strong independent predictor of disease progression [8,...

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Section: Patient Populationmentioning

confidence: 99%

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confidence: 99%

Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender^*

et al. 2007

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“…At the Royal Free Hospital approximately 60% of the HIV-positive women seen in the HIV clinic are of blackAfrican ethnicity. Although it is these women who should be targeted by screening programmes, research suggests that women from ethnic minorities are under-screened [7][8][9]. Few data exist on the reasons for this discrepancy, particularly in women of black-African ethnicity.…”

Section: Introductionmentioning

confidence: 99%

Cervical screening in HIV‐positive women: characteristics of those who default and attitudes towards screening

et al. 2005

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To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these. MethodsWe compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy. ResultsOf the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P 5 0.05), to have lower median viral loads (o 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P 5 0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P 5 0.04) and lower viral load (P 5 0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P 5 0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P 5 0.0007) and not speaking English as a first language (74 vs 26%, respectively, P 5 0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P 5 0.47 and 0.28, respectively). ConclusionsOur results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.

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“…Information on the prescribing of individual antiretrovirals comes largely from reports from individual clinic settings or researchbased cohorts [3][4][5][6][7]. Although initiation of antiretroviral therapy has been assessed relative to treatment guideline development and sociodemographic subgroups [8][9][10] …”

Section: Accepted 21 July 2009mentioning

confidence: 99%

Trends in uptake of recently approved antiretrovirals within a national healthcare system

Belperio¹,

La²,

Boothroyd³

et al. 2010

HIV Medicine

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ObjectiveThe aim of the study was to describe Veterans Healthcare Administration (VHA) system-wide uptake of three HIV protease inhibitors: atazanavir, darunavir and tipranavir. MethodsThis retrospective cohort study evaluated VHA uptake of three target antiretrovirals and lopinavir/ ritonavir in each complete 90-day quarter since approval to December 2007 using VHA HIV Clinical Case Registry data. We assessed uptake using number of new prescriptions, number of providers and facilities prescribing target agents, provider type, clinic type, facility size and location within four US regions. ResultsOverall, 6551 HIV-infected veterans received target antiretrovirals. Uptake was generally greatest within the first year after Food and Drug Administration (FDA) approval, and then slightly declined and plateaued. Geographically, early adoption of new antiretroviral drugs tended to occur in the Western USA, as evidenced by comparison of uptake patterns of new antiretrovirals to use of all antiretroviral agents. A small percentage of prescribers of all antiretrovirals were responsible for new prescriptions for target medications, particularly for darunavir and tipranavir. Providers at almost 50% of VHA facilities were prescribing these agents within the first year. ConclusionsUptake of new antiretrovirals in the VHA generally reflected overall prescribing of all antiretrovirals, suggesting a lack of VHA impediments to new antiretrovirals in the healthcare system. Some regional variation in uptake among the targeted antiretrovirals occurred over time but tended to resolve after the first several months. Providers responsible for early prescribing of the target medications were limited to a fraction of providers who tended to be physicians who practised in infectious disease (ID) clinics at medium-sized facilities.Keywords: antiretrovirals, HIV/AIDS, protease inhibitor, uptake, VA healthcare system Accepted 21 July 2009Introduction Antiretroviral selection depends on several factors, including patient characteristics such as disease severity and patient treatment experience and medication characteristics such as safety, tolerability, comparative efficacy and cost. How quickly a new antiretroviral disseminates throughout a healthcare system may further depend on additional factors such as provider experience, local practices, facility case load, pharmacy restrictions, accumulation of clinical data and revisions of treatment guidelines.Overall trends in antiretroviral use identified from observational databases, including trends in the use of different classes and combinations of antiretrovirals, have been described in the literature [1][2][3]. Information on the prescribing of individual antiretrovirals comes largely from reports from individual clinic settings or researchbased cohorts [3][4][5][6][7]. Although initiation of antiretroviral therapy has been assessed relative to treatment guideline development and sociodemographic subgroups [8][9][10] 209In addition, regional variation in clinical care and prescribing has be...

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An audit of antiretroviral treatment use in HIV‐infected patients in a London clinic: the limitations of observational databases when auditing antiretroviral treatment use

Cited by 31 publications

References 11 publications

Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender^*

Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender^*

Cervical screening in HIV‐positive women: characteristics of those who default and attitudes towards screening

Trends in uptake of recently approved antiretrovirals within a national healthcare system

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An audit of antiretroviral treatment use in HIV‐infected patients in a London clinic: the limitations of observational databases when auditing antiretroviral treatment use

Cited by 31 publications

References 11 publications

Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender*

Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender*

Cervical screening in HIV‐positive women: characteristics of those who default and attitudes towards screening

Trends in uptake of recently approved antiretrovirals within a national healthcare system

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Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender^*

Haemoglobin and albumin as markers of HIV disease progression in the highly active antiretrovial therapy era: relationships with gender^*