Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort

Abstract

ObjectivesThe aim of the study was to assess the adequacy of initial antiretroviral therapy (ART), in terms of its timing and the choice of regimens, according to the Spanish national treatment guidelines [Spanish AIDS Study Group−National Plan for AIDS (GeSIDA-PNS) Guidelines] for treatmentnaïve HIV-infected patients. MethodsA prospective cohort study of HIV-positive ART-naïve subjects attending 27 centres in Spain from 2004 to 2010 was carried out. Regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Delayed start of treatment was defined as starting treatment later than 12 months after the patient had fulfilled the treatment criteria. Multivariate logistic and Cox regression analyses were performed. ResultsA total of 6225 ART-naïve patients were included in the study. Of 4516 patients who started treatment, 91.5% started with a recommended or alternative treatment. The use of a nonrecommended treatment was associated with a CD4 count > 500 cells/μL [odds ratio (OR) 2.03; 95% confidence interval (CI) 1.14-3.59], hepatitis B (OR 2.23; 95% CI 1.50-3.33), treatment in a hospital with < 500 beds, and starting treatment in the years [2004][2005][2006]. Fourteen per cent of the patients had a delayed initiation of treatment. Delayed initiation of treatment was more likely in injecting drug users, patients with hepatitis C, patients with higher CD4 counts and during the years 2004-2006, and it was less likely in patients with viral loads > 5 log HIV-1 RNA copies/ml. The use of a nonrecommended regimen was significantly associated with mortality [hazard ratio (HR) 1.61; 95% CI 1.03-2.52; P = 0.035] and lack of virological response. ConclusionsCompliance with the recommendations of Spanish national guidelines was high with respect to the timing and choice of initial ART. The use of nonrecommended regimens was associated with a lack of virological response and higher mortality.

Clinical outcomes of patients infected with HIV through use of injected drugs compared to patients infected through sexual transmission: late presentation, delayed anti‐retroviral treatment and higher mortality

“…The delayed initiation of ART in PWID has been described in several studies , including one in this same cohort . The HIV‐IDU in our sample are a select group of patients who have already accessed the medical system, and their delayed treatment initiation cannot be explained by the diagnostic delay or lack of first contact with a health‐care provider.…”

Comparison of HIV Outcomes for Patients Linked at Hospital Versus Community-Based Clinics

“…[43][44][45] Similarly, data indicate that compliance with HIV treatment guidelines is associated with viral suppression and improved survival. 46 The number of HIV education and care resources has increased in recent years and are widely accessible to clinics. One example is the HRSA-sponsored in + care campaign, a national quality improvement effort aimed at optimizing retention in care.…”

Effectiveness of antiretroviral therapy in treatment-naïve patients. Results at 24 and 48 weeks

“…The success of strategies in achieving sustained virological suppression depends on the appropriate selection of the starting regimen, the performance of a prior drug resistance mutation (DRM) test, and good adherence. Other factors that are considered as predictors of success are low pre-therapy baseline viraemia and baseline CD4 count above 200 cells/µl [1,2,[6][7][8].…”