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Reasons for noncompliance with the national guidelines for initial antiretroviral therapy of HIV-infected patients in Spain, 2010-2015. Enferm Infecc Microbiol Clin 2019; 37:580-587. [PMID: 30982676 DOI: 10.1016/j.eimc.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010-2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. METHODS ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. RESULTS During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. CONCLUSIONS Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens.
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Dharan NJ, Radovich T, Che S, Petoumenos K, Juneja P, Law M, Huang R, McManus H, Polizzotto MN, Guy R, Cronin P, Cooper DA, Gray RT. HIV treatment regimens and adherence to national guidelines in Australia: an analysis of dispensing data from the Australian pharmaceutical benefits scheme. BMC Public Health 2019; 19:13. [PMID: 30606134 PMCID: PMC6318998 DOI: 10.1186/s12889-018-6325-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/14/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Treatment guidelines for antiretroviral therapy (ART) have evolved to emphasize newer regimens that address ageing-related comorbidities. Using national Australian dispensing data we compare ART regimens with Australian HIV treatment guidelines in the context of treated comorbidities. METHODS The study population included all individuals in a 10% sample of national data from the Australian Pharmaceutical Benefits Scheme (PBS) who purchased a prescription of ART during 2016. We defined each patient's most recently dispensed ART regimen and characterized them to evaluate regimen complexity and adherence to national HIV treatment guidelines. We then analyzed ART regimens in the context of other co-prescriptions purchased for defined comorbidities. RESULTS The 1995 patients in our sample purchased 212 different ART regimens during 2016; 1524 (76.4%) purchased one of the top ten most common regimens of which 62.3% were integrase strand transfer inhibitor-based. Among the 1786 (90%) patients that purchased the most common regimens, 83.7% purchased a regimen recommended by the guidelines for initial antiretroviral therapy and 11.4% purchased antiretrovirals that are not recommended for initial therapy; < 1% of the entire cohort purchased medications not recommended for use. While most patients purchased optimal ART regimens with low potential for significant drug interactions, regimen choices in the setting of risk factors for heart disease, renal disease and low bone mineral density appeared suboptimal. CONCLUSIONS Australian HIV providers are prescribing ART regimens in accordance with updated treatment guidelines, but could further optimize regimens in the setting of important medical comorbidities.
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Affiliation(s)
- Nila J Dharan
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | | | - Samuel Che
- Prospection Pty Ltd, Eveleigh, NSW, Australia
| | - Kathy Petoumenos
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | | | - Matthew Law
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Robin Huang
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Hamish McManus
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Mark N Polizzotto
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | | | - David A Cooper
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Richard T Gray
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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3
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Tandon N, Mao J, Shprecher A, Anderson AJ, Cao F, Jiao X, Brown K. Compliance with clinical guidelines and adherence to antiretroviral therapy among patients living with HIV. Curr Med Res Opin 2019; 35:63-71. [PMID: 30173561 DOI: 10.1080/03007995.2018.1519499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Evaluation of provider compliance with antiretroviral (ARV) treatment guidelines and patient adherence to ARVs is important for HIV care quality assessment; however, there are few current real-world data for guideline compliance and ARV adherence in the US. This study evaluated provider compliance with US Department of Health and Human Services (DHHS) guidelines and patient adherence to ARVs in a US population of patients with HIV.Methods: This was a retrospective claims study of adults with HIV-1 receiving ARV treatment between January 2010-December 2014. Follow-up began at first ARV treatment and ended at health plan disenrollment or study end. ARV regimens for treatment-naïve patients were categorized as "preferred/recommended", "alternative", or "non-preferred/recommended/alternative" according to DHHS guidelines. ARV adherence was evaluated using proportion of days covered (PDC) and medication possession ratio (MPR).Results: The analysis included 25,320 patients (84.4% male, mean age 45.3 years) and 39,071 regimens. Preferred/recommended regimens were most common during each study year, but the proportion of non-preferred/recommended/alternative regimens was substantial (15.9-20.6%). Only 53.6% of patients had optimal adherence by PDC ≥0.95, and 57.9% by MPR ≥0.95. Guideline non-compliance and sub-optimal adherence were more prevalent among female vs male patients (22.6% vs 14.8% [in 2014] and 65.9% vs 53.7%, respectively).Conclusions: Provider non-compliance with DHHS guidelines and sub-optimal ARV adherence among patients with HIV remain common in real-world practice, particularly for female patients. Healthcare providers should follow the latest clinical guidelines to ensure that patients receive recommended therapy, and address non-adherence when selecting ARV regimens.
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Affiliation(s)
- Neeta Tandon
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | | | | | - Xiaolong Jiao
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Trends in Racial/Ethnic Disparities Among Patients Living with HIV in Texas, 1996 to 2013. J Racial Ethn Health Disparities 2017; 5:1023-1032. [PMID: 29270841 DOI: 10.1007/s40615-017-0450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
National studies show that Blacks with HIV have higher mortality rates compared to Whites. This study aimed to identify trends in Black racial disparities among Texas residents living with HIV. Using HIV surveillance data from the Texas Department of State Health Services, a cohort of HIV-diagnosed patients (N = 70,996) were identified and grouped according to year of diagnosis, 1996-1997 (T1), 1998-2006 (T2), 2007-2010 (T3), and 2011-2013 (T4). Survival analysis was used to examine racial differences in death rate (analysis 1) and clinical progression to AIDS (analysis 2) for each subcohort, using Blacks as the reference group. In analysis 1, Whites (hazard ratio, HR = 0.80, 95% confidence interval, CI = 0.74-0.87, p < 0.001; HR = 0.82, 95% CI = 0.78-0.87, p < 0.001; respectively) and Hispanics (HR = 0.72, 95% CI = 0.66-0.79, p < 0.001; HR = 0.77, 95% CI = 0.74-0.81, p < 0.001, respectively) had lower death rates in T1 and T2. This remained significant after adjusting for covariates. In T3, death rate was higher for Hispanics after adjustment (HR = 1.13, 95% CI = 1.00-1.28, p < 0.05). In T4, death rate was higher for Whites (HR = 1.66, 95% CI = 1.30-2.13, p < 0.001) and Hispanics (HR = 1.66, 95% CI = 1.34-2.06, p < 0.001). These relationships became non-significant after adjusting for covariates. In analysis 2, the rate of clinical progression to AIDS was higher for Hispanics in all subcohorts. The significance remained after adjusting for covariates. The rate of clinical progression to AIDS was lower for Whites after adjustments in T2 and T3. Additional studies are needed to understand factors that may explain this unexpected finding of improved survival for Blacks over time. Such studies may inform decision-making in HIV care to reduce Black HIV disparities.
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Li J, Baird MA, Davis MA, Tai W, Zweifel LS, Adams Waldorf KM, Gale M, Rajagopal L, Pierce RH, Gao X. Dramatic enhancement of the detection limits of bioassays via ultrafast deposition of polydopamine. Nat Biomed Eng 2017; 1. [PMID: 29082104 PMCID: PMC5654575 DOI: 10.1038/s41551-017-0082] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The ability to detect biomarkers with ultrahigh sensitivity radically transformed biology and disease diagnosis. However, owing to incompatibilities with infrastructure in current biological and medical laboratories, recent innovations in analytical technology have not received broad adoption. Here, we report a simple, universal ‘add-on’ technology (dubbed EASE) that can be directly plugged into the routine practices of current research and clinical laboratories and that converts the ordinary sensitivities of common bioassays to extraordinary ones. The assay relies on the bioconjugation capabilities and ultrafast and localized deposition of polydopamine at the target site, which permit a large number of reporter molecules to be captured and lead to detection-sensitivity enhancements exceeding 3 orders of magnitude. The application of EASE in the enzyme-linked-immunosorbent-assay-based detection of the HIV antigen in blood from patients leads to a sensitivity lower than 3 fg ml−1. We also show that EASE allows for the direct visualization, in tissues, of the Zika virus and of low-abundance biomarkers related to neurological diseases and cancer immunotherapy.
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Affiliation(s)
- Junwei Li
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Madison A Baird
- Department of Pharmacology, University of Washington, Seattle, WA 98105, USA
| | - Michael A Davis
- Department of Immunology, University of Washington, Seattle, WA 98105, USA.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98105, USA
| | - Wanyi Tai
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Larry S Zweifel
- Department of Pharmacology, University of Washington, Seattle, WA 98105, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105, USA
| | - Kristina M Adams Waldorf
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98105, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98105, USA.,Department of Global Health, University of Washington, Seattle, WA 98105, USA.,Sahlgrenska Academy, Gothenburg University, Sweden
| | - Michael Gale
- Department of Immunology, University of Washington, Seattle, WA 98105, USA.,Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98105, USA.,Department of Global Health, University of Washington, Seattle, WA 98105, USA
| | - Lakshmi Rajagopal
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA 98105, USA.,Department of Pediatrics, University of Washington, Seattle, WA 98105, USA.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Global Health, University of Washington, Seattle, WA 98105, USA
| | - Robert H Pierce
- Fred Hutchinson Cancer Research Center, Program in Immunology, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Xiaohu Gao
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
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Pinheiro CAT, Mattos Souza LDD, Motta JVDS, Kelbert EF, Martins CDSR, Souza MSD, Pinheiro KAT, Coelho FMDC, Pinheiro RT. Aging, neurocognitive impairment and adherence to antiretroviral therapy in human immunodeficiency virus-infected individuals. Braz J Infect Dis 2016; 20:599-604. [PMID: 27789283 PMCID: PMC9427649 DOI: 10.1016/j.bjid.2016.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/31/2016] [Accepted: 09/18/2016] [Indexed: 11/14/2022] Open
Abstract
Background/objective There is an increasing number of older patients with human immunodeficiency virus infection due to the success of antiretroviral therapy, the improved prognosis and life expectancy of patients, and the higher number of new infections among older individuals. The main objective of the present study was to compare the characteristics of older human immunodeficiency virus patients with those of younger patients. Materials and methods We conducted a cross-sectional study with human immunodeficiency virus-infected patients who were treated at the Specialized Care Service (Serviço de Assistência Especializada) for human immunodeficiency virus/AIDS in the city of Pelotas, South Brazil. Sociodemographic information as well as data on human immunodeficiency virus infection and treatment were collected. All participants underwent psychiatric and neurocognitive assessments, and their adherence to antiretroviral therapy was evaluated. Results A total of 392 patients participated in the study, with 114 patients aged 50 years and older. The characteristics showing significant differences between older and younger human immunodeficiency virus-infected patients included race/ethnicity, comorbidities, duration and adherence to antiretroviral therapy, currently undetectable viral load, and cognitive impairment. Compared to younger patients, older patients were at higher risk of exhibiting cognitive impairment [OR 2.28 (95% CI: 1.35–3.82, p = 0.002)] and of having increased adherence to antiretroviral therapy [OR 3.11 (95% CI: 1.67–5.79, p < 0.001)]. Conclusions The prevalence of neurocognitive impairment remained high in human immunodeficiency virus-infected patients despite antiretroviral therapy. In the present study, the prevalence of this type of impairment was significantly higher in patients aged ≥50 years, most likely due to aging, human immunodeficiency virus infection, and a possible synergistic effect between these factors. Despite this higher prevalence, older patients exhibited higher rates of adherence to antiretroviral therapy and of undetectable human immunodeficiency virus viral load.
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Affiliation(s)
- Cezar Arthur Tavares Pinheiro
- Universidade Federal de Pelotas, Faculdade de Medicina, Serviço de Asssitência Especializada em HIV AIDS, Pelotas, RS, Brazil; Universidade Católica de Pelotas, Programa de Pós-Graduação em Saúde e Comportamento, Pelotas, RS, Brazil.
| | | | | | - Evelin Franco Kelbert
- Universidade Católica de Pelotas, Programa de Pós-Graduação em Saúde e Comportamento, Pelotas, RS, Brazil
| | | | - Marília Silva de Souza
- Universidade Católica de Pelotas, Programa de Pós-Graduação em Saúde e Comportamento, Pelotas, RS, Brazil
| | | | | | - Ricardo Tavares Pinheiro
- Universidade Católica de Pelotas, Programa de Pós-Graduação em Saúde e Comportamento, Pelotas, RS, Brazil
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Cotte L, Bénet T, Vanhems P, Brochier C, Perpoint T, Ferry T, Chidiac C. The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study. BMC Infect Dis 2014; 14:596. [PMID: 25395106 PMCID: PMC4233095 DOI: 10.1186/s12879-014-0596-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/29/2014] [Indexed: 11/12/2022] Open
Abstract
Background Guidelines for antiretroviral treatment (cART) are published regularly, but there is little information regarding the effect of adherence to guidelines on patient outcomes. We assessed the effect of following the "when-to-start" and "what-to-start" guidelines, on treatment modifications, and on immunological and virological outcome at 12 months in a cohort of HIV-1 infected patients initiating cART from 2000 to 2010. Methods Consecutive HIV-1 infected patients, antiretroviral naive, initiating cART from 2000 to 2010 at a University Hospital were enrolled. HIV-2 infection, cART for prevention of mother-to-child transmission or during primary HIV-infection and unlicensed drugs were excluded. The respect or not of the "when-to-start" and "what-to-start" guidelines was based on French guidelines published from 2000 to 2010. Factors associated with cART modifications at 12 months and factors associated with an HIV viral load of <50 copies/mL at 12 months were assessed by univariate and multivariate logistic regression modeling. Variations in CD4 counts from baseline were assessed by univariate and multivariate linear regression. Results Of 1365 patients starting cART, 151 were treated outside "when-to-start" guidelines and 150 were treated outside "what-to-start" guidelines. Not using "when-to-start" guidelines was mainly related to early initiation in young men having sex with men, and was not associated with a significantly different outcome at 12 months. Treatments that did not follow "what-to-start" guidelines were not observed in any specific population and were associated with more treatment modifications and a poorer virological outcome at 12 months. Conclusions Adherence to "what-to-start" guidelines is associated with a better outcome at 12 months in HIV-infected patients initiating antiretroviral therapy. Efforts should be made to promote adherence to these guidelines.
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8
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Ghidei L, Simone M, Salow M, Zimmerman K, Paquin AM, Skarf LM, Kostas T, Rudolph JL. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging 2013; 30:809-19. [PMID: 23959913 PMCID: PMC3844933 DOI: 10.1007/s40266-013-0107-7] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Older adults are generally considered to be at greater risk for medication non-adherence due to factors such as medication complexity, side effects, cost, and cognitive decline. However, this generalization may not apply to older adults with human immunodeficiency virus (HIV). Regardless of age, suboptimal adherence to antiretroviral therapy (ART) can lead to increased viral load, immunosuppression, drug-resistant viral strains, co-morbidities, and opportunistic infections. Understanding trends of adherence to ART among older adults is critical, especially as the population of people living with HIV grows older. OBJECTIVES The purpose of this systematic review and meta-analysis is to determine if older individuals with HIV are less likely to be non-adherent to antiretroviral therapy than younger individuals with HIV. DESIGN A systematic search in PubMed, Embase, and PsycINFO was conducted to identify peer-reviewed articles evaluating adherence to ART in older adults. Two independent reviewers screened abstracts, applied inclusion criteria, and appraised study quality. The bibliographies of qualifying studies were searched. Data were abstracted from studies by two independent authors. Meta-analyses were conducted, and adherence levels were reported as the relative risk of non-adherence in older individuals compared to younger individuals. RESULTS The systematic search yielded 1,848 abstracts. Twelve studies met full inclusion criteria. The overall meta-analysis found that older age reduced risk for nonadherence by 27 % (relative risk (RR) 0.72, 95 % confidence interval (CI) 0.64–0.82). Studies assessing both short-term and long-term adherence demonstrated a significant reduction in non-adherence among older patients (RR 0.75, 95 % CI 0.64–0.87 and RR 0.65, 95 % CI 0.50–0.85, respectively). CONCLUSIONS Older adults with HIV have a reduced risk for non-adherence to ART than their younger counterparts. Future studies should seek to elucidate contributing factors of adherence among older individuals with HIV.
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Affiliation(s)
- Luwam Ghidei
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Mark Simone
- Division of Aging, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marci Salow
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Kristin Zimmerman
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
- Massachusetts College of Pharmacy & Health Sciences, Boston, MA
| | - Allison M. Paquin
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - L. Michal Skarf
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tia Kostas
- Division of Aging, Brigham and Women’s Hospital, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | - James L. Rudolph
- Division of Aging, Brigham and Women’s Hospital, Boston, MA
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
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Suárez-García I, Sobrino-Vegas P, Tejada A, Viciana P, Ribas MA, Iribarren JA, Díaz Menéndez M, Rivero M, Arazo P, del Amo J, Moreno S. Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort. HIV Med 2013; 15:86-97. [DOI: 10.1111/hiv.12078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- I Suárez-García
- Infectious Diseases Unit; Infanta Sofía Hospital; Madrid Spain
| | | | - A Tejada
- Ramón y Cajal Hospital; Madrid Spain
| | - P Viciana
- Virgen del Rocío Hospital; Sevilla Spain
| | - MA Ribas
- Son Espases Hospital; Palma de Mallorca; Spain
| | | | | | - M Rivero
- Navarra Hospital; Pamplona Spain
| | - P Arazo
- Miguel Servet Hospital; Zaragoza Spain
| | - J del Amo
- National Epidemiology Center; Madrid Spain
| | - S Moreno
- Ramón y Cajal Hospital; Madrid Spain
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10
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Impact of Recommendation Updates in Well-Controlled Patients on Nonrecommended Antiretroviral Therapies. J Acquir Immune Defic Syndr 2013. [DOI: 10.1097/qai.0b013e31827b626a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marco A, Gallego C, Blanco XR, Puig A, Argüelles MJ, Moruno L. [An analysis of adherence to the "Recommendations for the treatment of human immunodeficiency virus-infected adults" in a penitentiary in Barcelona]. Enferm Infecc Microbiol Clin 2013; 31:392-5. [PMID: 23352212 DOI: 10.1016/j.eimc.2012.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/19/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022]
Abstract
AIM To analyze the adherence to the "Guidelines for the treatment of HIV-infected adults" among HIV-infected prison inmates. METHODS A cross-sectional study was conducted in 2010 in the Quatre Camins Prison (Barcelona, Spain). Epidemiological, clinical and therapeutic variables were collected. We verified whether antiretroviral therapy (ART) met the Guidelines and analyzed the variables associated with compliance using bivariate and multivariate analysis. RESULTS There were a total of 202 HIV infected prison inmates, 83.2% of whom were on ART. An undetectable viral load (VL) was observed in 80.4% of treated patients. The large majority (86.1%) met the guidelines, and 42.9% of non-compliance to guidelines was because the patients refused ART. More undetectable VL (P=.001; ORA: 4,30, 95%CI: 1,85 to 10.0) was found in those patients following the guidelines. CONCLUSION Compliance with the guidelines is high, and is significantly associated with undetectable VL. We suggest evaluating the quality of prescriptions periodically, and to correct them if needed.
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Affiliation(s)
- Andrés Marco
- Servicios Sanitarios Penitenciarios, Departamento de Justicia, Generalitat de Catalunya, Barcelona, España.
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Colombie V, Pugliese-Wehrlen S, Deuffic-Burban S, Cuzin L, Pugliese P, Katlama C, Poizot-Martin I, Raffi F, Cabie A, Dellamonica P, Yazdanpanah Y, Dat'Aids. Mean cost of a first combination antiretroviral therapy in HIV-infected patients in France, and determinants of expensive drugs prescription. Int J STD AIDS 2012; 23:865-9. [DOI: 10.1258/ijsa.2012.011438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To estimate the cost of the first combination antiretroviral drug therapy (cART) in HIV-infected patients and to determine factors associated with expensive prescriptions, 1698 patients starting cART between September 2002 and September 2007 were selected from the Dat'AIDS cohort. A multivariate linear regression model was used to assess associations between the cost of first cART and patient characteristics, clinical centre and cART adequacy. At cART initiation, the median age was 39 years, median CD4 count was 223 cells/mm3, median viral load (VL) was 5.2 log copies/mL and 18.3% presented with AIDS. cART was concordant with the French guidelines in 88.7%. The mean cost of cART varied from €26.69/day/person in 2002-2003 to €32.23 in 2006-2007 ( P < 0.0001), cost was associated with previous AIDS diagnosis (€31.83/day/person) versus (29.49; P < 0.0001), baseline VL > 5 log copies/mL (€30.99/day/person) versus (28.33; P < 0.0001) and centre. cART regimen not concordant with guidelines were more expensive (€38.31/day/person) versus (29.07; P < 0.0001). After adjusting for the year of initiation, the previous AIDS diagnosis, VL and recommended cART regimen, differences were still found between centres (from €27.81/day/person) to (33.12; P < 0.0001). Cost should be considered when choosing a first cART regimen, especially when considering clinically equivalent regimens.
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Affiliation(s)
- V Colombie
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Régional de Tourcoing, Faculté de Lille, Lille
| | - S Pugliese-Wehrlen
- Pharmacie Archet, Pôle Pharmacie, Centre Hospitalier Universitaire de Nice, Nice
| | | | - L Cuzin
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Toulouse, Toulouse
| | - P Pugliese
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Nice, Nice
| | - C Katlama
- Service Universitaire d'Immuno-Hématologie Clinique Hôspital Pitié-Salpètrière, Centre d'Informations et de soins de Nmmunodéficience Humaine et des hépatites Virales, Paris
| | - I Poizot-Martin
- Aix Marseille Univ, APHM Sainte-Marguerite, Service d'Immuno-hématologie clinique, Inserm U912 (SESSTIM), Marseille
| | - F Raffi
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Nantes, Nantes
| | - A Cabie
- Service d'Infectiologie Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Fort-de-France, Martinique
| | - P Dellamonica
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Régional de Tourcoing, Faculté de Lille, Lille
- ATIP-Avenir INSERM U783, Paris
| | - Y Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Régional de Tourcoing, Faculté de Lille, Lille
- ATIP-Avenir INSERM U783, Paris
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Adherence to HIV treatment guidelines for comorbid disease assessment and initiation of antiretroviral therapy. J Acquir Immune Defic Syndr 2012; 59:478-88. [PMID: 22367456 DOI: 10.1097/qai.0b013e31824a5473] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are limited data on adherence to HIV treatment guidelines. We assessed adherence to US Department of Health and Human Services guidelines with Australian Commentary for adults initiating antiretroviral therapy (ART). METHODS Data were recorded regarding "when to start", "what to start" and pre-ART comorbid disease assessment for consecutive adults initiating ART at primary care and hospital clinics in Sydney and Melbourne from 2004 through 2008. Independent predictors of adherence to guidelines were calculated by stepwise logistic regression. RESULTS For the 500 subjects (95.9% male, mean 40.2 years, median CD4 count 270 cells/μL) "when to start" adherence was 87.6%, and was less likely with initiation in a clinical trial [0.25 (95% CI: 0.13 to 0.49); P < 0.0001] and previous, short-term nontherapeutic antiretroviral exposure [0.08 (0.03 to 0.25); P < 0.0001]. "What to start" adherence was 69.0% for guideline-"preferred" regimens (85.8% for guideline-"preferred" or "alternative" regimens) and more likely with ART initiated in 2008 versus pre-2008 [OR: 2.69 (1.64 to 4.61); P = 0.0001]. Median comorbid disease assessment adherence was 56.8%, ranging from 25.6% for urinalysis to 99.2% for white blood cell count, and was more likely in patients with AIDS, and initiating ART in hospital or in a clinical trial. Hospital clinics were more likely to perform antiretroviral resistance testing (71.2% vs. 46.4%, P < 0.0001), to use "preferred" ART regimens (76.8% vs. 62.2%, P = 0.0002) but less likely to promote healthy diet and lifestyle (63.4% vs. 36.4%, P < 0.0001). CONCLUSIONS "When to start" and "what to start" guidelines have been largely adhered to in Australia, but pre-ART comorbid disease assessment requires greater attention.
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A comparison of initial antiretroviral therapy in the Swiss HIV Cohort Study and the recommendations of the International AIDS Society-USA. PLoS One 2011; 6:e27903. [PMID: 22205931 PMCID: PMC3243684 DOI: 10.1371/journal.pone.0027903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/27/2011] [Indexed: 11/28/2022] Open
Abstract
Background In order to facilitate and improve the use of antiretroviral therapy (ART), international recommendations are released and updated regularly. We aimed to study if adherence to the recommendations is associated with better treatment outcomes in the Swiss HIV Cohort Study (SHCS). Methods Initial ART regimens prescribed to participants between 1998 and 2007 were classified according to IAS-USA recommendations. Baseline characteristics of patients who received regimens in violation with these recommendations (violation ART) were compared to other patients. Multivariable logistic and linear regression analyses were performed to identify associations between violation ART and (i) virological suppression and (ii) CD4 cell count increase, after one year. Results Between 1998 and 2007, 4189 SHCS participants started 241 different ART regimens. A violation ART was started in 5% of patients. Female patients (adjusted odds ratio aOR 1.83, 95%CI 1.28–2.62), those with a high education level (aOR 1.49, 95%CI 1.07–2.06) or a high CD4 count (aOR 1.53, 95%CI 1.02–2.30) were more likely to receive violation ART. The proportion of patients with an undetectable viral load (<400 copies/mL) after one year was significantly lower with violation ART than with recommended regimens (aOR 0.54, 95% CI 0.37–0.80) whereas CD4 count increase after one year of treatment was similar in both groups. Conclusions Although more than 240 different initial regimens were prescribed, violations of the IAS-USA recommendations were uncommon. Patients receiving these regimens were less likely to have an undetectable viral load after one year, which strengthens the validity of these recommendations.
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Petersen TS, Andersen SE, Gerstoft J, Thorsteinsson K, Larsen CS, Pedersen G, Pedersen C, Obel N. Adherence to national guidelines for initiation of antiretroviral regimens in HIV patients: a Danish nationwide study. Br J Clin Pharmacol 2011; 72:116-24. [PMID: 21306418 DOI: 10.1111/j.1365-2125.2011.03935.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM To determine the adherence to the national guidelines for start of highly active antiretroviral treatment (HAART) in HIV infected patients. METHODS We used a Danish nationwide cohort of HIV infected patients to calculate the fraction of patients who in the period 1997-2006 started HAART according to the guidelines from The Danish Society of Infectious Diseases. We used Kaplan-Meier tables to estimate time from fulfilling the criteria for start of HAART to initiation of the treatment. Cox regression and logistic regression was used to identify risk factors for delayed initiation of treatment and chance of being included in clinical trials. RESULTS The study included 3223 patients, 74% of whom initiated HAART in the study period. Ninety-four% fulfilled the criteria for start of HAART, with minor differences over calendar periods. Ninety-four% initiated a recommended regimen or were included in a clinical trial. Intravenous drug use predicted initiation of a non-recommended regimen and delay in start of HAART, while non-Caucasians were less likely to be included in clinical trials. CONCLUSIONS In a Western world setting, the adherence to national guidelines for start of HAART can be high. We suggest that simplicity of the guidelines, centralization of treatment and involvement of local clinicians in the development of guidelines are of major importance for high adherence to treatment guidelines.
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Affiliation(s)
- Tonny S Petersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
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Oramasionwu CU, Brown CM, Lawson KA, Ryan L, Skinner J, Frei CR. Differences in national antiretroviral prescribing patterns between black and white patients with HIV/AIDS, 1996-2006. South Med J 2011; 104:794-800. [PMID: 22089356 PMCID: PMC3222681 DOI: 10.1097/smj.0b013e318236c23a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The benefit of improved health outcomes for blacks receiving highly active antiretroviral therapy (HAART) lags behind that of whites. This project therefore sought to determine whether the reason for this discrepancy in health outcomes could be attributed to disparities in use of antiretroviral therapy between black and white patients with HIV. MATERIALS AND METHODS The 1996-2006 National Hospital Ambulatory Medical Care Surveys were used to identify hospital outpatient visits that documented antiretrovirals. Patients younger than 18 years, of nonblack or nonwhite race, and lacking documentation of antiretrovirals were excluded. A multivariable logistic regression model was constructed with race as the independent variable and use of HAART as the dependent variable. RESULTS Approximately 3 million HIV/AIDS patient visits were evaluated. Blacks were less likely than whites to use HAART and protease inhibitors (odds ratio, 95% CI 0.81 [0.81-0.82] and 0.67 [0.67-0.68], respectively). More blacks than whites used non-nucleoside reverse transcriptase inhibitors (odds ratio, 95% CI 1.18 [1.17-1.18]). In 1996, the crude rates of HAART were relatively low for both black and white cohorts (5% vs 6%). The rise in HAART for blacks appeared to lag behind that of whites for several years, until 2002, when the proportion of blacks receiving HAART slightly exceeded the proportion of whites receiving HAART. In later years, the rates of HAART were similar for blacks and whites (81% vs 82% in 2006). Blacks appeared less likely than whites to use protease inhibitors and more likely than whites to use non-nucleoside reverse transcriptase inhibitors from 2000 to 2004. CONCLUSIONS Blacks experienced a lag in the use of antiretrovirals at the beginning of the study; this discrepancy dissipated in more recent years.
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Abstract
PURPOSE The health benefits for blacks on highly active antiretroviral therapy (HAART) lags behind that of whites. We therefore investigated whether this discrepancy in health outcomes is attributable to disparities in the receipt of appropriate HAART between black and white human immunodeficiency virus (HIV) patients. METHODS The 2000-2005 National Ambulatory Medical Care Surveys were used to identify patients receiving antiretrovirals. Regimens were evaluated for appropriateness according to national antiretroviral guideline recommendations. A multivariable logistic regression model was used to assess black race as a predictor for appropriate HAART. RESULTS An estimated 4.1 million HIV-related visits with antiretroviral therapy were identified. Eighty-six percent of visits were associated with appropriate therapy; inappropriate therapy was often due to antiretroviral monotherapy. Interestingly, blacks were more likely to receive appropriate therapy in comparison to white patients (94% vs 83%, P < .001). Multivariable analysis revealed black race as an independent predictor for an appropriate regimen (chi2 likelihood ratio, 12.3, P < .001) when controlling for age, gender, insurance status, and geographic region. CONCLUSIONS Health outcome disparities between black and white HIV patients do not appear to be attributable to differences in receipt of appropriate HAART. Further investigations are warranted to identify factors responsible for these outcome disparities.
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Belperio PS, Mole LA, Boothroyd DB, Backus LI. Trends in uptake of recently approved antiretrovirals within a national healthcare system. HIV Med 2009; 11:209-15. [PMID: 19863620 DOI: 10.1111/j.1468-1293.2009.00764.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to describe Veterans Healthcare Administration (VHA) system-wide uptake of three HIV protease inhibitors: atazanavir, darunavir and tipranavir. METHODS This 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. RESULTS Overall, 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. CONCLUSIONS Uptake 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.
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Affiliation(s)
- P S Belperio
- Department of Veterans Affairs, Center for Quality Management in Public Health, Palo Alto, CA, USA.
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Suarez-Lozano I, Viciana P, Lacalle JR, Teira R, Lozano F, Lopez-Aldeguer J, Pedrol E, Domingo P, Cosin J, Roca B, Geijo P, Fuente B, Vergara A, Ribera E, Galindo MJ, Zapata A, Sanchez T, Vidal F, Munoz-Sanz A, Munoz-Sanchez J, Garrido M. The relationship between antiretroviral prescription patterns and treatment guidelines in treatment-naïve HIV-1-infected patients. HIV Med 2009; 10:573-9. [DOI: 10.1111/j.1468-1293.2009.00731.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang HY, Daar ES, Sax PE, Young B, Cook P, Benson P, Cohen C, Scribner A, Hu H. The prevalence of transmitted antiretroviral drug resistance in treatment-naïve patients and factors influencing first-line treatment regimen selection. HIV Med 2008; 9:285-93. [PMID: 18400075 DOI: 10.1111/j.1468-1293.2008.00561.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the prevalence of transmitted antiretroviral (ARV) drug resistance, and to assess whether resistance testing influences first-line ARV regimen selection. METHODS Data on patients' characteristics were collected through questionnaires. ARV drug resistance was tested by genotypic methods and defined by Quest-Stanford classification rule. Physicians reported the intended and actual treatments and the factors considered in treatment selection. RESULTS Two hundred and twenty-eight patients were included. The prevalence of ARV drug resistance was 12.1%, with 9.8% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 4.5% for nucleoside reverse transcriptase inhibitors and 1.8% for protease inhibitors (PIs). Pill burdens, dosing frequency and physicians' experience with regimens were the major factors considered in treatment selection. The intended and actual treatment differed for 73 and 44% of the patients with and without ARV drug resistance, respectively [odds ratio (95% confidence interval, CI)=3.6 (1.5-9.0), P=0.006]. NNRTI-based regimens were intended for 10 patients with resistance to NNRTIs; these patients were prescribed PI-based regimens after genotypic testing. CONCLUSIONS Transmitted ARV drug resistance was detected in 12.1% of treatment-naïve patients, with resistance to NNRTIs the most common. Resistance-testing results played a partial role in first-line treatment selection. However, resistance to NNRTIs pre-empted NNRTI use.
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Affiliation(s)
- H-Y Huang
- Outcomes Research and Management, Merck & Co. Inc., West Point, PA 19446, USA.
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Valdiserri RO, Rodriguez F, Holodniy M. Frequency of HIV screening in the Veterans Health Administration: implications for early diagnosis of HIV infection. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2008; 20:258-264. [PMID: 18558822 DOI: 10.1521/aeap.2008.20.3.258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We evaluated the frequency of HIV testing across the Department of Veterans Affairs (VA), the largest provider of HIV care in the United States. An electronic survey was used to determine the volume and location of HIV screening, confirmatory testing, rapid testing and laboratory consent policies in VA medical centers between October 1, 2005, and September 30, 2006. One hundred thirty-five VA laboratories reported that 112,033 HIV screening tests were performed (81% outpatients vs. 19% inpatients, p<.0001). Overall HIV prevalence was 1.49% (1.62% in inpatients vs. 1.46% in outpatients, p=N.S., range=0.2-3.8%). Rapid testing was available in 67% of facilities, 60% of which took place in the clinical laboratory. Sixty-four percent of labs required a copy of the informed consent in order to perform testing. We estimate that fewer than 10% of VA inpatients and fewer than 5% of VA outpatients were tested for HIV during the survey period. Substantial opportunities for increasing routine HIV testing exist in this population.
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Affiliation(s)
- Ronald O Valdiserri
- Department of Veterans Affairs, Public Health Strategic Health Care Group, Washington, DC 20420, USA.
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Consistency of Initial Antiretroviral Therapy With HIV Treatment Guidelines in a US Cohort of HIV-Infected Women. J Acquir Immune Defic Syndr 2008; 47:377-83. [DOI: 10.1097/qai.0b013e318160d552] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The author discusses a new study that models the impact of the CDC's new recommendation of opt-out HIV testing in all health care encounters in the US for persons 13-64 years old.
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Affiliation(s)
- Ronald O Valdiserri
- US Department of Veterans Affairs, Washington, DC, United States of America.
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