Impact of recommendation updates in well-controlled patients on nonrecommended antiretroviral therapies: the Swiss HIV cohort study.

TitreImpact of recommendation updates in well-controlled patients on nonrecommended antiretroviral therapies: the Swiss HIV cohort study.
Publication TypeJournal Article
Year of Publication2013
AuthorsBoillat-Blanco, N, Darling, KEA, Taffé, P, Osih, R, Strahm, C, Adami, M, Elzi, L, Daou, S, Fehr, J, Wandeler, G, Cavassini, M
JournalJ Acquir Immune Defic Syndr
Volume62
Issue2
Pagination180-9
Date Published2013 Feb 1
DOI10.1097/QAI.0b013e31827b626a
ISSN1944-7884
ISBN Number1944-7884 (Electronic)
Mots-clésAdult, Cardiovascular Diseases, Chi-Square Distribution, Cholesterol, Diabetes Complications, Didanosine, Drug Therapy, Combination, Female, Guideline Adherence, HIV Infections, HIV Protease Inhibitors, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Physician's Practice Patterns, Practice Guidelines as Topic, Retrospective Studies, Reverse Transcriptase Inhibitors, Sex Factors, Statistics, Nonparametric, Stavudine, Switzerland, Viral Load
Abstract

BACKGROUND: HIV treatment recommendations are updated as clinical trials are published. Whether recommendations drive clinicians to change antiretroviral therapy in well-controlled patients is unexplored.

METHODS: We selected patients with undetectable viral loads (VLs) on nonrecommended regimens containing double-boosted protease inhibitors (DBPIs), triple-nucleoside reverse transcriptase inhibitors (NRTIs), or didanosine (ddI) plus stavudine (d4T) at publication of the 2006 International AIDS Society recommendations. We compared demographic and clinical characteristics with those of control patients with undetectable VL not on these regimens and examined clinical outcome and reasons for treatment modification.

RESULTS: At inclusion, 104 patients were in the DBPI group, 436 in the triple-NRTI group, and 19 in the ddI/d4T group. By 2010, 28 (29%), 204 (52%), and 1 (5%) patient were still on DBPIs, triple-NRTIs, and ddI plus d4T, respectively. 'Physician decision,' excluding toxicity/virological failure, drove 30% of treatment changes. Predictors of recommendation nonobservance included female sex [adjusted odds ratio (aOR) 2.69, 95% confidence interval (CI) 1 to 7.26; P = 0.01] for DPBIs, and undetectable VL (aOR 3.53, 95% CI 1.6 to 7.8; P = 0.002) and lack of cardiovascular events (aOR 2.93, 95% CI 1.23 to 6.97; P = 0.02) for triple-NRTIs. All patients on DBPIs with documented diabetes or a cardiovascular event changed treatment. Recommendation observance resulted in lower cholesterol values in the DBPI group (P = 0.06), and more patients having undetectable VL (P = 0.02) in the triple-NRTI group.

CONCLUSION: The physician's decision is the main factor driving change from nonrecommended to recommended regimens, whereas virological suppression is associated with not switching. Positive clinical outcomes observed postswitch underline the importance of observing recommendations, even in well-controlled patients.

Notes

Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/23187939?dopt=Abstract

Alternate JournalJ. Acquir. Immune Defic. Syndr.
Citation Key / SERVAL ID3349
PubMed ID23187939

                         

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