Adherence to national guidelines for initiation of antiretroviral regimens in HIV patients: a Danish nationwide study

TS Petersen, SE Andersen, Jan Gerstoft, K Thorsteinsson, Carsten Schade Larsen, Gitte Pedersen, C Pedersen, Niels Obel

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

17 Citationer (Scopus)

Abstract

What this paper adds What is already known about this subject •  National guidelines for start of highly active antiretroviral treatment (HAART) in HIV infected patients are available in many Western World countries however the impact of the guidelines on clinical practice is poorly documented What this study adds •  Adherence to the starting criteria for HAART and the choice of treatment regimen in the guidelines exceeded 90% •  Intravenous drug users were more likely to start HAART at a later time after fulfilling the starting criteria and starting an alternative regimen •  More than a third of the patients initiated HAART as a part of a clinical trial from 1998 to 2000 ABSTRACT: Aims: 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 HIV 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 3,223 patients, 74% of whom initiated HAART in the study period. 94% fulfilled the criteria for start of HAART, with minor differences over calendar periods. 94% 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. Conclusion: 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 development of guidelines are of major importance for high adherence to treatment guidelines.
OriginalsprogEngelsk
TidsskriftBritish Journal of Clinical Pharmacology
Vol/bind72
Sider (fra-til)116-24
Antal sider9
ISSN0306-5251
DOI
StatusUdgivet - 10 feb. 2011
Udgivet eksterntJa

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