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The relationship between antiretroviral prescription patterns and treatment guidelines in treatment‐naïve HIV‐1‐infected patients
Author(s) -
SuarezLozano I,
Viciana P,
Lacalle JR,
Teira R,
Lozano F,
LopezAldeguer 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,
MunozSanz A,
MunozSanchez J,
Garrido M
Publication year - 2009
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2009.00731.x
Subject(s) - medicine , guideline , medical prescription , regimen , clinical practice , viral load , cohort , antiretroviral therapy , retrospective cohort study , cohort study , human immunodeficiency virus (hiv) , multivariate analysis , antiretroviral treatment , family medicine , pediatrics , pharmacology , pathology
Background Reports have shown that the publication of practice guidelines does not guarantee their use in clinical practice. The objective of this study was to evaluate the agreement between antiretroviral treatments (ARTs) prescribed in clinical practice and the recommendations in published guidelines. Methods A retrospective cohort study was carried out in ART‐naïve adults of the Spanish Asociacion Medica Vach de Estudios Multicentricos (VACH) Cohort for the period from 2003 to 2006. Results A total of 945 patients initiated ART. Of these patients, 12.3% had a CD4 cell count above 350 cells/μL. A ‘nonrecommended’ antiretroviral regimen was prescribed to 5.3, 5.1 and 7.8% of patients with CD4 counts <200, 200–350 and >350 cells/μL, respectively. Multivariate analyses demonstrated that only a higher viral load was associated with the selection of a combination treatment that was recommended by the guidelines. Conclusions Most patients were prescribed initial treatments in agreement with the recommendations. Appropriate routine data collection in databases can be used to evaluate the level of antiretroviral guideline compliance. We propose that routine evaluations of the guidelines must be part of quality assessment to improve medical care.