Article date: July 2011
By: Tonny S. Petersen, Stig E. Andersen, January Gerstoft, Kristina Thorsteinsson, Carsten S. Larsen, Gitte Pedersen, Court Pedersen, Niels Obel, in Volume 72, Issue 1, pages 116-124
WHAT IS ALREADY KNOW 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.
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.
DOI: 10.1111/j.1365-2125.2011.03935.x
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