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

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Serval ID
serval:BIB_5EE95A0D4F7F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of recommendation updates in well-controlled patients on nonrecommended antiretroviral therapies: the Swiss HIV cohort study.
Journal
Journal of Acquired Immune Deficiency Syndromes
Author(s)
Boillat-Blanco N., Darling K.E., Taffe P., Osih R., Strahm C., Adami M., Elzi L., Daou S., Fehr J., Wandeler G., Cavassini M.
ISSN
1944-7884 (Electronic)
ISSN-L
1525-4135
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
62
Number
2
Pages
180-189
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
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.
Keywords
Adult, Cardiovascular Diseases/chemically induced, Cardiovascular Diseases/prevention & control, Chi-Square Distribution, Cholesterol/blood, Diabetes Complications/complications, Didanosine/therapeutic use, Drug Therapy, Combination/standards, Female, Guideline Adherence, HIV Infections/complications, HIV Infections/drug therapy, HIV Protease Inhibitors/therapeutic use, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Physician's Practice Patterns, Practice Guidelines as Topic, Retrospective Studies, Reverse Transcriptase Inhibitors/therapeutic use, Sex Factors, Statistics, Nonparametric, Stavudine/therapeutic use, Switzerland, Viral Load
Pubmed
Web of science
Create date
27/12/2012 15:41
Last modification date
09/04/2020 6:20
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