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Impact of recommendation updates in well-controlled patients on non-recommended antiretroviral therapies: the Swiss HIV Cohort Study


Boillat-Blanco, Noémie; Darling, Katharine E A; Taffe, Patrick; Osih, Regina; Strahm, Carol; Adami, Maddalena; Elzi, Luigia; Daou, Samira; Fehr, Jan; Wandeler, Gilles; Cavassini, Matthias (2013). Impact of recommendation updates in well-controlled patients on non-recommended antiretroviral therapies: the Swiss HIV Cohort Study. Journal of Acquired Immune Deficiency Syndromes, 62(2):180-189.

Abstract

INTRODUCTION: 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 (VL) on non-recommended 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 to 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%) patients 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 non-observance included female sex (adjusted odds ratio aOR 2.69, 95%CI 1-7.26; P=0.01) for DPBIs, and undetectable VL (aOR 3.53, 95%CI 1.6-7.8; P=0.002) and lack of cardiovascular (CV) events (aOR 2.93, 95%CI 1.23-6.97; P=0.02) for triple-NRTIs. All patient on DBPIs with documented diabetes or a CV 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. DISCUSSION: 'Physician decision' is the main factor driving change from non-recommended to recommended regimens, whilst virological suppression is associated with not switching. Positive clinical outcomes observed post-switch underline the importance of observing recommendations. even in well-controlled patients.

Abstract

INTRODUCTION: 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 (VL) on non-recommended 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 to 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%) patients 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 non-observance included female sex (adjusted odds ratio aOR 2.69, 95%CI 1-7.26; P=0.01) for DPBIs, and undetectable VL (aOR 3.53, 95%CI 1.6-7.8; P=0.002) and lack of cardiovascular (CV) events (aOR 2.93, 95%CI 1.23-6.97; P=0.02) for triple-NRTIs. All patient on DBPIs with documented diabetes or a CV 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. DISCUSSION: 'Physician decision' is the main factor driving change from non-recommended to recommended regimens, whilst virological suppression is associated with not switching. Positive clinical outcomes observed post-switch underline the importance of observing recommendations. even in well-controlled patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:14 Jan 2013 12:28
Last Modified:05 Apr 2016 16:19
Publisher:Lippincott, Williams & Wilkins
ISSN:1525-4135
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/QAI.0b013e31827b626a
PubMed ID:23187939

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