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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of recommendation updates in well-controlled patients on nonrecommended antiretroviral therapies: The swiss HIV cohort study
Journal of Acquired Immune Deficiency Syndromes, Volume 62, No. 2, Year 2013
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Description
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. Copyright © 2012 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Boillat-Blanco, Noémie
Switzerland, Lausanne
Université de Lausanne Unil
Darling, Katharine Elizabeth Anna
Switzerland, Lausanne
Université de Lausanne Unil
Taffé, Patrick
Switzerland, Lausanne
Data Coordination Centre for the Swiss Hiv Cohort
Osih, Regina B.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Strahm, Carol
Switzerland, St Gallen
Kantonsspital St.gallen
Adami, Maddalena
Switzerland, Lugano
Hospital of Lugano
Elzi, Luigia
Switzerland, Basel
Universitätsspital Basel
Daou, Samira
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Fehr, Jan Sven
Switzerland, Zurich
Universitatsspital Zurich
Wandeler, Gilles
Switzerland, Bern
University Hospital Bern
Switzerland, Bern
University of Bern
Cavassini, Matthias L.
Switzerland, Lausanne
Université de Lausanne Unil
Statistics
Citations: 11
Authors: 11
Affiliations: 10
Identifiers
Doi:
10.1097/QAI.0b013e31827b626a
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Noncommunicable Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative
Participants Gender
Female