Antiretroviral therapy initiation in France: adherence to national guidelines and outcome

J Int Assoc Physicians AIDS Care (Chic). 2012 Jan-Feb;11(1):40-6. doi: 10.1177/1545109711418362. Epub 2011 Aug 31.

Abstract

Objectives and methods: Retrospective study of all patients who started antiretroviral therapy (ART) in 2007 in a single center in Paris, with baseline characteristics and 1-year outcome, to assess adherence to national guidelines.

Results: We analyzed 118 patients. Time of ART initiation was in agreement with the guidelines for only 64 (54.2%) patients. Fifty patients (42%) started ART with AIDS or a CD4 count <200 cells/mm(3). In all, 62 (52%) and 47 patients (40%) received a combination of 2 nucleoside analogues with efavirenz (EFV) and 1 ritonavir-boosted protease inhibitor (PI/r), respectively. Treatment regimens were in accordance with the guidelines for 114 patients (97%). At 1 year, 16 patients (13.5%) were lost to follow-up, only 5 (4.9%) experienced HIV disease progression or death, but 19 (18.6%) required hospitalization. Antiretroviral therapy was changed in 21 patients (21%). Ten patients (8.4%) experienced virologic failure.

Conclusion: Antiretroviral therapy was in agreement with guidelines for the choice of combination but was often initiated too late.

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / immunology
  • Acquired Immunodeficiency Syndrome / virology
  • Adult
  • Alkynes
  • Anti-HIV Agents / therapeutic use*
  • Benzoxazines / therapeutic use
  • CD4 Lymphocyte Count
  • Cyclopropanes
  • Drug Therapy, Combination
  • Female
  • France
  • Guideline Adherence* / standards
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Reverse Transcriptase Inhibitors / therapeutic use
  • Ritonavir / therapeutic use
  • Time Factors
  • Treatment Outcome
  • Viral Load

Substances

  • Alkynes
  • Anti-HIV Agents
  • Benzoxazines
  • Cyclopropanes
  • Reverse Transcriptase Inhibitors
  • efavirenz
  • Ritonavir