Antiretroviral therapy in HIV-infected individuals in clinical practice: are the criteria for initiating and choosing the type of drug regimen based only on immunologic and virologic values?
OBJECTIVE
To determine factors associated with beginning antiretroviral therapy and with the number of drugs used.


METHODS
Longitudinal study of 3169 HIV-infected individuals naïve from antiretroviral drugs at enrollment in 65 infectious disease clinics in Italy. Initiation of antiretroviral therapy and number of drugs used (i.e., < 3 vs. > or = 3 drugs) were the main outcome measures. Adjusted odds ratios were calculated by logistic models to establish cofactors of these two measures.


RESULTS
From January 1997 to December 1998, 1288 (40.6%) individuals started therapy, 58.0% of whom were given a triple combination regimen. This regimen became more frequent over time. By multivariate analysis, high levels of HIV-RNA and low CD4 counts were the most important independent predictors of starting any type of therapy. A significant association was also found with HIV exposure category, reason for being antiretroviral-naïve, presence/absence of liver disease, presence/absence of a new AIDS-defining disease, and clinical centre. High levels of HIV-RNA and low CD4 counts were also the most important predictors of starting with > or = 3 drugs, compared to < 3 drugs, and men had an independent higher probability of starting with > or = 3 drugs, compared to women. The probability of starting with > or = 3 drugs significantly increased with calendar time.


CONCLUSIONS
CD4 and HIV-RNA were the main cofactors of initiating both any type of therapy and therapy with > or = 3 drugs. The large variability among clinical centres suggests that clinicians are uncertain as to the exact timing of beginning therapy and the specific regimen, especially among women.
Pezzotti
P
P
Istituto Superiore di Sanità, Centro Operativo AIDS, Rome, Italy. patrizio.pezzotti@iss.it
d'Arminio Monforte
A
A
Bugarini
R
R
Rezza
G
G
Arici
C
C
Angarano
G
G
Borderi
M
M
Alberici
F
F
Armignacco
O
O
Menichetti
F
F
Prestileo
T
T
Sighinolfi
L
L
Sinicco
A
A
Resta
F
F
Vigevani
M
M
Ippolito
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data / Q000639:trends; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003710:Demography; D019468:Disease Management; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012327:RNA Virus Infections / Q000188:drug therapy; D012367:RNA, Viral / Q000032:analysis; D012737:Sex Factors
D019380:Anti-HIV Agents; D012367:RNA, Viral