title: 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?
abstract: 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.
authors.affiliation: Istituto Superiore di Sanità, Centro Operativo AIDS, Rome, Italy. patrizio.pezzotti@iss.it
authors.forename: P
authors.initials: P
authors.lastname: Pezzotti
authors.forename: A
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: R
authors.initials: R
authors.lastname: Bugarini
authors.forename: G
authors.initials: G
authors.lastname: Rezza
authors.forename: C
authors.initials: C
authors.lastname: Arici
authors.forename: G
authors.initials: G
authors.lastname: Angarano
authors.forename: M
authors.initials: M
authors.lastname: Borderi
authors.forename: F
authors.initials: F
authors.lastname: Alberici
authors.forename: O
authors.initials: O
authors.lastname: Armignacco
authors.forename: F
authors.initials: F
authors.lastname: Menichetti
authors.forename: T
authors.initials: T
authors.lastname: Prestileo
authors.forename: L
authors.initials: L
authors.lastname: Sighinolfi
authors.forename: A
authors.initials: A
authors.lastname: Sinicco
authors.forename: F
authors.initials: F
authors.lastname: Resta
authors.forename: M
authors.initials: M
authors.lastname: Vigevani
authors.forename: G
authors.initials: G
authors.lastname: Ippolito
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral