title: An audit of antiretroviral treatment use in HIV-infected patients in a London clinic: the limitations of observational databases when auditing antiretroviral treatment use.
abstract: OBJECTIVE
  To audit the use of antiretroviral (ARV) treatment in a large treatment clinic in the UK against the British HIV Association (BHIVA) ARV treatment guidelines.
  
  
  METHODS
  All patients under follow-up between 1st January 2000 and 1st January 2001 were included. The most recent CD4 count and HIV RNA level prior to 1st January 2001, and the nadir CD4 count and peak HIV RNA level over follow-up, were used to identify which patients should be receiving HAART according to the guidelines.
  
  
  RESULTS
  One thousand two hundred and sixty-four patients were included in the analysis (63.8% homosexual, 29.0% heterosexual risk; 72.9% white; 79.2% male). Almost half of patients had ever had a CD4 count below 200 cells/ micro L and over 80% had previously had a viral load above 4 log10 HIV-1 RNA copies/mL. Under 2000 BHIVA guidelines, treatment would be recommended in 77.4% patients. Overall, 819 patients were receiving ARV therapy. Two hundred and eighty-five patients were not receiving treatment when guidelines suggest they should (including 33 patients who were receiving regimens not recommended in the guidelines). These patients were younger, less likely to be homosexual and had higher CD4 nadirs than those who were receiving ARV treatment. Almost half of these patients had previously received ARV therapy but were not currently receiving it.
  
  
  CONCLUSIONS
  Only a small proportion of patients at our centre were not receiving ARV treatment in line with national guidelines. While genuine reasons may exist for these departures from optimal care, this may simply reflect the limitations of using observational databases when auditing treatment use in a clinic setting.
authors.affiliation: Royal Free Centre for HIV Medicine, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, London, UK. c.sabin@pcps.ucl.ac.uk
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
authors.forename: F C
authors.initials: FC
authors.lastname: Lampe
authors.forename: C
authors.initials: C
authors.lastname: Chaloner
authors.forename: S J
authors.initials: SJ
authors.lastname: Madge
authors.forename: M C I
authors.initials: MC
authors.lastname: Lipman
authors.forename: M
authors.initials: M
authors.lastname: Youle
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
authors.forename: M A
authors.initials: MA
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D016015:Logistic Models; D008131:London; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D016896:Treatment Outcome