The relationship between antiretroviral prescription patterns and treatment guidelines in treatment-naïve HIV-1-infected patients.
BACKGROUND
Reports have shown that the publication of practice guidelines does not guarantee their use in clinical practice. The objective of this study was to evaluate the agreement between antiretroviral treatments (ARTs) prescribed in clinical practice and the recommendations in published guidelines.


METHODS
A retrospective cohort study was carried out in ART-naïve adults of the Spanish Asociacion Medica Vach de Estudios Multicentricos (VACH) Cohort for the period from 2003 to 2006.


RESULTS
A total of 945 patients initiated ART. Of these patients, 12.3% had a CD4 cell count above 350 cells/microL. A 'nonrecommended' antiretroviral regimen was prescribed to 5.3, 5.1 and 7.8% of patients with CD4 counts <200, 200-350 and >350 cells/microL, respectively. Multivariate analyses demonstrated that only a higher viral load was associated with the selection of a combination treatment that was recommended by the guidelines.


CONCLUSIONS
Most patients were prescribed initial treatments in agreement with the recommendations. Appropriate routine data collection in databases can be used to evaluate the level of antiretroviral guideline compliance. We propose that routine evaluations of the guidelines must be part of quality assessment to improve medical care.
Infectious Disease Unit, Hospital Infanta Elena, Huelva, Spain. myriam@vach.es
I
I
Suarez-Lozano
P
P
Viciana
J-R
JR
Lacalle
R
R
Teira
F
F
Lozano
J
J
Lopez-Aldeguer
E
E
Pedrol
P
P
Domingo
J
J
Cosin
B
B
Roca
P
P
Geijo
B
B
Fuente
A
A
Vergara
E
E
Ribera
M-J
MJ
Galindo
A
A
Zapata
T
T
Sanchez
F
F
Vidal
A
A
Munoz-Sanz
J
J
Munoz-Sanchez
M
M
Garrido
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors; D019562:Viral Load
D044966:Anti-Retroviral Agents