title: Adherence to national guidelines for initiation of antiretroviral regimens in HIV patients: a Danish nationwide study.
abstract: OBJECTIVE
  To determine the adherence to the national guidelines for start of highly active antiretroviral treatment (HAART) in HIV infected patients.
  
  
  METHODS
  We used a Danish nationwide cohort of HIV infected patients to calculate the fraction of patients who in the period 1997-2006 started HAART according to the guidelines from The Danish Society of Infectious Diseases. We used Kaplan-Meier tables to estimate time from fulfilling the criteria for start of HAART to initiation of the treatment. Cox regression and logistic regression was used to identify risk factors for delayed initiation of treatment and chance of being included in clinical trials.
  
  
  RESULTS
  The study included 3223 patients, 74% of whom initiated HAART in the study period. Ninety-four% fulfilled the criteria for start of HAART, with minor differences over calendar periods. Ninety-four% initiated a recommended regimen or were included in a clinical trial. Intravenous drug use predicted initiation of a non-recommended regimen and delay in start of HAART, while non-Caucasians were less likely to be included in clinical trials.
  
  
  CONCLUSIONS
  In a Western world setting, the adherence to national guidelines for start of HAART can be high. We suggest that simplicity of the guidelines, centralization of treatment and involvement of local clinicians in the development of guidelines are of major importance for high adherence to treatment guidelines.
authors.affiliation: Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark. tsp@person.dk
authors.forename: Tonny S
authors.initials: TS
authors.lastname: Petersen
authors.forename: Stig E
authors.initials: SE
authors.lastname: Andersen
authors.forename: January
authors.initials: J
authors.lastname: Gerstoft
authors.forename: Kristina
authors.initials: K
authors.lastname: Thorsteinsson
authors.forename: Carsten S
authors.initials: CS
authors.lastname: Larsen
authors.forename: Gitte
authors.initials: G
authors.lastname: Pedersen
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000592:standards; D015331:Cohort Studies; D003718:Denmark; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D013222:State Medicine; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents