Patterns and predictors of the use of different antiretroviral drug regimens at treatment initiation in the UK

NMUH Staff Publications

9

<br /><div style="line-height: 17.999801635742188px;"><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 8pt;">BACKGROUND:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;">We describe the <span class="highlight">patterns</span> of <span class="highlight">antiretroviral</span> <span class="highlight">drug</span> use at <span class="highlight">treatment</span> <span class="highlight">initiation</span> from 1996 to 2005 in a large <span class="highlight">UK</span>multicentre cohort.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 8pt;">METHODS:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;">We examined trends over time and across 10 clinical sites in stage of disease and type of <span class="highlight">antiretroviral</span>therapy (ART). Multivariable regression was used to identify factors associated with the CD4 cell count at ART <span class="highlight">initiation</span>, and with the choice of a protease inhibitor (PI) over a nonnucleoside reverse transcriptase inhibitor (NNRTI), and use of nevirapine over efavirenz.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 8pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;">A total of 14 252 patients initiated ART, of whom 54% had a CD4 count <200 cells/microL. The most important<span class="highlight">predictors</span> of starting ART at a lower CD4 cell count were being male, nonwhite, and heterosexual or an injecting <span class="highlight">drug</span> user (P<0.0001). Among those starting ART, the use of highly active ART increased from 23% in 1996 to >96% from 2000 onwards. There were differences over time and across the clinics in the use of PIs vs. NNRTIs, in the choice of specific PIs, NNRTIs and nucleoside reverse transcriptase inhibitor (NRTI) backbone, and in the rate at which prescribing practices changed.</span></p><h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left;"><span style="font-size: 8pt;">CONCLUSIONS:</span></h4><p style="margin: 0px 0px 0.5em;"><span style="font-size: 8pt;">Clinic site and calendar year were important determinants of choice of <span class="highlight">drug</span> at ART <span class="highlight">initiation</span>, whereas clinical and demographic characteristics were more important in influencing the CD4 cell count at <span class="highlight">initiation</span> of ART.</span></p></div>