Consistency of initial antiretroviral therapy with HIV treatment guidelines in a US cohort of HIV-infected women
Finding the best treatment for an HIV-positive person can be challenging for clinicians. This is because there are many different medicines to choose from and many different combinations to put them in. Studies on HAART come out so quickly that it may be difficult for clinicians to keep up. To help solve these problems, the United States Department of Health and Human Services writes guidelines on how to use antiretroviral therapy. These guidelines recommend certain regimens. Not all patients will get these recommended regimens for many reasons, including side effects, resistance, and other patient likes and dislikes. This study looked to see how many WIHS participants used HAART regimens that were recommended by U.S. HIV treatment guidelines and whether patients who got these regimens had higher CD4 counts or lower viral loads. This study only looked at information that was already collected in WIHS from April 1998 to October 2004. The study found that 17% of WIHS women starting their first HAART medicines said they used a combination that the U.S. HIV treatment guidelines recommended against using. These combinations were not recommended to be used because they were not powerful enough, have too many side effects, or are a combination of interacting drugs. Women who used HAART combinations the guidelines were against did not gain as many CD4 cells and continued to have detectable viral loads in 2 years compared to women who used guideline HAART or HAART not mentioned at all in the guidelines. It is unclear why these women were using these poor HAART combinations that the guidelines recommended against but it was not related to race, education, income, and insurance. If a woman had a higher viral load, or started her first HAART after the year 2001, she was less likely to get a HAART regimen the guidelines advised against.
Cocohoba J, Wang QJ, Cox C, Gange SJ, Cohen M, Glesby M, DeHovitz JA and Greenblatt RM. Consistency of initial antiretroviral therapy with HIV treatment guidelines in a US cohort of HIV-infected women. J Acquir Immune Defic Syndr 2008;47:377-383.