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The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study
BACKGROUND: Guidelines for antiretroviral treatment (cART) are published regularly, but there is little information regarding the effect of adherence to guidelines on patient outcomes. We assessed the effect of following the "when-to-start" and "what-to-start" guidelines, on trea...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233095/ https://www.ncbi.nlm.nih.gov/pubmed/25395106 http://dx.doi.org/10.1186/s12879-014-0596-y |
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author | Cotte, Laurent Bénet, Thomas Vanhems, Philippe Brochier, Corinne Perpoint, Thomas Ferry, Tristan Chidiac, Christian |
author_facet | Cotte, Laurent Bénet, Thomas Vanhems, Philippe Brochier, Corinne Perpoint, Thomas Ferry, Tristan Chidiac, Christian |
author_sort | Cotte, Laurent |
collection | PubMed |
description | BACKGROUND: Guidelines for antiretroviral treatment (cART) are published regularly, but there is little information regarding the effect of adherence to guidelines on patient outcomes. We assessed the effect of following the "when-to-start" and "what-to-start" guidelines, on treatment modifications, and on immunological and virological outcome at 12 months in a cohort of HIV-1 infected patients initiating cART from 2000 to 2010. METHODS: Consecutive HIV-1 infected patients, antiretroviral naive, initiating cART from 2000 to 2010 at a University Hospital were enrolled. HIV-2 infection, cART for prevention of mother-to-child transmission or during primary HIV-infection and unlicensed drugs were excluded. The respect or not of the "when-to-start" and "what-to-start" guidelines was based on French guidelines published from 2000 to 2010. Factors associated with cART modifications at 12 months and factors associated with an HIV viral load of <50 copies/mL at 12 months were assessed by univariate and multivariate logistic regression modeling. Variations in CD4 counts from baseline were assessed by univariate and multivariate linear regression. RESULTS: Of 1365 patients starting cART, 151 were treated outside "when-to-start" guidelines and 150 were treated outside "what-to-start" guidelines. Not using "when-to-start" guidelines was mainly related to early initiation in young men having sex with men, and was not associated with a significantly different outcome at 12 months. Treatments that did not follow "what-to-start" guidelines were not observed in any specific population and were associated with more treatment modifications and a poorer virological outcome at 12 months. CONCLUSIONS: Adherence to "what-to-start" guidelines is associated with a better outcome at 12 months in HIV-infected patients initiating antiretroviral therapy. Efforts should be made to promote adherence to these guidelines. |
format | Online Article Text |
id | pubmed-4233095 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42330952014-11-17 The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study Cotte, Laurent Bénet, Thomas Vanhems, Philippe Brochier, Corinne Perpoint, Thomas Ferry, Tristan Chidiac, Christian BMC Infect Dis Research Article BACKGROUND: Guidelines for antiretroviral treatment (cART) are published regularly, but there is little information regarding the effect of adherence to guidelines on patient outcomes. We assessed the effect of following the "when-to-start" and "what-to-start" guidelines, on treatment modifications, and on immunological and virological outcome at 12 months in a cohort of HIV-1 infected patients initiating cART from 2000 to 2010. METHODS: Consecutive HIV-1 infected patients, antiretroviral naive, initiating cART from 2000 to 2010 at a University Hospital were enrolled. HIV-2 infection, cART for prevention of mother-to-child transmission or during primary HIV-infection and unlicensed drugs were excluded. The respect or not of the "when-to-start" and "what-to-start" guidelines was based on French guidelines published from 2000 to 2010. Factors associated with cART modifications at 12 months and factors associated with an HIV viral load of <50 copies/mL at 12 months were assessed by univariate and multivariate logistic regression modeling. Variations in CD4 counts from baseline were assessed by univariate and multivariate linear regression. RESULTS: Of 1365 patients starting cART, 151 were treated outside "when-to-start" guidelines and 150 were treated outside "what-to-start" guidelines. Not using "when-to-start" guidelines was mainly related to early initiation in young men having sex with men, and was not associated with a significantly different outcome at 12 months. Treatments that did not follow "what-to-start" guidelines were not observed in any specific population and were associated with more treatment modifications and a poorer virological outcome at 12 months. CONCLUSIONS: Adherence to "what-to-start" guidelines is associated with a better outcome at 12 months in HIV-infected patients initiating antiretroviral therapy. Efforts should be made to promote adherence to these guidelines. BioMed Central 2014-11-14 /pmc/articles/PMC4233095/ /pubmed/25395106 http://dx.doi.org/10.1186/s12879-014-0596-y Text en © Cotte et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Cotte, Laurent Bénet, Thomas Vanhems, Philippe Brochier, Corinne Perpoint, Thomas Ferry, Tristan Chidiac, Christian The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study |
title | The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study |
title_full | The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study |
title_fullStr | The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study |
title_full_unstemmed | The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study |
title_short | The effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a French cohort study |
title_sort | effect of adherence to guidelines for initial antiretroviral therapy on 1-year outcomes: a french cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233095/ https://www.ncbi.nlm.nih.gov/pubmed/25395106 http://dx.doi.org/10.1186/s12879-014-0596-y |
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