Boillat-Blanco N., Darling K.E.A., Taffe P., Osih R., Strahm C., Adami M., Elzi L., Daou S., Fehr J., Wandeler G., Cavassini M.
Department of Medicine, Infectious Diseases Service, University Hospital and University of Lausanne (CHUV), 1011 Lausanne, Switzerland; Data Coordination Centre for the Swiss HIV Cohort, Lausanne, Switzerland; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Medicine, Cantonal Hospital, St Gallen, Switzerland; Division of Infectious Diseases, Hospital of Lugano, Lugano, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, BERN, Switzerland
Boillat-Blanco, N., Department of Medicine, Infectious Diseases Service, University Hospital and University of Lausanne (CHUV), 1011 Lausanne, Switzerland; Darling, K.E.A., Department of Medicine, Infectious Diseases Service, University Hospital and University of Lausanne (CHUV), 1011 Lausanne, Switzerland; Taffe, P., Data Coordination Centre for the Swiss HIV Cohort, Lausanne, Switzerland; Osih, R., Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa; Strahm, C., Division of Infectious Diseases, Department of Medicine, Cantonal Hospital, St Gallen, Switzerland; Adami, M., Division of Infectious Diseases, Hospital of Lugano, Lugano, Switzerland; Elzi, L., Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Daou, S., Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland; Fehr, J., Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Wandeler, G., Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland, Institute of Social and Preventive Medicine, University of Bern, BERN, Switzerland; Cavassini, M., Department of Medicine, Infectious Diseases Service, University Hospital and University of Lausanne (CHUV), 1011 Lausanne, Switzerland
BACKGROUND: HIV treatment recommendations are updated as clinical trials are published. Whether recommendations drive clinicians to change antiretroviral therapy in well-controlled patients is unexplored. METHODS: We selected patients with undetectable viral loads (VLs) on nonrecommended regimens containing double-boosted protease inhibitors (DBPIs), triple-nucleoside reverse transcriptase inhibitors (NRTIs), or didanosine (ddI) plus stavudine (d4T) at publication of the 2006 International AIDS Society recommendations. We compared demographic and clinical characteristics with those of control patients with undetectable VL not on these regimens and examined clinical outcome and reasons for treatment modification. RESULTS: At inclusion, 104 patients were in the DBPI group, 436 in the triple-NRTI group, and 19 in the ddI/d4T group. By 2010, 28 (29%), 204 (52%), and 1 (5%) patient were still on DBPIs, triple-NRTIs, and ddI plus d4T, respectively. 'Physician decision,' excluding toxicity/virological failure, drove 30% of treatment changes. Predictors of recommendation nonobservance included female sex [adjusted odds ratio (aOR) 2.69, 95% confidence interval (CI) 1 to 7.26; P = 0.01] for DPBIs, and undetectable VL (aOR 3.53, 95% CI 1.6 to 7.8; P = 0.002) and lack of cardiovascular events (aOR 2.93, 95% CI 1.23 to 6.97; P = 0.02) for triple-NRTIs. All patients on DBPIs with documented diabetes or a cardiovascular event changed treatment. Recommendation observance resulted in lower cholesterol values in the DBPI group (P = 0.06), and more patients having undetectable VL (P = 0.02) in the triple-NRTI group. CONCLUSION: The physician's decision is the main factor driving change from nonrecommended to recommended regimens, whereas virological suppression is associated with not switching. Positive clinical outcomes observed postswitch underline the importance of observing recommendations, even in well-controlled patients. Copyright © 2012 by Lippincott Williams & Wilkins.