Relationship between antiretroviral prescribing patterns and treatment guidelines in treatment-naive HIV-1-infected US veterans (1992-2004)
Relationship between antiretroviral prescribing patterns and treatment guidelines in treatment-naive HIV-1-infected US veterans (1992-2004)
复制标题
DOI：
10.1097/01.qai.0000248354.63748.54
复制
发表时间：
2007-01-01
影响因子：
3.6
通讯作者：
Deyton, Lawrence
中科院分区：
文献类型：
--
作者：
Holodniy, Mark;Hornberger, John;Deyton, Lawrence
旨在分析相对于国家规定的 HIV-1 感染初治患者的抗逆转录病毒 (ARV) 处方实践的时间模式。设计：回顾性队列研究。方法：我们评估了 1992 年至 2004 年期间在美国退伍军人事务部 (VA) 接受护理的未接受过 ARV 治疗的退伍军人的 ARV 处方模式，并与不断发展的成人 HIV-1 治疗指南进行比较。 结果：共有 15,934 名患者开始了 ARV 治疗。自 1999 年以来，超过 94% 的患者至少开始使用 3-ARV 药物组合，尽管开始采用指南“首选”或“替代”方案的患者百分比从未上升至超过 72%，并且与黑人和护理地区显着相关。 1999 年之后，20% 的患者开始联合使用 4 种或更多活性抗逆转录病毒药物，这与较低的基线 CD4 细胞计数、较高的病毒载量以及在美国西部接受护理显着相关。 1997 年之后，接受指南“不推荐”方案（病毒学不良或重叠毒性）的患者比例 < 1%。VA 处方趋势通常早于指南建议 6 至 12 个月。结论：VA 开始 ARV 的处方模式遵循最大限度提高安全性的治疗指南。旨在最大限度提高功效的指南并未得到严格遵循。根据当代治疗指南评估临床实践模式可以为指南的制定提供信息。
To analyze temporal patterns of antiretroviral (ARV) prescribing practices relative to nationally defined guidelines in treatment-naive patients with HIV-1 infection.Design: Retrospective cohort study. Methods: We evaluated ARV prescribing patterns among ARV treatment-naive veterans who were receiving care within the US Department of Veterans Affairs (VA) from 1992 through 2004 in comparison to evolving adult HIV-1 treatment guidelines.Results: A total of 15,934 patients initiated ARV treatment. Since 1999, > 94% of patients initiated at least a 3-ARV medication combination, although the percentage of patients who initiated a guideline "preferred" or "alternative" regimen never rose to greater than 72% and was significantly associated with being black and with region of care. After 1999, 20% of patients started 4 or more active ARV agents in combination, which was significantly associated with lower baseline CD4 cell count, higher viral load, and receiving care in the western United States. The proportion of patients receiving guideline "not recommended" regimens (virologically undesirable or overlapping toxicities) was < 1% after 1997. VA prescribing trends generally predated guideline recommendations by 6 to 12 months.Conclusions: VA prescribing patterns for ARV initiation adhere to treatment guidelines that maximize safety. Guidelines designed to maximize efficacy were not followed as stringently. Evaluating clinical practice patterns against contemporary treatment guidelines can inform guideline development.