ART regimens based on HHS guidelines more often achieve positive outcomes
SAN DIEGO — HIV patients prescribed ART regimens that adhered to Department of Health and Human Services guidelines appeared more likely to achieve positive outcomes, according to data presented at IDWeek 2015.
“The FDA has approved more than 26 antiretroviral drugs and several fixed-dose combinations to treat HIV infection,” Yunfeng Tie, PhD, of the consulting firm ICF International, said during a press conference. “Although ART has been well-studied in clinical trials, little is known about HIV providers’ prescribing practices and the real-world effectiveness of these regimens in the U.S. … as the population could be very different they might be used for a longer period of time.”
Tie and CDC researchers examined the regimens of 18,095 adults with HIV enrolled in the Medical Monitoring Project, a nationally-representative sample of U.S. HIV patients receiving medical care, from 2009 through 2012. Outcomes among patients prescribed ART regimens which did or did not follow guidelines issued by the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents were compared using multivariable logistic regression.
Ninety-two percent of HIV patients receiving medical care were assigned ART, and among these 52% were prescribed a recommended regimen, 6% an alternate regimen, 29% a nonrecommended regimen and 13% other regimens. Viral suppression persisting throughout the previous year was met by 66% of patients, 84% reported regimen adherence within the past 3 days, and 16% reported ART-related adverse side effects.
When compared with those prescribed recommended ART regimens, persistent viral suppression was less likely among those given nonrecommended (adjusted prevalence ratio = 0.98; 95% CI, 0.96-0.99) or other (aPR = 0.92; CI, 0.88-0.96) ART regimens. Similar trends also were seen among other outcomes, with those prescribed recommended therapies more likely to report adherence and less likely to experience ART-related side effects.
These results give a real-world representation of ART’s effectiveness, according to Tie, but do not reveal the various reasons a practitioner’s prescription would deviate from those recommended by the HHS.
“We do not have information or factors that might infirm a clinician’s position to choose from among recommended regimens, such as initial viral suppression and whether a previous regimen had failed already,” Tie said. “HHS guidelines change over time, and thus some regimens recommended in 2009 might no longer be on the recommended list in 2014.” – by Dave Muoio
Tie Y, et al. Abstract 122. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.
Disclosure: The researchers report no relevant financial disclosures.