20th International AIDS Conference - Melbourne, Australia

Abstract

THPE076 - Poster Exhibition


Predictors of receiving guideline recommended antiretroviral treatment: infectious disease specialists are critical to providing optimum HIV treatment

E. Brouwer, S. Wixson, D. Moga

University of Kentucky, Pharmacy Practice and Science, Lexington, United States

Background: Randomized clinical trials of combination antiretroviral therapy (cART) have informed the use of specific antiretrovirals (ARV) and their combination for optimizing therapeutic efficacy. Given these advances, it is critical that patients have access to and receive the most appropriate first-line treatment. Therefore, we aimed to examine factors that impact receiving an initial guideline recommended cART regimen within a cohort of insured patients receiving care in the United States.
Methods: We established an employed, commercially insured, population-based cohort of HIV patients receiving a new ARV prescription throughout the United States between January 2007 and December 2009. HIV patients were identified through ICD-9 codes (042) or a national drug code for any of the FDA approved antiretrovirals. The primary outcome was defined as a claim for a prescription containing a recommended cART regimen consisting of two nucleoside reverse transcriptase antiretrovirals (NRTI) and either a non-nucleoside reverse transcriptase inhibitor (NNRTI), protease inhibitor (boosted or unboosed with ritonavir), or an integrase strand transfer inhibitor (ISTI). Monotherapy, dual therapy, and triple nucleoside regimens were not considered recommended cART. Multivariate logistic regression models including patient demographic
(age, race, sex, location) and provider characteristics evaluated predictors of receiving recommended cART.
Results: Between 2007 and 2009, 2,316 HIV patients received a new antiretroviral prescription. The patient population was 57% white, 79% male with a median age of 42 years (Interquartile Range: 35-49). Overall, 66% of the population received recommended cART. Receiving care from an infectious disease specialist was the strongest predictor of receiving a recommended cART regimen (Odds Ratio: 1.47 (95% Confidence Interval: 1.38, 1.56). Men, those with less than a high school education, and younger individuals were also more likely to receive recommended cART
(p < 0.01).
Conclusions: Our results demonstrate that many HIV-infected patients with access to antiretroviral treatment are not prescribed recommended cART. Initial treatment established by an infectious disease specialist is an important factor in determining optimum cART. Increased communication and training of all healthcare providers is necessary to insure patients receive the most durable first-line regimen.


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