Abstract
BackgroundTreatment guidelines for antiretroviral therapy (ART) have evolved to emphasize newer regimens that address ageing-related comorbidities. Using national Australian dispensing data we compare ART regimens with Australian HIV treatment guidelines in the context of treated comorbidities.MethodsThe study population included all individuals in a 10% sample of national data from the Australian Pharmaceutical Benefits Scheme (PBS) who purchased a prescription of ART during 2016. We defined each patient’s most recently dispensed ART regimen and characterized them to evaluate regimen complexity and adherence to national HIV treatment guidelines. We then analyzed ART regimens in the context of other co-prescriptions purchased for defined comorbidities.ResultsThe 1995 patients in our sample purchased 212 different ART regimens during 2016; 1524 (76.4%) purchased one of the top ten most common regimens of which 62.3% were integrase strand transfer inhibitor-based. Among the 1786 (90%) patients that purchased the most common regimens, 83.7% purchased a regimen recommended by the guidelines for initial antiretroviral therapy and 11.4% purchased antiretrovirals that are not recommended for initial therapy; < 1% of the entire cohort purchased medications not recommended for use. While most patients purchased optimal ART regimens with low potential for significant drug interactions, regimen choices in the setting of risk factors for heart disease, renal disease and low bone mineral density appeared suboptimal.ConclusionsAustralian HIV providers are prescribing ART regimens in accordance with updated treatment guidelines, but could further optimize regimens in the setting of important medical comorbidities.
Highlights
Treatment guidelines for antiretroviral therapy (ART) have evolved to emphasize newer regimens that address ageing-related comorbidities
Several international cohort studies have evaluated the impact of clinical guidelines on when to start ART based on CD4 thresholds [6, 7, 10] and the choice of ART regimen [11,12,13,14], and have demonstrated that closer adherence to guideline-recommended regimens is associated with improved clinical outcomes such as increased virologic control [11, 12]
As we found in our analysis, 84% of the ten most common ART regimens taken in 2016 by Australian Human Immunodeficiency virus (HIV) Observational Database (AHOD) participants [25], were guideline “recommended”, “alternative” or “other” regimens
Summary
Treatment guidelines for antiretroviral therapy (ART) have evolved to emphasize newer regimens that address ageing-related comorbidities. Using national Australian dispensing data we compare ART regimens with Australian HIV treatment guidelines in the context of treated comorbidities. With the introduction of combination antiretroviral therapy (ART), people with HIV have been living longer lives, experiencing fewer AIDS-related health events and developing more medical comorbidities associated with the natural aging process [1, 2]. Recent ART treatment guidelines emphasize using these newer ART agents to improve clinical outcomes, in the setting of certain co-prescriptions and ageing-related comorbidities such as dyslipidemia, heart disease and renal insufficiency [3]. More recent and national data on the use of specific ART regimens are limited, with respect to -recommended regimens in the setting of medical comorbidities. To our knowledge only one study has looked adherence to ART treatment guidelines, but did not evaluate this in the setting of comorbidities and coprescriptions [10]
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