Reasons for noncompliance with the national guidelines for initial antiretroviral therapy of HIV-infected patients in Spain, 2010–2015

• Published in: Enfermedades infecciosas y microbiologia clinica Vol. 37; no. 9; pp. 580 - 587
• Main Authors: Suárez-García, Inés, González, Juan, Berenguer, Juan, García, Federico, Portilla, Joaquín, Muga, Roberto, Moreno, Santiago, Jarrín, Inmaculada
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.11.2019
• Subjects: Cohort studies; Estudios de cohortes; Guías de práctica clínica; Highly active antiretroviral therapy; Infectious Disease; Practice guidelines; Tratamiento antirretroviral; Highly active antiretroviral therapy; Guías de práctica clínica; Practice guidelines; Estudios de cohortes; Tratamiento antirretroviral; Cohort studies
• ISSN: 0213-005X; 1578-1852
• DOI: 10.1016/j.eimc.2019.02.007

Abstract Introduction Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010–2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. Methods ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. Results During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. Conclusions Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens.