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Influence of gender on receipt of guideline-based antiretroviral therapy in the era of HAART

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Abstract:

United States HIV guidelines delineate preferred antiretroviral treatment (ART) and discourage use of sub-potent, toxic, or adversely interacting combinations. It is unclear how often patients receive guideline concordant ART and what factors are correlated with receiving guideline-inconsistent ART. The objective of this study was to assess ART reported by participants of the Women's Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS) to determine whether gender is associated with receipt of guideline-inconsistent ART. ART reported by WIHS and MACS participants from 1 January 2001, to 31 December 2007, was assessed for concordance with HIV guidelines. Logistic regression with generalized estimating equations estimated the crude and adjusted odds ratios and 95% confidence intervals associated with guideline-inconsistent regimens. Of 2937 participants, 463 subjects (WIHS n = 263; MACS n = 200) reported guideline-inconsistent ART during the study period. Age > 50 years (aOR = 2.22, 95% CI 1.14, 4.33) and HIV-1 RNA (aOR = 1.17, 95% CI 1.08, 1.25) but not participant gender (aOR = 1.21, 95% CI 0.88, 1.65) were associated with guideline-inconsistent ART. The prevalence of guideline-inconsistent ART peaked in 2004; however, there was not a statistically significant increase or decrease over time. Guideline-inconsistent ART was not related to gender, but was often used by older patients and patients with higher viral loads. Monitoring ART quality based on concordance with expert guidelines could improve treatment outcomes in a substantial number of patients.

Keywords: antiretroviral; gender; guideline concordance; sex; treatment disparities

Document Type: Research Article

DOI: http://dx.doi.org/10.1080/09540121.2011.592814

Affiliations: 1: Department of Clinical Pharmacy, School of Pharmacy,University of California, San Francisco,CA, USA 2: Department of Epidemiology, John Hopkins Bloomberg School of Public Health,John Hopkins University, Baltimore,MD, USA 3: Department of Molecular Microbiology and Immunology, John Hopkins Bloomberg School of Public Health,John Hopkins University, Baltimore,MD, USA 4: Infectious Diseases Division, Department of Medicine, Feinberg School of Medicine,Northwestern University, Chicago,IL, USA

Publication date: January 1, 2012

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