Adherence to HIV treatment guidelines for initiation of antiretroviral therapy in Australia

Results Of 500 subjects initiating ART (by 54 physicians with mean 14 years HIV experience), 95% were male (mean age 40 years, CD4 count 287 cells/μL, HIV RNA 89,000 copies/mL). ART initiation was mean 3.1 years after diagnosis, via clinical trial in 20.4% and as hospital in-patient in 7.7%. For “When to start”, adherence to Dec 1 2009 guidelines was 91%, 82% for Nov 3 2008 guidelines, and 88% for guidelines current at ART initiation. Preferred or alternative regimens were prescribed (after exclusion of patients receiving experimental clinical trial regimens) in 79%, 90%, and 89%, according to 2009, 2008 and guidelines current at ART initiation, respectively. Preferred regimen was prescribed according to guidelines in 50%, 55% and 65%, respectively. Contraindicated ART was prescribed in 4%. Strong recommendations (level A) in 2008 guidelines were adhered to variably: for hepatitis serology (74%), oral/dental check (63%), fasting lipids (52%), fasting glucose (47%), CMV serology (50%), resistance testing (48%), vaccination history 39%, Chlamydia screening (38%), gonorrhea screening (36%), chest X ray (35%), pap smear (32%), urinalysis (26%), and TB testing (9%). Sydney patients were more likely than Melbourne patients to have co-morbidity history assessed (96% vs 62%, p<0.0001), and to commence ART via a clinical trial (36% vs 5%, p<0.0001), but less likely to have treatment adherence ability assessed (62 vs 84%, p<0.0001) with no significant difference in STI testing. Hospital sites were more likely than GP sites to perform investigations resistance testing (71 vs 46%, p<0.0001), but less likely to discuss lifestyle health promotion (36% vs 63%, p<0.001).