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

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
• treatment disparities
• sex

Acknowledgements

Data in this manuscript were collected by the Women's Interagency HIV Study (WIHS) Collaborative Study Group and the Multicenter AIDS Cohort Study (MACS). WIHS has centers (Principal Investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington DC Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); Data Coordinating Center (Stephen Gange). The WIHS is funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632) with co-funding from the National Cancer Institute, the National Institute on Drug Abuse, National Institute on Deafness and Other Communication Disorders, and the National Center for Research Resources (UCSF-CTSI Grant Number UL1 RR024131). The MACS has centers (Principal Investigators) at The Johns Hopkins University Bloomberg School of Public Health (Joseph B. Margolick, Lisa Jacobson), Howard Brown Health Center and Northwestern University Medical School (John Phair), University of California, Los Angeles (Roger Detels), and University of Pittsburgh (Charles Rinaldo). The MACS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute and the National Heart, Lung and Blood Institute. UO1-AI-35042, 5-MO1-RR-00722 (GCRC), UO1-AI-35043, UO1-AI-37984, UO1-AI-35039, UO1-AI-35040, UO1-AI-37613, UO1-AI-35041. The MACS website is located at http://www.statepi.jhsph.edu/macs/macs.html. Dr. Cocohoba's research is funded by the Building Interdisciplinary Research Careers in Women's Health Program (K12HD052163) and the National Institutes of Mental Health (K23MH087218). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.