Is clinical practice concordant with the changes in guidelines for antiretroviral therapy initiation during primary and chronic HIV-1 infection? The ANRS PRIMO and COPANA cohorts.

Evguenia Krastinova (1, 2) , Remonie Seng (2) , Patrick Yeni (3) , Jean-Paul Viard (4) , Daniel Vittecoq (1) , Caroline Lascoux-Combe (5) , Erwan Fourn (6) , Golriz Pahlavan (3) , Jean François Delfraissy (6) , Cécile Goujard (2, 6) , Laurence Meyer (2)

1 Service des Maladies Infectieuses et Tropicales, AP-HP, Hôpital Paul Brousse
2 CESP - Centre de recherche en épidémiologie et santé des populations
3 Service des maladies infectieuses et tropicales
4 Centre de Diagnost ic et de Thérapeutique
5 Service de maladies infectieuses et tropicales [Saint-Louis]
6 Service de médecine interne et maladies infectieuses

OBJECTIVE: Guidelines for initiating HIV treatment are regularly revised. We explored how physicians in France have applied these evolving guidelines for ART initiation over the last decade in two different situations: chronic (CHI) and primary HIV-1 infection (PHI), since specific recommendations for PHI are also provided in France. METHODS: Data came from the ANRS PRIMO (1267 patients enrolled during PHI in 1996-2010) and COPANA (800 subjects enrolled at HIV diagnosis in 2004-2008) cohorts. We defined as guidelines-inconsistent during PHI and CHI, patients meeting criteria for ART initiation and not treated in the following month and during the next 6 months, respectively. RESULTS: ART initiation during PHI dramatically decreased from 91% of patients in 1996-99 to 22% in 2007 and increased to 60% in 2010, following changes in recommendations. In 2007, however, after the CD4 count threshold was raised to 350 cells/mm(3) in 2006, only 55% of the patients with CD4≤350 were treated and 66% in 2008. During CHI, ART was more frequently initiated in patients who met the criteria at entry (96%) than during follow-up: 83% when recommendation to treat was 200 and 73% when it was 350 cells/mm(3). Independent risk factors for not being treated during CHI despite meeting the criteria were lower viral load, lower educational level, and poorer living conditions. CONCLUSION: HIV ART initiation guidelines are largely followed by practitioners in France. What can still be improved, however, is time to treat when CD4 cell counts reach the threshold to treat. Risk factors for lack of timely treatment highlight the need to understand better how patients' living conditions and physicians' perceptions influence the decision to initiate treatment.

Domaines: Maladies infectieuses

Evguenia Krastinova, Remonie Seng, Patrick Yeni, Jean-Paul Viard, Daniel Vittecoq, et al.. Is clinical practice concordant with the changes in guidelines for antiretroviral therapy initiation during primary and chronic HIV-1 infection? The ANRS PRIMO and COPANA cohorts.. PLoS ONE, 2013, 8 (8), pp.e71473. ⟨10.1371/journal.pone.0071473⟩. ⟨hal-00874822⟩