Reasons for noncompliance with the national guidelines for initial antiretroviral therapy of HIV-infected patients in Spain, 2010-2015
Por:
Gonzalez, J, Jarrin, I, del Amo, J, Luisa Navarro, M, Isabel Gonzalez, M, Luis Blanco, J, Sobrino, P, Hernando, V, Alejos, B, Alvarez, D, Jarrin, I, Sanz, N, Moreno, C, Angeles Munoz-Fernandez, M, Garcia-Merino, I, Gomez Rico, C, Gallego de la Fuente, J, Garcia Torre, A, Portilla J, Merino E, Reus S, Boix V, Giner L, Gadea, C, Portilla I, Pampliega, M, Diez, M, Rodriguez J, Sanchez J, Luis Gomez, J, Hernandez, J, Remedios Aleman, M, del Mar Alonso, M, Inmaculada Hernandez, M, Diaz-Flores, F, Garcia, D, Pelazas, R, Lopez Lirola, A, Asensi, V, Valle, E, Antonio Carton, J, Rivas Carmenado, M, Rubio, R, Pulido, F, Bisbal, O, Hernando, A, Lagarde, M, Matarranz, M, Dominguez, L, Bermejo, L, Santacreu, M, Antonio Iribarren, J, Arrizabalaga, J, Jose Aramburu, M, Camino, X, Rodriguez-Arrondo, F, Angel von Wichmann, M, Pascual Tome, L, Angel Goenaga, M, Jesus Bustinduy, M, Azkune Galparsoro, H, Ibarguren, M, Umerez, M, Gutierrez, F, Masia, M, Padilla, S, Navarro, A, Montolio, F, Robledano, C, Gregori Colome, J, Adsuar, A, Pascual, R, Fernandez, M, Garcia, E, Alberto Garcia, J, Barber, X, Muga, R, Tor, J, Sanvisens, A, Berenguer, J, Lopez Bernaldo de Quiros, J, Miralles, P, Gutierrez, I, Ramirez, M, Padilla, B, Gijon, P, Carrero, A, Aldamiz-Echevarria, T, Tejerina, F, Jose Parras, F, Balsalobre, P, Diez, C, Vidal, F, Peraire, J, Vilades, C, Veloso, S, Vargas, M, Lopez-Dupla, M, Olona, M, Rull, A, Rodriguez-Gallego, E, Alba, V, Montero Alonso, M, Lopez Aldeguer, J, Blanes Julia, M, Tasias Pitarch, M, Castro Hernandez, I, Calabuig Munoz, E, Cuellar Tovar, S, Salavert Lleti, M, Fernandez Navarro, J, Gonzalez-Garcia, J, Arnalich, F, Ramon Arribas, J, Ignacio Bernardino, J, Miguel Castro, J, Escosa, L, Herranz, P, Hontanon, V, Garcia-Bujalance, S, Garcia Lopez-Hortelano, M, Gonzalez-Baeza, A, Luz Martin-Carbonero, M, Mayoral, M, Jose Mellado, M, Mican, R, Montejano, R, Luisa Montes, M, Moreno, V, Perez-Valero, I, Rodes, B, Sainz, T, Sendagorta, E, Stella, N, Valencia, E, Ramon Blanco, J, Antonio Oteo, J, Lbarra, V, Metola, L, Sanz, M, Perez-Martinez, L, Pascual, A, Ramos, C, Arazo, P, Gil, D, Dalmau, D, Jaen, A, Sanmarti, M, Cairo, M, Martinez-Lacasa, J, Velli, P, Font, R, Xercavins, M, Alonso, N, Rivero, M, Reparaz, J, Gracia Ruiz de Alda, M, Irigoyen, C, Jesus Arraiza, M, Segura, F, Jose Amengual, M, Navarro, G, Sala, M, Cervantes, M, Pineda, V, Segura, V, Navarro, M, Anton, E, Merce Nogueras, M, de los Santos, I, Sanz Sanz, J, Salas Aparicio, A, Sarria Cepeda, C, Garcia-Fraile Fraile, L, Moreno, S, Luis Casado, J, Dronda, F, Moreno, A, Perez Elias, M, Gomez Ayerbe, C, Gutierrez, C, Madrid, N, del Campo Terron, S, Marti, P, Ansa, U, Serrano, S, Jesus Vivancos, M, Cano, A, Bernal, E, Munoz, A, Garcia, F, Hernandez, J, Pena, A, Munoz, L, Belen Perez, A, Alvarez, M, Chueca, N, Vinuesa, D, Angel Fernandez, J, Del Romero, J, Rodriguez, C, Puerta, T, Carlos Carrio, J, Vera, M, Ballesteros, J, Antela, A, Losada, E, Riera, M, Penaranda, M, Leyes, M, Angels Ribas, M, Campins, A, Vidal, C, Fanjul, F, Murillas, J, Homar, F, Santos, J, Marquez, M, Viciana, I, Palacios, R, Perez, I, Maria Gonzalez, C, Viciana, P, Espinosa, N, Fernando Lopez-Cortes, L, Podzamczer, D, Ferrer, E, Imaz, A, Tiraboschi, J, Silva, A, Saumoy, M, Ribera, E, Olalla, J, del Arco, A, de la Torre, J, Luis Prada, J, de Lomas Guerrero, J, Juan Martinez, O, Jesus Vera, F, Martinez, L, Garcia, J, Alcaraz, B, Jimeno, A, Poveda, E, Pernas, B, Mena, A, Grandal, M, Castro, A, Pedreira, J, Munoz, J, Zurine Zubero, M, Mirena Baraia-Etxaburu, J, Ibarra, S, Ferrero, O, Lopez de Munain, J, Mar Camara, M, Lopez, I, de la Pena, M, Galera, C, Albendin, H, Perez, A, Iborra, A, Moreno, A, Angeles Campillo, M, Vidal, A, Amador, C, Pasquau, F, Ena, J, Benito, C, Fenoll, V, Suarez-Garcia, I, Malmierca, E, Gonzalez-Ruano, P, Martin Rodrigo, D, Omar Mohamed-Balghata, M, Gomez Vidal, M, Alberto de Zarraga, M, Estrada Perez, V, Tellez Molina, M, Vergas Garcia, J, Perez-Cecila Carrera, E, Gorgolas, M, Cabello, A, Alvarez, B, Prieto, L, Sanz Moreno, J, Arranz Caso, A, de Miguel Prieto, J, Casas Garcia, E, Galindo Puerto, M, Fernando Vilalta, R and Ferrer Ribera, A
Publicada:
1 nov 2019
Categoría:
Microbiology (medical)
Resumen:
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. (C) 2019 Elsevier Espafia, S.L.U. and Sociedad Espaliola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.
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