Consistency of initial antiretroviral therapy with HIV treatment guidelines in a US cohort of HIV-infected women

BACKGROUND: HIV treatment guidelines define optimal initial antiretroviral therapy (ART). OBJECTIVE: To characterize initial ART used by a cohort of HIV-infected women according to US HIV treatment guidelines and determine whether regimen characteristics predict short-term outcomes. METHODS: Initial ART self-reported by Women's Interagency HIV Study (WIHS) participants. Regimens were classified as guideline consistent (GC), guideline not recommended (GNR), or unlisted. Univariate and multivariate logistic regression was used to analyze factors associated with guideline category. RESULTS: Two hundred seventeen WIHS participants initiated ART during the study period. Fifty-three percent reported use of GC ART, 17% reported GNR ART, and 30% reported ART unlisted in guidelines. Study site, higher pretreatment CD4 cell count, lower HIV RNA level, and initiation before 2001 were associated with use of GNR regimens. GC ART users had a higher rise in CD4 cell counts and more frequent undetectable HIV-1 RNA levels 2 years after initiation compared with those GNR (P = 0.0003) or unlisted initial ART. CONCLUSIONS: A higher than expected proportion of WIHS participants reported using initial ART not recommended by HIV treatment guidelines, although this decreased over time. Use of such regimens was associated with a higher incidence of switching and poorer short-term immunologic and virologic outcomes.