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PHYSICIAN EXPERIENCE, PRESCRIBING PRACTICES, PATIENT CHARACTERISTICS, AND SURVIVAL FROM HIV DISEASE IN SINCE JULY 1996
Evan Wood, Chan K, Montaner JS, Schechter MT, O’Shaughnessy MV, Hogg RS
British Columbia Centre for Excellence in HIV/AIDS/Department of Healthcare and Epidemiology, University of British Columbia
Objectives: We explored sociodemographic and health care related factors associated with survival in the British Columbia Centre for Excellence’s province-wide HIV Treatment Program.
Methods: The first analysis included the 1408 participants who initiated either a double or triple combination regimen over the period July 1996 to January 1999. A subanalysis of the 1031 participants who initiated triple therapy was also conducted. Cumulative mortality rates were estimated by Kaplan-Meir methods, and cox-proportional hazard regression was used to model the simultaneous effect of prognostic variables on survival.
Results: In a multivariate model that considered the entire group and adjusted for 2 versus 3 drugs in the initial regimen: having a more experienced physician (RR=0.97; [95% CI: 0.94-0.99] per 10 patients enrolled in the program), having a higher median income (RR=0.93; [95% CI: 0.90-0.97] per $1,000 increase), and having a higher CD4 cell count (RR=0.66; [95% CI: 0.58-0.75] per 100 cell increase), were all associated with improved survival. When only patients who initiated triple therapy are considered, having a higher baseline CD4 cell count (RR=0.61; [95% CI: 0.51-0.72]) was the only significant factor associatrd with improved survival. We investigated if inequitable access to triple combination therapy by income might explain this discrepancy. Interestingly, when those treated with 2 or 3 drugs were reanalyzed, after adjustment for baseline plasma viral load, CD4 cell count, and physician experience, participants prescribed double therapy were more likely to be injection drug users (adjusted OR=1.5; p=0.005) and to have lower incomes (adjusted OR=1.4; p=0.014).
Conclusions: Differential access to triple therapy, may explain why lower income and lower physician experience were associated with shorter survival when patients prescribed double therapy are considered. These data remain highly relevant given the increasing complexity of HIV treatment.