Effect of once-daily FDC treatment era on initiation of cART

OBJECTIVES: Combination antiretroviral therapy (cART) is associated with increased survival among HIV-infected persons. Yet, no research to date has examined whether introduction of once-daily fixed-dosed combinations (FDC) affects the likelihood of cART initiation. We aimed to determine whether implementation of once-daily FDC regimens was associated with changes to cART initiation. We also identified clinical, treatment regimen, and provider characteristics possibly associated with cART initiation. STUDY DESIGN: Retrospective observational analysis. METHODS: We queried electronic medical records between July 1999-June 2006 to identify incident cases of detectable HIV infection in antiretroviral-naive adults. Cox regression with time-dependent covariates was used to examine the effects of once-daily FDC era, clinical, provider, and treatment regimen characteristics on cART initiation. RESULTS: Once-daily FDC availability did not change the likelihood of cART initiation, but other characteristics were associated with an increased likelihood: AIDS diagnosis, above-median daily pill consumption, and 16+ yrs of physician HIV experience. Decreased likelihood of cART initiation was associated with CD4 201-350 cells/muL, HIV RNA < 100,000 copies/mL, and with CD4 > 350 cells/muL (any HIV RNA level), compared to CD4

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