Re-audit of antiretroviral prescribing in HIV patients

We have found an overall improvement in the prescribing of antiretroviral therapy (ART) in the Yorkshire region between 1997 and 1999 but have identified a clinic where a significant number of patients continue on suboptimal treatment. It has been shown that the substantial reduction in the HIV-associated morbidity and mortality was related to the introduction of protease inhibitors (PIs), which became part of triple ART regimens in mid 1990s. There is evidence that treatment with 2 agents will eventually fail and such prescribing needs to be addressed. Further investigation has shown that patient choice has been an important issue in this locality. Treatment options need to be negotiated between patient and physician and prescribing contrary to patients' wishes may adversely affect adherence. The British HIV Association (BHIVA) guidelines were updated earlier this year to reflect recent advances in management. In view of the importance of optimal prescribing, ART is kept as a standing item on the agenda at our regional audit meetings. These are held every 4 months. We will continue to audit this topic at regular intervals.