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Changing treatment patterns among patients with HIV: Royal Free Hospital 1987-97
A Mocroft1, C A Sabin, M Youle
1Department of Primary Care and Population Sciences, Royal Free Centre for HIV Medicine, Royal Free and University College Medical School, University College London, Royal Free Campus, Rowland Hill Street, London, UK.
Insights
Antiretroviral therapy for HIV has dramatically evolved, with a significant shift from no treatment or monotherapy to triple combination therapy by 1997. This study tracked these changes in HIV treatment regimens over a decade.
Area of Science:
- * Clinical Medicine
- * Virology
- * Pharmacology
Background:
- * Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) has undergone substantial evolution following major clinical trial publications.
- * Understanding treatment patterns is crucial for managing HIV infection and its long-term outcomes.
Purpose of the Study:
- * To describe the changes in antiretroviral treatment strategies and drug combinations used in HIV patients.
- * To analyze treatment trends at a single center (Royal Free Hospital, London, UK) between 1988 and 1997.
Main Methods:
- * Retrospective analysis of patient treatment data from a single HIV clinic.
- * Quarterly data collection to track the number of patients receiving treatment and participating in clinical trials.
- * Evaluation of treatment regimens, including monotherapy, dual, and triple combination therapies.
Main Results:
- * Proportion of patients on no therapy decreased from over 90% (1988) to under 15% (1997).
- * Monotherapy use declined from the sole option pre-1992 to 2% by 1997; triple combination therapy became standard (over 40%).
- * Significant shifts in individual agent use: zidovudine decreased, while lamivudine and stavudine use rose sharply in 1997. Protease inhibitor use increased, with dual protease therapy emerging.
Conclusions:
- * Major shifts in antiretroviral therapy use were observed, particularly in 1996-1997, indicating rapid adoption of new treatment guidelines.
- * The long-term implications of intensive ART regimens, including cost and side effects, require further investigation.
Objective:
Following the publication of results of large-scale clinical trials, antiretroviral treatment for HIV has changed dramatically. The aim of this study was to describe changes in antiretroviral treatment and the way treatments were combined among 1806 patients with HIV seen at a single centre at the Royal Free Hospital, London, UK.
Design And Method:
Each calendar year was divided into quarters, and the number of patients receiving treatment and participating in clinical trials was determined.
Results:
The proportion of patients on no therapy decreased from over 90% at the beginning of 1988 to under 15% at the end of 1997. Monotherapy was the only form of treatment available before 1992 but its use dropped to 2% by the end of 1997. The standard of care at the end of 1997 was triple combination therapy, used in over 40% of patients. There were dramatic changes in the use of individual agents; use of zidovudine decreased from 50% during 1989 to 25% during 1997, while use of lamivudine and stavudine saw an exponential rise in 1997. The protease inhibitors were used in equal proportions in this clinic population; the use of dual protease therapy began in 1997 and was rising rapidly by the end of the year.
Conclusions:
There have been major changes in the use of antiretroviral therapy at this centre, particularly during 1996 and 1997. The long-term cost implications and side-effects of intensive treatment regimens remain to be addressed.
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