Rapid change in the use of antiretroviral agents and improvement in a population of HIV-infected patients: France, 1995 to 1997

Purpose: To describe the recent evolution of antiretroviral prescriptions and to look for clinical and biological changes among a population of HIV-infected patients. Subjects: Patients received follow-up in the hospital-based information system of the Groups d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA), Southwestern France, from 1995 to 1997. Methods: Quarterly evolution of the prescriptions of antiretroviral treatments and of the population clinical and biological indicators were studied in this observational survey of computerized records obtained after each hospital contact, Results: Overall numbers of patients who received follow-up and of hospital contacts remained stable. The proportion of untreated patients decreased from 38.5% to 10.5%. Monotherapies were progressively abandoned. Double combination therapies with two nucleoside analogues were used for 55% of the patients by early 1996 and then decreased. whereas triple combination therapies with one protease inhibitor (PI) rapidly increased to comprise up to 40% of the prescriptions in 1997. PIs were prescribed earlier and earlier in the course of HIV infection. Overall incidence of AIDS diagnoses and mortality rare decreased by 18% and 22%, respectively, in the first 9 months of use of PIs compared with the preceding 9 months, and by 47% and 56%, respectively, in the following 9 months (p <.001). The number of hospitalizations and the proportion of patients with a CD4 cell count <200/mm(3) decreased. AIDS cases diagnosed after introduction of PIs had rarely been treated with PIs. Conclusion: Over this 3-year period, physicians prescribed antiretroviral treatments more and more frequently, and triple combination therapy with PI is now common practice in France. Patients clinical and biological patterns have improved IS months after the introduction of PIs.