REGIONAL DIFFERENCES IN USE OF ANTIRETROVIRAL AGENTS AND PRIMARY PROPHYLAXIS IN 3122 EUROPEAN HIV-INFECTED PATIENTS

Little is known about how widely HIV-related drugs are used outside co ntrolled clinical trials, We therefore assessed factors associated wit h use of antiretroviral (ARV) therapy and primary prophylactic regimen s to prevent HIV-associated opportunistic infections. Baseline data fr om a prospective study from May to August 1994, on 3122 consecutive HI V infected patients with a CD4 count <500 cells/mu l, followed in 37 c enters from 16 European countries, were analyzed. Two thousand and twe nty patients (65%) were receiving at least 1 ARV drug at the time of t he study. ARV therapy was more frequently used among patients from sou thern and central Europe as compared with patients from northern Europ e, especially among patients with CD4 counts >200 cells/mu l (73%, 57% , and 42%, respectively, p < 0.0001). Of patients on ARV therapy, 34% received open-label combination therapy. This proportion was higher in central Europe compared with other regions (27%, 5O%, and 31% for sou thern, central, and northern Europe, respectively, p < 0.0001). Primar y prophylaxis against Pneumocystis carinii pneumonia (PCP) was used by 85% of patients with a CD4 count <200 cells/mu l, without marked regi onal differences. In patients without esophageal candidiasis or other invasive fungal infections, antifungal drugs were far less frequently used in patients from southern and central Europe compared with patien ts from northern Europe (10%, 10%, and 25%, respectively, p < 0.0001). Only 5% of patients with a CD4 count <100 cells/mu l received rifabut ine as primary prophylaxis against nontuberculous mycobacterioses. ARV and antifungal therapies are used differently in different parts of E urope, whereas primary PCP prophylaxis is uniformly administered to mo st at-risk patients. U.S. recommendations on the use of antimycobacter ial prophylaxis have not been implemented in Europe.