MANAGEMENT OF HIV-INFECTED PATIENTS - TO WHAT EXTENT ARE GUIDELINES USEFUL - RESULTS OF A NATIONWIDE AUDIT

Background: Antiretroviral treatment and prophylaxis in HIV-infected p atients follows guidelines. Aim of the study was to evaluate to what e xtent guidelines are useful. We used a cohort of patients (I) and a na tionwide audit (II). Subjects and methods: Over a 48-month period demo graphic data, immunologic function and stage of HIV-infection of 433 p atients were recorded (I). Questionnaires about the practicability of antiretroviral therapy according to recently published guidelines were mailed to experienced hospital departments and private offices (II). Results: I. In 307 of 433 (70.9%) patients antiretroviral therapy and in 107 of these 433 (24.7%) patients primary prophylaxis against PC-in fection could be initiated according to the guidelines. In 21 of 433 p atients (4.8%) Ganciclovir prophylaxis was applicated using Port-a-Cat h systems in a homecare setting. II. In Austria 118 questionnaires wer e mailed in June 1996 43 (36.4%) were returned and 38 could be evaluat ed. 1450 patients were treated by physicians, who answered the questio nnaires, 78.1% of these worked in hospitals and 78.9% were specialists . 75% of the physicians had experience with HIV-infected patients exce eding 5 years. CD4+ lymphocyte count was routinely done in 73.7% of th e physicians, viral load only in 42.1%. These examinations were predom inantly performed in hospitals (in 64.3% and 81.2%, respectively). Onl y 13/36 of the physicians prescribed the recommended combination thera py consisting of 2 nucleosides and 1 protease-inhibitor. 5/6 hospitals and 4/8 private offices in Vienna and 6/12 hospitals outside of Vienn a used proteaseinhibitors. Conclusions: Antiretroviral treatment accor ding to the guidelines published recently, is only possible in centres for the treatment of HIV-infected patients at the moment.