RAPID CHANGE IN THE USE OF ANTIRETROVIRAL AGENTS AND IMPROVEMENT IN APOPULATION OF HIV-INFECTED PATIENTS - FRANCE, 1995 TO 1997

Purpose: To describe the recent evolution of antiretroviral prescripti ons and to look for clinical and biological changes among a population of HIV-infected patients. Subjects: Patients received follow-up in th e hospital-based information system of the Groups d'Epidemiologie Clin ique du SIDA en Aquitaine (GECSA), Southwestern France, from 1995 to 1 997. Methods: Quarterly evolution of the prescriptions of antiretrovir al treatments and of the population clinical and biological indicators were studied in this observational survey of computerized records obt ained after each hospital contact, Results: Overall numbers of patient s who received follow-up and of hospital contacts remained stable. The proportion of untreated patients decreased from 38.5% to 10.5%. Monot herapies were progressively abandoned. Double combination therapies wi th two nucleoside analogues were used for 55% of the patients by early 1996 and then decreased. whereas triple combination therapies with on e protease inhibitor (PI) rapidly increased to comprise up to 40% of t he prescriptions in 1997. PIs were prescribed earlier and earlier in t he course of HIV infection. Overall incidence of AIDS diagnoses and mo rtality rare decreased by 18% and 22%, respectively, in the first 9 mo nths of use of PIs compared with the preceding 9 months, and by 47% an d 56%, respectively, in the following 9 months (p <.001). The number o f hospitalizations and the proportion of patients with a CD4 cell coun t <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 freque ntly, and triple combination therapy with PI is now common practice in France. Patients clinical and biological patterns have improved IS mo nths after the introduction of PIs.