CHANGES IN USE OF ANTIRETROVIRAL THERAPY IN REGIONS OF EUROPE OVER TIME

Objectives: To analyse use of antiretroviral therapy within Europe bet ween 1994 and 1997. Design: From September 1994, the EuroSIDA study (c ohorts I-III) has prospectively followed unselected HIV-infected patie nts from 50 clinical centres in 17 European countries (total, 7230). M ethods: Patients under follow-up at half-year intervals from September 1994 (n = 2871) to September 1997 (n = 3682) were classified accordin g to number of drugs currently used (none, one, two, three, four or mo re). Use of antiretroviral therapy was stratified by CD4 cell count (< 200 versus greater than or equal to 200 x 10(6)/l) and by region of E urope (south, central, or north). Frequency data were compared by chi( 2) test and logistic regression modelling. Results: The proportion of patients on antiretroviral monotherapy diminished over time (1994, 42% ; 1997, 3%), as did the proportion of patients without therapy (from 9 7 to 9%). Over time, the proportion of patients on triple (from 2 to 5 5%) and quadruple (from 0 to 9%) therapy increased, whereas use of dua l therapy peaked in 1996 and subsequently fell. In the three regions o f Europe, changes in use of antiretroviral therapy differed substantia lly. However, as of September 1997, only minor differences persisted. The proportion of patients on dual, triple, and quadruple therapy were as follow. south, 33, 52 and 5%, respectively; central, 23, 55 and 14 %, respectively; north, 16, 59 and 10%, respectively. In September 199 7, odds for use of three or more drugs including at least one protease inhibitor did not differ significantly between regions. Conclusions: Use of antiretroviral therapy in Europe has changed dramatically towar ds combination treatment in the last few years. Regional differences i n use of antiretroviral therapy have decreased, and by September 1997 only minor differences remained. Antiretroviral therapy with three or more drugs and use of protease inhibitors has become more common in al l regions of Europe. (C) 1998 Lippincott Williams & Wilkins.