Physician experience in the care of HIV-infected persons is associated with earlier adoption of new antiretroviral therapy

Recent advances in antiretroviral therapy have led to effective but increas ingly complex strategies for the treatment of HIV infection. In a previous study, we demonstrated that physicians' experience in the care of patients with AIDS improves survival. We conducted this study to determine whether g reater physician experience is associated with earlier adoption and appropr iate use of new antiretroviral treatment regimens. Design: Retrospective medical record review of a population-based sample of HIV-infected individuals who received antiretroviral treatment between Dec ember 1995 and May 1997 by primary care physicians practicing throughout th e state of Washington. We classified antiretroviral regimens observed into one of four categories based on national treatment guidelines. Results: The use of new antiretroviral treatment regimens significantly inc reased during the study period; 22% of patients were treated with a proteas e inhibitor (PI)-based regimen or an alternative PI- or nonnucleoside rever se transcriptase inhibitor (NNRTI)-based regimen between December 1995 and November 1996, compared with 57% between April and May 1997 (p < .001). Aft er controlling for CD4 count and the calendar period of treatment, patients cared for by physicians with greater HIV experience were significantly mor e likely to receive PI-based regimens or alternative PI- or NNRTI-based ant iretroviral regimens (p = .02). Use of PI-based regimens was also associate d with lower CD4 count (p < .001) and treatment after January 1997 (p = .02 ), but independent of patient demographic characteristics and the geographi c location of physicians' practices. Conclusions: Greater physician experience in the care of persons with HIV i nfection is associated with earlier adoption of new antiretroviral treatmen t regardless of whether physicians practice in a rural or urban area.