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Results for “DHHS Guidelines”

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At least 19 recordsLinked to original sources
PubMed2000

The implementation of the DHHS guidelines for the use of antiretroviral agents in HIV-infected adults: a pilot study.

The objective of this study was to assess whether United States DHHS guidelines for treatment with antiretroviral therapies are being implemented by health care providers when discussing treatment options with newly diagnosed HIV patients. Health care providers were observed interacting with HIV patients while making decisions about treatment. Observers assessed whether providers and patients discussed the five benefits and six risks of initiating antiretroviral therapy, as recommended in the DHHS Guidelines. Preliminary results indicate that the DHHS Guidelines are not being implemented in the way they were intended. The risks and benefits of antiretroviral therapy were infrequently discussed. No more than four of the 11 risk/benefit items were discussed with any patient, and four of the six risk items were never mentioned to any patient. Potential reasons why the guidelines are not being implemented are discussed.

Adult↗
PubMed2004

HIV update: emerging clinical evidence and a review of recommendations for the use of highly active antiretroviral therapy.

PURPOSE: This supplement will focus on recent trial data concerning the efficacy of certain nucleoside reverse transcriptase inhibitor (NRTI)-based highly active antiretroviral therapy (HAART) regimens, the most recent guidelines from the Department of Health and Human Services (DHHS) for the timing of antiretroviral (ARV) therapy initiation, and recommended ARV drug classes for managing treatment-naïve patients with HIV. SUMMARY: When choosing an initial regimen for the treatment of HIV, it is important to carefully consider therapeutic goals. These goals include choosing HAART that is likely to maximally suppress viral replication, maintain or restore immunologic function, improve quality of life, and reduce HIV-related morbidity and mortality. The evidence-based DHHS guidelines recommend HAART regimens that are non-nucleoside reverse transcriptase inhibitor (NNRTI)- or protease inhibitor (PI)-based. DHHS, however, does not recommend the use of triple-NRTI therapy for the initial treatment of HIV unless a preferred or alternative NNRTI- or PI-based regimen cannot be used. This recommendation concerning triple-NRTI therapy is supported by results from recent trials that demonstrated inferior outcomes with triple-NRTI-containing regimens compared with NNRTI- or PI-based HAART regimens. The timing for initiation of ARV therapy continues to change over time as the DHHS guidelines have evolved. Although the benefits of initiating ARV when CD4 cell count is < 200 cells/mm3 are well established, the use of early versus late initiation of ARV therapy in patients with CD4 cell counts > 200 cells/mm3 has its own benefits and drawbacks. CONCLUSION: To successfully manage people with HIV, it is crucial to find a balance between ARV potency, tolerability, safety, and convenience while providing durable viral suppression.

Anti-HIV Agents↗
PubMed2003

Evaluation of a brief low-cost intervention to improve antiretroviral treatment decisions.

An earlier pilot study found that US DHHS guidelines for antiretroviral treatment were not being successfully implemented (Mann et al., 2000). A brief and inexpensive intervention (visual aid checklist) was developed with the assistance of HIV-expert physicians in order to aid HIV/AIDS health care providers' and their patients' decisions about antiretroviral therapy. The visual aid checklist consisted of a two-page coloured diagram and explanation of key concepts (T-cell, viral load and resistance) and a checklist of the benefits and risks of antiretroviral therapy. Twenty adult HIV-positive subjects and eight health care providers were studied. Ten subjects were observed with their providers without the intervention being used, and then ten subjects were observed with the intervention. A pre-/post-test format was used to assess the patients' antiretroviral knowledge, patient-provider discussion of the DHHS guidelines, and provider satisfaction with the intervention. No differences in baseline HIV knowledge were found between the two groups. Results showed that patients in the intervention condition had greater knowledge of the benefits and risks of antiretroviral therapy than patients in the control condition. Providers reported that the intervention was useful in aiding and encouraging communication as well as conveying knowledge.

Adult↗
PubMed2003

Tailored health communication: crafting the patient message for HIV TIPS.

The HIV TIPS project will pilot and evaluate the use of web-based information technology on prescription errors and quality of care by providing tailored practice guidelines and patient education in ambulatory practice settings of the National AIDS Education and Training Centers (NAETC) network. In the first phase of the project, we tailored messages to guide patient adherence and self-care, using DHHS guidelines. We developed a method based on communication theory to ensure complete and effective messages.

Anti-Retroviral Agents↗
PubMed2003

Simple markers for initiating antiretroviral therapy among HIV-infected Ethiopians.

BACKGROUND: We explored the relevance of simple markers (clinical or laboratory markers not requiring sophisticated laboratories) in the decision of initiation of therapy in resource-poor settings. METHODS: Among HIV-infected Ethiopian cohort participants, simple markers predicting short-term death were examined using time-dependent Cox proportional hazards models. Timing of hypothetical treatment was compared between guidelines using the simple markers (based on presence of at least one marker), guidelines recommended by the United States Department of Health and Human Services (based on CD4 cell count and viral load), and guidelines for resource-limited settings recommended by the World Health Organization (WHO). RESULTS: From February 1997 to August 2001, 35 deaths were recorded among 155 HIV-positive participants. Simple independent predictors of death were low body mass index, HIV-related conditions, anaemia, and lymphocyte count < 1500 x 106/l. In such time as was covered by our study, 135 (87%) of 155 cohort participants would have had the same management under both the simple markers and the DHHS guidelines, i.e., would have been treated (n = 114, 74%) or not treated (n = 21, 14%). Of the 114 participants hypothetically treated under either set of guidelines, 91 (80%) would have started treatment at the same time. Application of the WHO guidelines for resource-limited settings (without CD4 cell counts) would have resulted in 11 participants dying without ever meeting a treatment indication during regular follow-up visits. CONCLUSION: Simple markers for the initiation of highly active antiretroviral therapy were identified among HIV-infected Ethiopian patients. The validity of these markers for monitoring patients' improvement following therapy remains to be evaluated.

Adult↗
PubMed2003

Simple markers for initiating antiretroviral therapy among HIV-infected Ethiopians.

BACKGROUND: We explored the relevance of simple markers (clinical or laboratory markers not requiring sophisticated laboratories) in the decision of initiation of therapy in resource-poor settings. METHODS: Among HIV-infected Ethiopian cohort participants, simple markers predicting short-term death were examined using time-dependent Cox proportional hazards models. Timing of hypothetical treatment was compared between guidelines using the simple markers (based on presence of at least one marker), guidelines recommended by the United States Department of Health and Human Services (based on CD4 cell count and viral load), and guidelines for resource-limited settings recommended by the World Health Organization (WHO). RESULTS: From February 1997 to August 2001, 35 deaths were recorded among 155 HIV-positive participants. Simple independent predictors of death were low body mass index, HIV-related conditions, anaemia, and lymphocyte count < 1500 x 10(6)/l. In such time as was covered by our study, 135 (87%) of 155 cohort participants would have had the same management under both the simple markers and the DHHS guidelines, i.e., would have been treated (n = 114, 74%) or not treated (n = 21, 14%). Of the 114 participants hypothetically treated under either set of guidelines, 91 (80%) would have started treatment at the same time. Application of the WHO guidelines for resource-limited settings (without CD4 cell counts) would have resulted in 11 participants dying without ever meeting a treatment indication during regular follow-up visits. CONCLUSION: Simple markers for the initiation of highly active antiretroviral therapy were identified among HIV-infected Ethiopian patients. The validity of these markers for monitoring patients' improvement following therapy remains to be evaluated.

Antiretroviral Therapy, Highly Active↗
PubMed2000

Antiretroviral prescribing patterns in the texas prison system.

PURPOSE: Although prison inmates are reported to exhibit substantially elevated rates of HIV infection, little is known about HIV treatment patterns, particularly pharmacotherapy, in correctional institutions. The purpose of the present study, therefore, was to describe antiretroviral prescribing patterns in one of the nation's largest prison populations.METHODS: The study population consisted of all known (n = 2,360) HIV-infected inmates incarcerated in the Texas prison system in 1998. Information on medical conditions, sociodemographic factors, and pharmacotherapy was obtained from an institution-wide medical information system. Inmates who received more than one type of pharmacotherapy in 1998 were included in the appropriate number of categories.RESULTS: In 1998, 66.8 percent (95% CI = 64.0-69.4) of all HIV-infected inmates with CD4 counts below 500 were treated with highly active antiretroviral therapy (HAART); and 31.1 percent (95% CI = 29.3-33.0) were given no antiretroviral therapy. Logistic regression results showed that HAART treatment decreased monotonically as a function of patient CD4 count category.CONCLUSIONS: A substantial proportion of HIV-infected TDCJ inmates were placed on therapies that were not consistent with the generally recommended DHHS guidelines for their disease stage. It will be important to for future investigations to assess whether such patterns continue to exist among prison populations, and to assess the determinants of these patterns.

Journal Article↗
PubMed2004

Comparing total health care costs and treatment patterns of HIV patients in a managed care setting.

The objective of this study was to investigate total health care costs and time to occurrence of hospitalization in HIV-infected patients treated according to the 1998 DHHS guidelines in a managed care setting. The study also investigated which patients do not receive guideline treatment. We used a retrospective cross-sectional study design using medical and pharmacy claims data. Data from 1,791 HIV-infected patients using antiretroviral agents between 1 February 1998 and 31 July 1999, including demographic characteristics, medication guideline use, medication adherence and cost of care, were examined. Factors associated with total health care costs and time-to-inpatient admission (as a proxy for patient outcomes) were assessed. Patients receiving guideline (HAART) therapy (55%) had higher prescription and total health care costs but lower medical costs. Patients not receiving treatment according to guidelines were more likely to be female, older, have comorbidities, lower medication adherence and no AIDS-defining illness. Treatment with HAART guidelines was associated with longer time-to-inpatient admission controlling for other factors. In a short-term cross-sectional analysis, patients treated with HAART guidelines had better outcomes based on time-to-inpatient admission but higher prescription and total health care costs. Some patients are at risk for not receiving care according to national treatment guidelines and may be targeted for intervention programmes.

Adolescent↗
PubMed2005

[Use of thymidine-sparing regimens in first-line therapy and in switches from thymidine analogues].

Therapy with two NRTIs/NtRTI represents the current basis of highly active antiretroviral therapy (HAART) and is almost always associated either with a NNRTI or a protease inhibitor. Thymidine analogues zidovudine and stavudine were largely used in the past and the use of backbones not including one of them was uncommon. However, the use of thymidine analogues today has several drawbacks, such as fragile pharmacokinetics, the need of two daily doses, unsatisfactory safety and toxicity profiles, a large number of pills and important cross-resistance phenomena. The possibility of using backbones not including thymidine analogues is thus becoming increasingly popular, provided that efficacy is not affected. Moreover, as some of the problems related to thymidine analogue toxicity are only partly reversible, the strategy supporting the use of a thymidine analogue sparing regimen appears to be the only way to prevent damage that otherwise could be potentially irreversible. However, the quality and benefit of this approach have long been acknowledged in the DHHS guidelines, positioning the association of tenofovir and emtricitabine among the choices recommended for naive patients, for a modern approach to HIV infection therapy.

Anti-HIV Agents↗