SEATTLEThe number of
HIV-infected patients that a physician has treated independently predicts
HIV-related mortality in patients starting anti-retroviral therapy for the
Robert S. Hogg, PhD, said at the 9th Conference on Retroviruses and
Opportunistic Infections (abstract 749W).
Dr. Hogg is program director of population health, British
Columbia Centre for Excellence in HIV/AIDS, and associate professor of health
care and epidemiology, University of British Columbia, Vancouver.
Dr. Hogg and his colleagues analyzed determinants of
HIV-related and all-cause mortality in 1,219 HIV-infected, antiretroviral-naïve
patients who were first prescribed triple-drug therapy between August 1996 and
September 1999. Data for the patients and their approximately 100 treating
physicians were obtained from the database of the British Columbia HIV/AIDS
Drug Treatment Program.
Physician experience was assessed from the cumulative number
of HIV-infected patients treated and was classified as above or below first
quartile. Adherence to therapy was expressed as the number of months of
medication dispensed divided by the number of months of follow-up during the
first year of therapy, and was classified as intermittent if the value was less
During an approximate 30-month follow-up, the rates of
HIV-related and all-cause mortality were 6.7% and 8.5%, respectively. All of
the non-HIV-related deaths were either suicides or accidental drug overdoses.
At the start of the study, the median number of HIV-infected patients
previously treated by the physicians was 47 (interquartile range, 7 to 133).
In multivariate analysis of HIV-related mortality, the risk
of death was significantly decreased with physician experience above the first
quartile (risk ratio, 0.54) and significantly increased with intermittent
adherence (risk ratio, 3.83) and CD4 cell count below 200/µL (risk ratios at 50
to 199/µL and less than 50/µL, 3.61 and 7.29, respectively).
In multivariate analysis of all-cause mortality, the risk of
death was significantly increased with intermittent adherence (risk ratio,
3.19) and CD4 cell count below 200/µL (risk ratios at 50 to 199/µL and less
than 50/µL, 2.25 and 4.96, respectively). However, physician experience was not
a significant predictor of all-cause mortality.