HIV-positive women whose doctors followed federal treatment guidelines faired far better in terms of CD4 count and viral load than women whose doctors put them on treatment regimens that were not recommended or covered by those guidelines, say researchers of a study published in the Journal of Acquired Immune Deficiency Syndromes.

Jennifer Cocohoba, Pharm D, from the department of clinical pharmacy at the University of California San Francisco School of Pharmacy, and her colleagues analyzed the medical records of women enrolled in the Women’s Interagency HIV Study (WIHS). They found 217 HIV-positive women who started antiretroviral treatment between April 1998 and October 2004.

Cocohoba’s team separated the women into three categories. The first category included women whose doctors initiated antiretroviral treatment regimens that were listed as “preferred” or “alternative” according to the version of the Department of Health and Human Services (DHHS) HIV treatment guidelines that was current at the time the women started treatment. The second category included women whose treatment regimen the DHHS guidelines specifically mentioned as not recommended. The third category of women included those who started a treatment regimen that was not listed in the guidelines at all.

The majority of women who took a recommended regimen were on a three-drug combination that included two nucleoside reverse transcriptase inhibitors (NRTI) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI), a triple NRTI combination or two NRTIs plus a protease inhibitor. Examples of treatment regimens that the guidelines recommended against included monotherapy (taking only one drug), dual therapy (taking only two drugs) or taking a combination of drugs that were known to have negative interactions. Examples of treatment regimens that were unlisted in the guidelines included four-drug combinations.

The results were resounding. Women who followed the guidelines gained an average of 181 CD4 cells the first two years after starting treatment. This compared with a 144 CD4 cell gain in women whose treatments were not listed in the guidelines, and only a 21 CD4 cell gain in women whose treatment the guidelines recommended against.

The trend in terms of viral load was similar. Sixty-one percent of women who followed the guidelines had an undetectable viral load two years after starting treatment, compared with 56 percent of women who started a treatment unlisted in the guidelines and just 33 percent of the women whose treatment regimen the guidelines recommended against.

The results of this study are highly significant, because only 53 percent of the women in this study received a treatment regimen that was recommended by the DHHS guidelines.