Prescription of HIV Antiretroviral Therapy

Percentage of patients, regardless of age, with a diagnosis of HIV prescribed antiretroviral therapy for the treatment of HIV infection during the measurement year.

Measure specifications are in the Public Domain.

This material contains CPT(R) copyright 2004-2016 American Medical Association, 
LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc., SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation, and ICD-10 copyright 2015 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

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Antiretroviral therapy (ART) reduces HIV-associated morbidity and mortality by maximally inhibiting HIV replication (as defined by achieving and maintaining plasma HIV RNA (viral load) below levels detectable by commercially available assays). Durable viral suppression improves immune function and quality of life, lowers the risk of both AIDS-defining and non-AIDS-defining complications, and prolongs life. Emerging evidence also suggests that additional benefits of ART-induced viral load suppression include a reduction in HIV-associated inflammation and possibly its associated complications. 

ART has also been shown to reduce transmission of HIV. The risk of sexual HIV transmission is highly correlated with HIV viral load in the blood and genital secretions of the infected individual, and ART reduces HIV blood viral load as well as HIV viral shedding in potentially infectious body fluids including semen, cervicovaginal secretions, and anorectal secretions. A recent randomized controlled trial of sero-discordant heterosexual couples documented a 96% reduction in transmission from treated persons to their partners, and observational studies are consistent with these findings.

Antiretroviral therapy (ART) is recommended for all HIV-infected individuals. The strength of this recommendation varies on the
basis of pretreatment CD4 cell count:
• CD4 count <350 cells/mm3 (AI)
• CD4 count 350 to 500 cells/mm3 (AII)
• CD4 count >500 cells/mm3 (BIII)

Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions:
• Pregnancy (AI) (see perinatal guidelines for more detailed discussion)
• History of an AIDS-defining illness (AI)
• HIV-associated nephropathy (HIVAN) (AII)
• HIV/hepatitis B virus (HBV) coinfection (AII)

A higher score indicates better quality

HIV Trialists' Collaborative Group. Zidovudine, didanosine, and zalcitabine in the treatment of HIV infection: meta-analyses of the randomised evidence. Lancet. Jun 12 1999; 353(9169):2014- 2025.

Hammer SM, Squires KE, Hughes MD, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med. Sep 11 1997; 337(11):725-733.

Zolopa A, Andersen J, Powderly W, et al. Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS One. 2009; 4(5):e5575.

Mocroft A, Vella S, Benfield TL, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. EuroS IDA Study Group. Lancet. Nov 28 1998; 352(9142):1725-1730.

Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA. Nov 28 2001; 286(20):2568-2577.

Sterne JA, May M, Costagliola D, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. Apr 18 2009; 373(9672):1352-1363.

Baker JV, Peng G, Rapkin J, et al. CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS. Apr 23 2008; 22(7):841-848.

Palella FJ, Jr., Deloria-Knoll M, Chmiel JS, et al. Survival benefit of initiating antiretroviral therapy in HIV-infected persons in different CD4+ cell strata. Ann Intern Med. Apr 15 2003; 138(8):620-626.

Cain LE, Logan R, Robins JM, et al. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study. Ann Intern Med. Apr 19 2011; 154(8):509-515.

Severe P, Juste MA, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med. Jul 15 2010; 363(3):257-265.

Kitahata MM, Gange SJ, Abraham AG, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. Apr 30 2009; 360(18):1815-1826.

Writing Committee of the CASCADE Collaboration. Timing of HAART initiation and clinical outcomes in human immunodeficiency virus type 1 seroconverters. Arch Intern Med. Sep 26 2011; 171(17):1560-1569.

Atta MG, Gallant JE, Rahman MH, et al. Antiretroviral therapy in the treatment of HIV-associated nephropathy. Nephrol Dial Transplant. Oct 2006; 21(10):2809-2813.

Schwartz EJ, Szczech LA, Ross MJ, Klotman ME, Winston JA, Klotman PE. Highly active antiretroviral therapy and the epidemic of HIV+ end-stage renal disease. J Am Soc Nephrol. Aug 2005; 16(8):2412-2420.

Kalayjian RC, Franceschini N, Gupta SK, et al. Suppression of HIV-1 replication by antiretroviral therapy improves renal function in persons with low CD4 cell counts and chronic kidney disease. AIDS. Feb 19 2008; 22(4):481-487.

Calmy A, Gayet-Ageron A, Montecucco F, et al. HIV increases markers of cardiovascular risk: results from a randomized, treatment interruption trial. AIDS. May 15 2009; 23(8):929-939.

Kuller LH, Tracy R, Belloso W, et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. Oct 21 2008; 5(10):e203.

Torriani FJ, Komarow L, Parker RA, et al. Endothelial function in human immunodeficiency virus-infected antiretroviralnaive subjects before and after starting potent antiretroviral therapy: The ACTG (AIDS Clinical Trials Group) Study 5152s. J Am Coll Cardiol. Aug 12 2008; 52(7):569-576.

Mellors JW, Rinaldo CR, Jr., Gupta P, White RM, Todd JA, Kingsley LA. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science. May 24 1996; 272(5265):1167-1170.

Vlahov D, Graham N, Hoover D, et al. Prognostic indicators for AIDS and infectious disease death in HIV-infected injection drug users: plasma viral load and CD4+ cell count. JAMA. Jan 7 1998; 279(1):35-40.

Anastos K, Kalish LA, Hessol N, et al. The relative value of CD4 cell count and quantitative HIV-1 RNA in predicting survival in HIV-1-infected women: results of the women's interagency HIV study. AIDS. Sep 10 1999; 13(13):1717-1726.

O'Brien TR, Blattner WA, Waters D, et al. Serum HIV-1 RNA levels and time to development of AIDS in the Multicenter Hemophilia Cohort Study. JAMA. Jul 10 1996; 276(2):105-110.

Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. Jul 13 2002; 360(9327):119-129.

Anastos K, Barron Y, Cohen MH, et al. The prognostic importance of changes in CD4+ cell count and HIV-1 RNA level in women after initiating highly active antiretroviral therapy. Ann Intern Med. Feb 17 2004; 140(4):256-264.

O'Brien WA, Hartigan PM, Martin D, et al. Changes in plasma HIV-1 RNA and CD4+ lymphocyte counts and the risk of progression to AIDS. Veterans Affairs Cooperative Study Group on AIDS. N Engl J Med. Feb 15 1996; 334(7):426-431.

Hughes MD, Johnson VA, Hirsch MS, et al. Monitoring plasma HIV-1 RNA levels in addition to CD4+ lymphocyte count improves assessment of antiretroviral therapeutic response. ACTG 241 Protocol Virology Substudy Team. Ann Intern Med. Jun 15 1997; 126(12):929-938.

Chene G, Sterne JA, May M, et al. Prognostic importance of initial response in HIV-1 infected patients starting potent antiretroviral therapy: analysis of prospective studies. Lancet. Aug 30 2003; 362(9385):679-686.

Deeks SG, Gange SJ, Kitahata MM, et al. Trends in multidrug treatment failure and subsequent mortality among antiretroviral therapy-experienced patients with HIV infection in North America. Clin Infect Dis. Nov 15 2009; 49(10):1582-1590.

Quinn TC, Wawer MJ, Sewankanbo N, et al. for the Rakai Project Study Group. Viral Load and heterosexual transmission of human immunodeficiency virus type-1. NEJM 2000;342:921-929.

Chakraborty H., Sen, PK, Helms, RW, et.al. Viral burden in genital secretions determines male-to-female sexual transmission of HIV-1: a probabilistic empiric model. AIDS, 2001 Mar 30;15(5):621-7.

Baeten JM, Kahle E, Lingappa JR, et al, Partners in Prevention HSV/HIV Transmission Study Team. Genital HIV-1 RNA predicts risk of heterosexual HIV-1 transmission.Sci Transl Med. 2011 Apr 6;3(77):77ra29.

Gulick RM, Mellors JW, Havlir D, et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med. 1997 Sep 11;337(11):734-9.

Zhang H, Dornadula G, Beumont M, et al. Human immunodeficiency virus type 1 on the semen of men receiving highly active antiretroviral therapy. N Engl J Med 1998;339:1803-1809.

Vernazza PL, Troiani L, Flepp MJ, et al, The Swiss HIV Cohort Study. Potent antiretroviral treatment of HIV-infection results in suppression of the seminal shedding of HIV. AIDS. 2000 Jan 28;14(2):117-21.

Cu-Uvin S, Caliendo AM, Reinert S, et al. Effect of highly active antiretroviral therapy on cervicovaginal HIV-1 RNA. AIDS. 2000 Mar 10;14(4):415-21.

Kotler DP, Shimada T, Snow G, et al. Effect of combination antiretroviral therapy upon rectal mucosal HIV RNA burden and mononuclear cell apoptosis. AIDS. 1998 Apr 16;12(6):597-604.

Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. Aug 11 2011;365(6):493-505.

Hughes JP, Baeten JM, Lingappa JR, et al. Determinants of Per-Coital-Act HIV-1 Infectivity Among African HIV-1- Serodiscordant Couples. J Infect Dis. Feb 2012;205(3):358-365.

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed 11/25/2016.

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TBD

Patients, regardless of age, diagnosed with HIV during the first 3 months of the measurement year or prior to the measurement year who had at least one medical visit in the measurement year.

Equals Initial Patient Population

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Patients prescribed HIV antiretroviral therapy during the measurement year.

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

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