Findings from the British HIV Association's national clinical audit of first-line antiretroviral therapy and survey of treatment practice and maternity care, 2002

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Abstract
To assess the impact of and adherence to the British HIV Association (BHIVA) guidelines in routine clinical practice in the UK and Ireland. A self-completed postal survey of practice with regard to HIV management and maternity care of HIV-positive women was carried out. A case-note review of all patients starting their first antiretroviral (ART) therapy (up to a maximum of 25 patients) between April and September 2002 was also performed. A total of 113 treatment centres participated. Ninety-nine units (88%) use the BHIVA ART guidelines as part of their treatment policy. Problems revealed by the survey include limited access to some ARTs in a small number of units and a wait longer than 4 weeks before the first assessment of patients started on ART in some units. Thirty-one centres (33%) felt that their maternity services had reached the government target of >90% antenatal HIV testing by October 2002. A total of 942 case-notes audited showed shortfalls in reported pretreatment testing of blood glucose, lipids and hepatitis C virus. Three patients had not strictly met the BHIVA guidelines for starting ART, but all had a high viral load (>100 000 HIV-1 RNA copies/mL). The majority (844 patients; 90%) had started on recommended therapies, most commonly two nucleoside reverse transcriptase inhibitors and a nonnucleoside reverse transcriptase inhibitor. The other 98 patients (10%) were given a variety of nonstandard triple or quadruple ART. This audit again shows a high rate of consistency and quality of care of patients with HIV across the UK and Ireland. Problems with pretreatment assessment and early follow up of patients starting ART have been found.