Treatment-Experienced Patients: Physician and Patient Perspectives on Choosing Antiretroviral Regimens
Posted: April 29, 2005
Selecting an effective and tolerable antiretroviral regimen is very important, especially in treatment-experienced patients in whom multi-drug resistant virus may be present. When choosing an antiretroviral regimen there are many questions and variables to consider, such as:
(1) effect on CD4+ cell count;
(2) effect on viral load;
(3) likelihood viral resistance will develop;
(4) whether the regimen will prevent opportunistic infections;
(5) whether the regimen will have a good lipid profile;
(6) if there are significant side effects, and if they are tolerable;
(7) if the regimen includes a drug from a new class; and,
(8) the method and frequency of drug delivery (i.e., can patient be compliant?).
Treatment expectations are well defined in treatment-naïve patients, but more information is needed in treatment-experienced patients. There is a sense that physicians and patients may not be communicating about treatment expectations.
amfAR commissioned Harris Interactive to conduct a survey to define treatment goals and priorities of physicians and treatment-experienced patients who have taken at least two ARV regimens. The objectives of the survey were to compare physician and patient definitions of successful treatment, and whether physicians and patients agreed on their definitions. In addition, the survey looked at physicians’ and patients’ attitudes toward current ARV options, including fusion inhibitors, the only available drug from a new class of injectable HIV medications.
Physicians and patients were recruited by Harris Interactive and surveyed over the telephone. Harris Interactive determined that a sample size of 150 physicians and 150 patients would provide a statistically sound survey. Physicians were recruited randomly from a list of HIV-treating physicians in the U.S. Physicians surveyed included family practitioners, general practitioners, infectious disease specialists, and internists. To protect the confidentiality of HIV-infected individuals, surveyed physicians were used to recruit qualified treatment-experienced patients. Qualified patients needed to have taken at least two regimens.
Survey results demonstrated that both physicians and treatment-experienced HIV patients view reaching an undetectable viral load and increasing CD4 cells as very important to successful treatment. More than 80% of patients surveyed and 57% of their physicians view reaching an undetectable viral load as very important to successful treatment. Both patients (88%) and physicians (55%) view significantly increased CD4 cells as very important to successful treatment.
Physicians tend to underestimate their patients’ willingness to use and comply with an injectable antiretroviral medication. A majority (79%) of patients said that they would be willing to try an injectable medication if it suppressed the virus and gave them more energy, and only 20% of physicians reported having major reservations about prescribing this type of medication. Overall, 68% of physicians surveyed reported minor or major reservations about prescribing an injectable medication, and the large majority (90%) of these physicians attributed these reservations to concerns about compliance. However, most patients (85%) feel that they would be able to comply with a regimen with an injectable medication.
The survey results underscore the importance of patient-doctor discussions on treatment goals and available options. Patients should share treatment goals with their HIV-treating physicians to determine the best possible treatment options, and physicians should ensure they have a clear understanding of their patients’ needs and desires.
Click here for the presentation of survey results from amfAR’s 17th National HIV/AIDS Update Conference held in Oakland, April 10-13, 2005, in PDF format (1 MB).