An IAPAC Survey Reveals Priorities in Physician and Patient Treatment Perspectives
LifeGuide
[Treatment Horizons]
by Chael Needle
Though physicians and patients living with HIV/AIDS often work together to explore treatment regimens, these dialogues can be limited by differing perceptions and priorities about treatment goals on both sides of the exam table.
In May 2006, the International Association of Physicians in AIDS Care (IAPAC) released the results of its U.S.-based surveys of physicians and patients. Conducted annually with the participation of the organization’s physician members, the “IAPAC State of HIV Treatment” surveys, says José M. Zuniga, President/CEO of IAPAC, look for “potential gaps in educational, capacity building, or technical assistance activities of the Association,” which are then shared with not-for-profit institutions that share IAPAC’s goals of improving the quality of care of people living with HIV/AIDS through advocacy and education.
Part of the impetus for the study and the expansion of the survey to include patient responses, says Zuniga, arose from a general move to assess lessons learned and map out the challenges ahead during this tenth-year anniversary of highly active antiretroviral therapy. To that end, the survey, which was sponsored by Bristol Myers-Squibb, worked to identify “potential gaps around definitions of what constitutes successful ART, the impact of treatment on patient quality of life, and the relationship and interaction between patients and physicians, especially as antiretroviral therapy becomes increasingly complex.”
Some treatment goals were more or less equally shared by physicians and patients. For example, sixty-nine percent of physicians and sixty-eight percent of patients considered keeping viral load low as a treatment goal. Fifty-one percent of physicians and sixty-five percent of patients stated that avoiding resistance was an important goal.
Many patients and physicians did not wholly agree on what constitutes successful antiretroviral therapy. Fourteen percent of physicians versus sixty percent of patients were concerned about keeping patients looking healthy as a goal. Zuniga points out that while the physicians’ focus on lab markers is to some extent understandable, one of the costs of this focus is that “quality of life tends to take a back seat.” Without a good quality of life assured for patients, “every effort to assure adherence and every effort to keep CD4 counts high or avoid resistance can be undermined.” Zuniga argued that patients should not have to choose between an efficacious antiretroviral regimen and a high quality of life—both can be attained for most patients with some diligence from physicians and patients.
This might still be more challenging than one would think, especially if treatment issues important to patients are inadvertently sidelined by physicians. While seventy-percent of physicians disagreed/strongly disagreed with the statement that side effects were worse than the disease, only forty-seven percent of patients disagreed/strongly disagreed. Forty-four percent of patients reported delaying the initiation of treatment to avoid side effects. Advances like convenient dosing lose their luster in this context, says Zuniga. Success cannot simply mean living longer, he suggests, “it’s living longer with quality.”
“What use is being undetectable and having a great CD4 count if you, in this day and age, continue to live with daily diarrhea? Or blinding headaches? Having said that, we know better because there is the ability to either prescribe regimens that have lower side effect profiles or manage side effects a little better.”
“In a typical week, physicians reported switching, on average, five percent of their patients from one regimen to another, specifically because of side effects. That’s a significant number of patients,” says Zuniga. “Sixty-eight percent of patients surveyed reported having switched treatment regimens due to side effects at least once. And so we have been advocating the quality of life agenda and looking at the different antiretroviral regimens available, looking at their side effect profiles in addition to dealing with potency and resistance concerns because of this very issue.”
While plans are underway to conduct surveys with physicians and the patients they treat, IAPAC will fine-tune its educational activities geared toward physicians and patients to address these identified gaps. IAPAC urges physicians to pay more attention to side effect issues, including recognizing conditions that may not yet even be considered as side effects, and asking patients about them more directly in an effort to make antiretroviral therapy as successful as it can be. Patients need to involve or continue to involve themselves in decisions about their treatment. An informed dialogue and an equal partnership between patients and physicians needs to be supported and improved, as well—a tough challenge, says Zuniga, in an era of both dwindling funding for ASOs from both public and private sectors, as well as treatment options that often alienate patients.
Chael Needle wrote about the Sustiva/Truvada one pill, once-a-day formulation in the June issue.
July 2006
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