Reasons for not starting antiretroviral therapy in

Authors: Jan Fehr Dunja Nicca JeanChristophe Goffard David Haerry Michael Schlag Vasileios Papastamopoulos Andy Hoepelman Athanasius Skoutelis Ruth Diazaraque Bruno Ledergerber

Publish Date: 2016/03/16

Volume: 44, Issue: 4, Pages: 521-529

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Abstract

Before the consultation treatmentnaive patients and their physicians independently completed a 90itemquestionnaire about barriers and their readiness to start/defer ART The study was carried out at 34 sites in nine countries in Europe and AustraliaBetween December 2011 and October 2012 508 pairs of patient and physicianquestionnaires were completed 426 84  patients were male and 39 8  138 27  and 330 65  were in the three stratified groups based on CD4 count respectively In the category ‘Body and symptoms’ the most commonly identified reason for patients not to start was “As long as I feel good I don’t have to take medication” 44  Less than 20  of respondents indicated fears of side effects and toxicity or problems to manage pills Most patients were in the lowest stage of treatmentreadiness N = 323 68  especially patients with CD4 cells ≥500 cells/μL N = 240 79  Physicians answered in 92 18  cases that ART was not indicated for CD4 cells 500 cells/μL Main reasons for physicians not starting treatment for these patients were their perception that patients were ‘too depressed’ 13  or that they had not known them long enough 13 Nowadays patientbarriers to ART are commonly related to healthand treatmentbeliefs compared to fear of toxicity or ART manageability in the past This new barrier pattern seems to reflect the era of well tolerated easier ART regimens and has to be considered in light of the new recommendations to treat all HIVinfected individuals regardless of the CD4 cell countThanks to our patients and participating centres Cavassini Chave Florence GarglianosKakolyris Greil Hildebrand Knysz Lacor Lazanas Mansinho Moore Moutschen Nikolaidis Orth Paparizos Petrikkos Rieger Sambatakou Schalk Schmit Teofilo Vandekerckhove Valente Van Wijngaerden Vera Vernazza Vetter Witor Woolley and Wurzer Special thanks also to Melanie Cain and Clare Gleeson who helped to establish this survey in different countries and thanks also for proofreadingJF was a member of the advisory board of Abbvie BristolMyers Squibb Gilead Sciences Janssen Merck Sharp and Dome and has received unrestricted grants and travel grants from AbbVie Boehringer Ingelheim BristolMyers Squibb Gilead Sciences Janssen Merck Sharp and Dome Pfizer Roche and ViiV He is a member of the Swiss Federal Commission for Sexual Health JCG has received travel grants grants and honoraria from Abbvie BristolMyers Squibb Gilead Sciences Merck Sharp and Dohme and Janssen DH has received honoraria from Gilead and travel grants from Janssen He is a member of the Swiss Federal Commission for Sexual Health cochair of the Patient and Consumer Working Party of the European Medicines Agency and cochair of the Patient and Consumer Working Group for Swissmedic AH has current grants from Gilead and Pfizer and is a member of the advisory board of BristolMyers Squibb Gilead Sciences for hepatitis Janssen for Hepatitis Merck Sharp and Dome for Hepatitis Abbvie for hepatitis BristolMyers Squibb for hepatitis and ViiV BL has received travel grants grants or honoraria from Abbott BristolMyers Squibb Gilead Sciences Pfizer GlaxoSmithKline Merck Sharp and Dohme Roche and Janssen DN has received travel grants grants and honoraria from Abbvie BristolMyers Squibb ViiV Gilead Merck Sharp and Dohme Janssen Roche and ViiV MS was a Gilead Sciences employee VP has received travel grants grants or honoraria from BristolMyers Squibb Gilead Sciences ViiV Merck Sharp and Dohme and Janssen AS has received travel grants and honoraria from Abbvie BristolMyers Squibb ViiV Gilead MSD and Janssen RD is a Gilead Sciences employee

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