According to results of national surveys released today in the Journal of the International Association of Physicians in AIDS Care (JIAPAC), 95% of HIV-treating physicians surveyed said they believe half or fewer of their patients "typically understand" what they are told about HIV and its treatment. In contrast, 66% of patients surveyed reported they "almost always" understand their conversations with physicians.
These and other gaps in perception were revealed in the peer-reviewed article, "State of HIV Treatment: Results of IAPAC Surveys of HIV-Positive Patients and HIV-Treating Physicians in the United States," which examined the attitudes of more than 500 HIV-positive patients and HIV-treating physicians regarding satisfaction with current treatment options, treatment side effects, patient-physician relationships, and several other aspects related to HIV treatment.
"While the surveys highlighted many similar views between physicians and patients on issues such as treatment goals and satisfaction with currently available antiretroviral drugs, it is clear that more candid dialogue is needed to ensure a satisfactory treatment experience for people living with HIV/AIDS, " said José M. Zuniga, IAPAC President/CEO and the author of the JIAPAC article. "In particular, the surveys uncovered a need for greater understanding between physicians and patients on the importance of looking healthy, the significance of adherence to treatment regimens, the incidence of side effects, and estimates of patient understanding of HIV and its treatment."
A total of 152 physicians and 399 HIV-positive patients participated in the IAPAC State of HIV Treatment Survey. Physician participants were recruited nationally, and all had been treating HIV patients for at least two years at the time of the surveys, with 16 years being the average length of time. Patient participants were recruited via a national online provider panel and through clinics and AIDS service organizations nationwide. Of patient participants, 80% were currently taking medications for HIV, 11% were currently off-treatment but had been on treatment previously, and the remaining 9% were treatment naïve.
Treatment Objectives and Satisfaction
The surveys indicated that a majority (79%) of physicians and on-treatment patients (79%) are "somewhat" or "very" satisfied with current treatment regimens. Most physicians surveyed also agreed that the positives of current treatments outweigh the negatives, with 72% indicating they "agree" or "strongly agree" that with current treatments, it is reasonable to expect that HIV-positive patients will live a normally long life. Five percent of physicians agreed that the side effects of HIV treatments were worse than the disease itself. Patients expressed less certainty on these issues than physicians, with 59% "agreeing" or "strongly agreeing" that they expect to live a normally long life, and 23% "agreeing" or "strongly agreeing" that the side effects of treatment were worse than the disease itself.
The surveys also uncovered differences of opinions between patients and physicians about various goals of treatment. For example, 60% of on-treatment patients and 64% of off-treatment patients rated "looking healthy" as an extremely important goal of treatment. In comparison, 14% of physicians rated keeping patients "looking healthy" as an extremely important goal. Patients and physicians shared similar views on other goals of treatment, such as viral suppression, with 68% of on-treatment patients and 69% of physicians ranking "keeping viral load as low as possible" as an extremely important goal of treatment.
Starting Treatment
In determining when to start newly diagnosed patients on treatment, physicians said they decided to delay treatment an average of 39% of the time. However, patients appeared to express more reluctance about beginning treatment than physicians reported. While 39% of on-treatment patients said they were reluctant to begin treatment, physicians estimated an average of 15% of their patients were reluctant to begin treatment.
Side Effects
According to the surveys, the types and incidence of side effects varied from the patient perspective and physician perspective, with more patients reporting experiencing side effects than physicians reported. The three most common side effects patients reported experiencing were fatigue (77%), sleep disturbance (73%), and depression or anxiety (69%). The most common side effects reported by physicians in their patients were increased lipid levels (32% of physicians reported their patients were experiencing), gastrointestinal problems (27%), body shape changes (26%) and fatigue (26%).
According to the surveys, the gaps between patient and physician-reported incidence of side effects were largest for sleep disturbances (73% of patients reported experiencing versus 20% of physicians who reported their patients were experiencing), fatigue (77% of patients versus 26% of physicians), and joint or muscle pain (63% of patients versus 11% of physicians).
Adherence
The surveys indicated that 88% of physicians considered a patient to be adherent if the patient takes his or her medication at least 90% of the time. Physicians participating in the survey estimated that an average of 71% of their own patients were adherent.
In comparison, 84% of patients currently on treatment indicated they considered themselves adherent when it comes to taking their medication; however, 76% of all on-treatment patients said they took their full dosage of medication in the seven days leading up to the survey.
Physician-Patient Relations
Findings from the surveys indicated that patients and physicians hold differing perceptions of their relationships with each other. While 65% of patients reported having an equal partnership with their physician when making treatment decisions, 44% of physicians reported an equal partnership, and 47% of physicians said they make most of the treatment decisions on their own.
Opinions on the content and frequency of conversations between physicians and patients also varied. For example, fewer patients than physicians reported physicians discussing some important issues related to HIV treatments "very often" or "all the time," such as diet and physical exercise (53% of patients versus 78% of physicians), and safer sex (40% of patients versus 73% of physicians).
Despite these differences, the surveys pointed out that both patients and physicians agreed that physicians listen and take into consideration patients' expressed treatment objectives (71% of patients reported their doctor "very often" or "always" asks for and listens to their opinions, and 77% of physicians reported taking into account patients' treatment objectives "a great deal").
An executive summary providing complete survey results may be downloaded from the IAPAC website.
Source:
International Association of Physicians in AIDS Care
