EUROPEAN AND U.S. HIV PRESCRIBERS RANK LONG-TERM EFFICACY AND AVOIDING RESISTANCE AS TOP TREATMENT GOALS BUT ARE DIVIDED ON OTHER IMPORTANT ISSUES
First International AIDS Society Survey Highlights HIV Prescribing Patterns and Priorities
STOCKHOLM, Sweden, 21 Jan. 2004- Prescribers of HIV/AIDS medications in Europe and North America agree that long-term efficacy and avoiding resistance are the primary treatment goals for people living with HIV.
However, they disagree on other issues in HIV care such as the importance placed on dosing and side effect profiles of HIV medications. Further, prescribers on both sides of the Atlantic Ocean believe their priorities differ from the priorities of their patients regarding HIV care. These findings are from the Perspectives from the Frontline survey, the first International AIDS Society (IAS) survey to highlight prescribers’ attitudes toward HIV treatment.
“Optimal care and long-term management for patients living with HIV is contingent on doctors’ access to current information for best treatment practices,” said Joep Lange, M.D., Ph.D., IAS President. “Perspectives from the Frontline was designed to provide a clinical perspective on prescribing patterns and treatment priorities among HIV/AIDS treatment specialists. In the clinical setting, patients are being treated according to European and U.S. guidelines for recommended goals of therapy, according to survey findings.”
Perspectives from the Frontline is the first survey to assess treatment patterns of IAS’s physician membership and IAS Paris conference delegates. Five hundred-twelve (512) self-described prescribers of HIV medications from Western Europe and North America participated in the survey. The average respondent has nearly nine years HIV treatment experience and actively treats an average of 145 patients living with HIV/AIDS.
Goals of HIV Therapy
The international survey reveals 83 percent of participants on both continents agree that long-term efficacy is the most important consideration when prescribing treatment regimens and nearly 90 percent of participants agree avoiding resistance should be a key consideration for the long-term success of HIV therapy. Side effect profile and dosing convenience are less important in their treatment decisions, with 74 percent and 62 percent of prescribers selecting these factors as important considerations. U.S. prescribers, however, perceive side effect profile and dosing convenience to be significantly more important than Western European prescribers, with a difference of 9 percent and 15 percent, respectively.
“There is no doubt that great strides in HIV research have been made. However, we can’t forget that resistance to HIV agents can undermine these advances in therapy, which brings us back to the essential goals of treatment,” said Dr. Lange. “Sustained viral suppression, limiting viral replication and resistance development, with tolerability and convenience in mind, can improve patients’ health and preserve treatment options.”
The survey also shows that nearly three-fourths of prescribers agree that achieving and maintaining undetectable viral load (less than 50 copies/mL) is the best predictor of long-term success for patients new to therapy. Nine of 10 prescribers agree patients who achieve and maintain undetectable viral load have an optimistic outlook about their future —U.S. practitioners are more likely than Western Europeans to believe using drug regimens with convenient dosing is highly effective in helping patients maintain long-term undetectable viral load (74 percent vs. 63 percent). Overall, 4 percent of prescribers rank a regimen with a low pill burden and taken once-a-day as the most important goal for patients new to therapy.
Prescribers and Patients Living With HIV May Differ on Treatment Priorities
According to the survey, prescribers believe that they and their patients may not think alike about the importance placed on treatment outcomes. While prescribers say long-term efficacy and avoiding resistance are paramount to treatment success, only 49 percent and 27 percent of prescribers, respectively, believe their patients consider these the most important considerations. Prescribers perceive quality of life (93 percent) and side effect profile (90 percent) to be what their patients would believe to be the most important factors relating to treatment. However, Western European prescribers believe their patients place more importance on avoiding resistance than U.S. prescribers who believe their patients favour dosing convenience, according to survey data.
“The potential disconnect between what physicians and patients believe about important treatment considerations highlights the need for ongoing communication from both parties about HIV therapy,” said Dr. Lange.
Assessing Prescribing Patterns
To assess prescribing patterns, survey participants were asked to select the antiretroviral drug in each drug class that they prescribe, in combination with other anti-HIV medications, most often. Treaters’ relative prescribing patterns in classes of anti-HIV medications were similar regardless of geographic location. Fifty-two percent (52%) of prescribers selected lamivudine/zidovudine (Combivir) as the nucleoside analogue reverse transcriptase inhibitor (NRTI) of choice, followed by lamivudine/3TC (Epivir), with 28 percent of prescribers selecting the drug. Lopinavir/ritonavir (Kaletra) was the PI of choice, followed by nelfinavir (Viracept), with 67 percent and 17 percent of prescribers, respectively, using these drugs most often. Seventy-three percent (73%) of prescribers selected efavirenz/stacrin (Sustiva) as the nonnucleoside reverse transcriptase inhibitor (NNRTI) they used most often, followed by 24 percent of prescribers who selected nevirapine (Viramune) as the NNRTI of choice. Only drugs in these three classes that were approved by The European Agency for the Evaluation of Medicinal Products (EMEA) and the U.S. Food and Drug Administration (FDA) at the onset of the survey were included.
Survey data also show that the majority of prescribers on both continents believe boosted protease inhibitor (PI)-containing regimens are the standard of care for all patients. However, Western European prescribers believe boosted protease inhibitor (PI)-containing regimens are more important to patients new to therapy than U.S. prescribers (70 percent vs. 60 percent).
Data from treatment prescribers was collected by an Internet-based survey between July 7 and September 24, 2003, and was analyzed by WirthlinWorldwide in partnership with IAS. The margin of error for the overall response is +/- 3.7 percent at the 95 percent confidence level. IAS received an educational grant from Abbott Laboratories to fund the survey.
The International AIDS Society (IAS) represents the world’s professional society for scientists, health care and public health workers, and others engaged in HIV/AIDS prevention, control and care, through advocacy, education, facilitation of networks and scientific debate.