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Reasons for not starting antiretroviral therapy in HIV-1-infected individuals: a changing landscape

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Abstract

Purpose

A cross-sectional survey was conducted to better understand why chronically HIV-1-infected individuals stratified by CD4 count (≤349; 350–499; ≥500 cells/μL) were not on antiretroviral therapy (ART).

Methods

Before the consultation, treatment-naive patients and their physicians independently completed a 90-item-questionnaire about barriers and their readiness to start/defer ART. The study was carried out at 34 sites in nine countries in Europe and Australia.

Results

Between December 2011 and October 2012, 508 pairs of patient- and physician-questionnaires 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 treatment-readiness (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 %).

Conclusions

Nowadays patient-barriers to ART are commonly related to health-and treatment-beliefs 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 HIV-infected individuals regardless of the CD4 cell count.

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Acknowledgments

Thanks to our patients and participating centres: Cavassini, Chave, Florence, Garglianos-Kakolyris, 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 proof-reading.

Author information

Author notes

    Authors and Affiliations

    1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

      Jan Fehr & Bruno Ledergerber

    2. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland

      Dunja Nicca

    3. Internal Medicine AIDS Reference Centre ULB-Hôpital Erasme, Brussels, Belgium

      Jean-Christophe Goffard

    4. Positive Council Switzerland, Zurich, Switzerland

      David Haerry

    5. Gilead Sciences, Foster city, USA

      Michael Schlag & Ruth Diazaraque

    6. 5th Department of Medicine and Infectious Diseases Unit, “Evangelismos” General Hospital, Athens, Greece

      Vasileios Papastamopoulos & Athanasius Skoutelis

    7. Department of Internal Medicine and Infectious Diseases, University Medical Utrecht, Utrecht, The Netherlands

      Andy Hoepelman

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    1. Jan Fehr
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    Correspondence to Jan Fehr.

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    Conflict of interest

    JF was a member of the advisory board of Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck Sharp and Dome and has received unrestricted grants and travel grants from AbbVie, Boehringer Ingelheim, Bristol-Myers 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, Bristol-Myers 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, co-chair of the Patient and Consumer Working Party of the European Medicines Agency and co-chair 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 Bristol-Myers Squibb, Gilead Sciences for hepatitis, Janssen for Hepatitis, Merck Sharp and Dome for Hepatitis, Abbvie for hepatitis, Bristol-Myers Squibb for hepatitis, and ViiV. BL has received travel grants, grants or honoraria from Abbott, Bristol-Myers Squibb, Gilead Sciences, Pfizer, GlaxoSmithKline, Merck Sharp and Dohme, Roche and Janssen. DN has received travel grants, grants and honoraria from Abbvie, Bristol-Myers 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 Bristol-Myers Squibb, Gilead Sciences, ViiV, Merck Sharp and Dohme, and Janssen. AS has received travel grants and honoraria from Abbvie, Bristol-Myers Squibb, ViiV, Gilead, MSD and Janssen. RD is a Gilead Sciences employee.

    Source of funding

    This study was supported by Gilead Sciences. Investigators have full intellectual ownership of the study.

    Additional information

    J. Fehr and D. Nicca contributed equally.

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    Fehr, J., Nicca, D., Goffard, JC. et al. Reasons for not starting antiretroviral therapy in HIV-1-infected individuals: a changing landscape. Infection 44, 521–529 (2016). https://doi.org/10.1007/s15010-016-0887-x

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