Faculty Collaboration Database

Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. J Acquir Immune Defic Syndr 2000 Apr 15;23(5):396-404

Date

06/24/2000

Pubmed ID

10866232

DOI

10.1097/00126334-200004150-00006

Scopus ID

2-s2.0-0034655045 (requires institutional sign-in at Scopus site)   113 Citations

Abstract

To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly active antiretroviral therapy (HAART), we sent a survey to a random sample of 995 infectious disease physicians who treat patients with HIV/AIDS in the United States in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral treatment and the extent to which each of three medical and 17 nonmedical factors would influence them for or against prescribing HAART to a hypothetical HIV-positive patient. Most reported initiating HAART with findings of low CD4+ cell counts and high viral loads, and weighing CD4+ cell counts, viral load, and opportunistic infection heavily in their decisions to prescribe HAART. Patients' prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injection drug use, and prior psychiatric hospitalization were cited by most physicians as weighing against HAART initiation. Thus, most physicians in this sample follow guidelines for the use of HAART, and nonmedical factors related to patients' life situations are weighed as heavily as disease severity in treatment decisions. As HIV increasingly becomes a disease associated with economic disadvantage and other social health problems, it will be essential to develop interventions and care support systems to enable patients experiencing these problems to benefit from HIV treatment advances.

Author List

Bogart LM, Kelly JA, Catz SL, Sosman JM

Author

Jeffrey A. Kelly PhD Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-HIV Agents
Communicable Diseases
Decision Making
Drug Therapy, Combination
Female
HIV Infections
Humans
Male
Physician-Patient Relations
Physicians
Practice Patterns, Physicians'
Specialization
Surveys and Questionnaires