HIV Patients Often Unaware of Drug Resistance
July 24, 2006
A recently released survey commissioned by the American Academy of HIV Medicine in Washington shows that knowledge of available treatment options and the significance of drug resistance has declined in HIV patients.
"In the early days of HIV, patients often understood the science of HIV as much as most clinicians," said Dr. Howard Grossman, executive director of the academy. "But once the complex drug regimens with HAART [highly active antiretroviral therapy] came out, and complicated drug resistance testing was developed," it became harder for patients to keep up with rapid advances in the field and to understand how the wealth of new information affected their treatment options.
The survey included responses from 385 physicians who treat HIV patients and 400 adults with HIV/AIDS. Results showed 91 percent of physicians to be "extremely" or "very" concerned about HIV drug resistance, compared with 54 percent of patients. Sixty-one percent of patients said they were knowledgeable about HIV drug resistance, but 59 percent were unsure whether their virus had become drug-resistant. Among those with resistant virus, 45 percent did not know which classes of drugs were involved.
Dr. Martin Markowitz of the Aaron Diamond AIDS Research Center in New York City said that as a result of poor compliance, "in 2003-2004, about one out of seven new HIV infections in major cities was resistant to the non-nucleoside reverse transcriptase inhibitors, and about one in ten were resistant to at least two classes of drugs." He emphasized the significance of patient education and stressing the importance of drug adherence.
Because "people who are more disadvantaged are disproportionately affected by HIV, it has become harder to educate or even reach that population effectively," Markowitz said, noting that patient education materials need to be modified to make the message clear and readily understandable. "And we need to teach providers how to teach about HIV and drug resistance," the doctor added.
Because new infection rates with HIV strains that are already resistant to some drugs have increased over time, the academy's guidelines recommend resistance testing for all patients starting therapy, Markowitz noted. Although 99 percent of physicians said they test for resistance when they consider switching a patient's therapy, only 67 percent tested for resistance before starting patients on antiretroviral therapy.
In better news, Grossman said, "A number of new treatments are on the horizon, including integrase inhibitors, entry inhibitors, and new protease inhibitors."
07.19.06; Karla Gale