title: Variability of attitudes toward early initiation of HAART for HIV infection: a study of French prescribing physicians.
abstract: This study assessed prescribing physicians' attitudes toward early initiation of HAART, three months after the dissemination of the first French official treatment guideline. Telephone interviews have been made in a national random sample of physicians with full- or part-time practice in hospital departments delivering care for HIV-infected patients. Questionnaires included hypothetical clinical cases. Logistic regression compared characteristics of respondents according to attitudes toward HAART. Among the 483 respondents (response rate = 87.0%), agreement was high with official recommendations to systematically initiate HAART with protease inhibitors (PIs) for patients with CD4+ cell counts < or = 300/mm3, following a diagnosis of acute primary HIV infection, or for HIV sexual risk post-exposure prophylaxis. Confronted with a case of a naive asymptomatic patient with stable 450 CD4+/mm3, 34.6% would prescribe HAART with PIs in any case, and 29.8% only if the patient has plasma viral load < or = 10,000 HIV RNA copies/ml. The remaining 35.6% would not prescribe PIs and were older, had limited activity in HIV care and expressed more interest in alternative medicines. To avoid a confusing impact of variability of clinical attitudes toward uncertainties associated with antiretroviral treatments among HIV-infected patients, shared decision-making between patient and physician should be promoted for initiation of HAART.
authors.affiliation: Department of Infectious and Tropical Diseases, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Landman
authors.forename: J P
authors.initials: JP
authors.lastname: Moatti
authors.forename: V
authors.initials: V
authors.lastname: Perrin
authors.forename: P
authors.initials: P
authors.lastname: Huard
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001291:Attitude of Health Personnel; D018791:CD4 Lymphocyte Count; D005260:Female; D005602:France; D015658:HIV Infections / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D019562:Viral Load