Prevalence and predictors of deterioration of a trustful patient-provider relationship among HIV-infected persons treated with antiretroviral therapy.
OBJECTIVE
We studied the evolution of the patient-provider relationship (PPR) in HIV-infected patients who reported trustful relationships at highly active antiretroviral therapy (HAART) treatment initiation.


METHODS
Psychosocial and clinical data were obtained from the French ANRS CO-8 cohort. Break of trust was defined using the question "How much do you trust the provider who usually treats you at this clinic?" Predictors of a possible break of trust during the 5 years after initiating treatment for those patients reporting a trustful PPR at month 0 were identified using a Cox model.


RESULTS
During a total follow-up of 3,044 person-years, 68 (7%) patients reported having at least 1 break of trust in their PPR. Break of trust is independently associated with younger age, dissatisfaction with medical staff's explanations, cigarette smoking, and self-reported side effects and is independently inversely associated with severe HIV-related events and changes of treatment.


CONCLUSIONS
A patient's break of trust in his provider is relatively infrequent. Accounting for the influence of immunologic status and psychosocial factors, self-reported side effects are shown to be detrimental to the PPR. Interestingly, clinical events and changes of treatment prevent a possible break of trust by reinforcing the provider's role. These results underline the importance of recognizing a patient's perceived secondary effects and developing appropriate care.
Préau
Marie
M
Laboratory of Psychology, Laboratoire Education Cognition et Développement, Nantes University, Nantes, France.
Leport
Catherine
C
Villes
Virginie
V
Michelet
Christian
C
Collin
Fidéline
F
Carrieri
Maria-Patrizia
MP
Ragnaud
Jean-Marie
JM
Taieb
Audrey
A
Raffi
François
F
Spire
Bruno
B
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D015995:Prevalence; D013997:Time Factors