title: Prevalence and predictors of deterioration of a trustful patient-provider relationship among HIV-infected persons treated with antiretroviral therapy.
abstract: 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.
authors.affiliation: Laboratory of Psychology, Laboratoire Education Cognition et Développement, Nantes University, Nantes, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Préau
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
authors.forename: Virginie
authors.initials: V
authors.lastname: Villes
authors.forename: Christian
authors.initials: C
authors.lastname: Michelet
authors.forename: Fidéline
authors.initials: F
authors.lastname: Collin
authors.forename: Maria-Patrizia
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ragnaud
authors.forename: Audrey
authors.initials: A
authors.lastname: Taieb
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
mesh_terms: 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