title: [Barriers to ART initiation in HIV infected subjects and with treatment indication in Spain. Why don't they start their treatment? Bridgap Study].
abstract: BACKGROUND
  In Spain, HIV treatment guidelines are well known and generally followed. However, in some patients there are no plans to initiate ART despite having treatment indications. The current barriers to ART initiation are presented.
  
  
  METHODS
  A cross-sectional survey including every HIV infected patient in care in 19 hospitals across Spain in 2012, with ≥1 indication to start ART according to 2011 national treatment guidelines, who had not been scheduled for ART initiation. Reasons for deferring treatment were categorized as follows (non-exclusive categories): a) The physician thinks the indication is not absolute and prefers to defer it; b) The patient does not want to start it; c) The physician thinks ART must be started, but there is some limitation to starting it, and d) The patient has undetectable viral load in absence of ART.
  
  
  RESULTS
  A total of 256 patients, out of 784 originally planned, were included. The large majority (84%) were male, median age 39 years, 57% MSM, 24% heterosexuals, and 16% IDUs. Median time since HIV diagnosis was 3 years, median CD4 count, 501 cells/mm3, median viral load 4.4 log copies/ml. Main ART indications were: CD4 count <500 cells/mm(3), 48%; having an uninfected sexual partner, 28%, and hepatitis C coinfection, 23%. Barriers due to, the physician, 55%; the patient, 28%; other limitations, 23%; and undetectable viral load, 6%.
  
  
  CONCLUSIONS
  The majority of subjects with ART indication were on it. The most frequent barriers among those who did not receive it were physician-related, suggesting that the relevance of the conditions that indicate ART may need reinforcing.
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Pompeyo
authors.initials: P
authors.lastname: Viciana-Fernández
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebrón, Barcelona, España.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Falcó
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Regional Carlos Haya, Málaga, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castaño
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario de la Princesa, Madrid, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: de los Santos-Gil
authors.affiliation: Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, España.
authors.forename: Julián
authors.initials: J
authors.lastname: Olalla-Sierra
authors.affiliation: Unidad de VIH, Hospital Universitario 12 de Octubre, Universidad Europea de Madrid, Madrid, España.
authors.forename: Asunción
authors.initials: A
authors.lastname: Hernando
authors.affiliation: Unidad de VIH-Servicio de Medicina Interna, Hospital General de Granollers, Granollers, España.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Deig
authors.affiliation: Fundación IrsiCaixa, Instituto Germans Trias i Pujol, Barcelona, España.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, España.
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.affiliation: Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, España. Electronic address: Pere.Domingo@uab.es.
authors.forename: Pere Domingo
authors.initials: PD
authors.lastname: Pedrol
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D015897:Comorbidity; D000075202:Contraindications; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D013030:Spain; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D016312:Treatment Refusal; D019562:Viral Load
keywords: Antiretroviral treatment; Barreras al inicio del tratamiento; España; Human immunodeficiency virus; Spain; Tratamiento antirretroviral; Treatment barriers; Virus de la inmunodeficiencia humana