July 18, 2006

Doctors, Patients Disagree on Resistance Concerns

HIV-positive people and their doctors agree that anti-HIV drug resistance is one of the most challenging issues in HIV care today. However, their degree of concern is dramatically different, according to a survey commissioned by the American Academy of HIV Medicine (AAHIVM).

According to the survey, involving 400 HIV-positive adults and 385 doctors who practice in the United States, nearly twice as many doctors were “extremely” or “very” concerned about HIV drug resistance (91%) as people living with HIV (54%). The survery also revealed a gap in HIV patients’ perceived knowledge versus actual understanding of drug resistance, highlighting the need for increased doctor-patient communication and consumer-friendly education tools to help patients better understand the potential impact of HIV drug resistance on their overall health.

While recent surveillance data are not available, an earlier estimate suggests that 76% of HIV-infected individuals failing treatment in the United States have a virus that is resistant to at least one anti-HIV medication, according to a study published in a July 2004 issue of AIDS.

“While great strides have been made in HIV therapy, resistance to anti-HIV medications continues to be one of the most significant challenges facing patients and physicians today,” said Dr. Howard Grossman, Executive Director of AAHIVM (and Medical Editor of this website). “Everyone living with and affected by HIV should be concerned about drug resistance and aware of current strategies to minimize and manage its development, such as adherence to treatment regimens, use of resistance testing to help select the most active (or sensitive) regimen and selection of agents with a high genetic barrier to resistance. Ongoing patient-physician communication and education are both essential to successful implementation of these strategies.”

The disparity in the level of concern about HIV drug resistance between patients and doctors may partially be attributed to patients overestimating their level of knowledge about this issue. While 61% of patients say they are knowledgeable about HIV drug resistance, nearly half (45%) of those whose virus has developed resistance do not know to which class of drugs their virus is resistant. In addition, 59% of patients have never been told or are unsure if their virus has developed resistance to any anti-HIV medications.

Survey findings show that more patient-friendly language and a wider array of resources may be necessary to help close the gap in patient knowledge of HIV drug resistance. Sixty-five percent of patients say their doctors are their primary source of drug resistance information. HIV magazines (11%), the Internet (10%), and AIDS Service Organizations (ASOs) (6%) are also cited as information resources. However, half of physicians (51%) do not display educational materials about drug resistance in their office, and 77% of patients agreed that some of the terms physicians use to explain resistance are difficult to understand. Nearly two out of three patients (64%) also noted that they were interested in learning more about new treatment regimens, particularly patients who are “extremely” or “very” concerned about resistance (76%).

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