HIV patients often unaware of drug resistance: survey

By Karla Gale

NEW YORK (Reuters Health) – Knowledge of available
treatment options and the significance of drug resistance has
declined in patients infected with HIV, the virus that causes
AIDS, according to results of a survey presented Tuesday.

“In the early days of HIV, patients often understood the
science of HIV as much as most clinicians,” Dr. Howard Grossman
told Reuters Health. “But once the complex drug regimens with
HAART (highly active antiretroviral therapy) came out, and
complicated drug resistance testing was developed,” it became
harder for patients to keep up with the rapid advances in the
field and to understand how all of this new information affects
their own treatment options.

Grossman is executive director of the American Academy of
HIV Medicine in Washington DC, which commissioned the survey.
Included were responses from 385 physicians who treat HIV
patients and 400 adults diagnosed with HIV/AIDS.

The survey results showed that 91 percent of physicians are
“extremely” or “very” concerned about HIV drug resistance,
compared with 54 percent of patients living with the disease.

And while 61 percent of patients said they were
knowledgeable about HIV drug resistance, 59 percent were unsure
if their virus had become resistant to any drugs. Among those
with resistant virus, 45 percent did not know which classes of
drugs were involved.

“It took a good 10 to 15 years to develop effective
antiretroviral therapy, but as drug regimens became more
complicated and more side effects occurred, patient adherence
became more difficult,” Dr. Martin Markowitz of the Aaron
Diamond AIDS Research Center in New York City said in an
interview with Reuters Health.

As a result of poor patient compliance, “in 2003-2004,
about one out of seven new HIV infections in major cities was
resistant to the non-nucleoside reverse transcriptase
inhibitors, and about one in ten were resistant to at least two
classes of drugs,” Markowitz added.

“As a result of drug resistance, patients’ treatment
options are reduced.” Therefore, patient education is
paramount, as is emphasis on adherence to the prescribed drugs.

Both of the physicians noted that there are a number of
Internet web sites, such as aidsmed.com and thebody.com, which
provide “fair, balanced information.”

Because “people who are more disadvantaged are
disproportionately affected by HIV; it has become harder to
educate or even reach that population effectively,” Markowitz
said. Patient education materials therefore need to be modified
so the message is clear and more understandable. “And we need
to teach providers how to teach about HIV and drug resistance,”
he added.

There are often slip-ups among physicians as well, the
survey found. Because new infection rates with HIV strains that
are already resistant to some drugs have increased over time,
the guidelines now recommend resistance testing for all
patients before they start therapy, Markowitz noted.

While 99 percent of physicians said they test for
resistance when considering a switch in a patient’s therapy,
only 67 percent test for resistance before antiretroviral drug
treatment begins.

Grossman noted that the future is not hopeless because of
emerging drug resistance. “A number of new treatments are on
the horizon, including integrase inhibitors, entry inhibitors
and new protease inhibitors.”