Survey Finds Gaps in Patient-Physician Conversations Affect Treatment
New results from a survey of more than 2000 people with HIV/AIDS
around the world has shown that HIV patients and their healthcare
providers may not communicate effectively, which can adversely
influence disease progression, treatment outcomes, management
of side effects, and quality of life. The International Association
of Physicians in AIDS Care (IAPAC) released the survey findings
this week to coincide with the XVIII International AIDS Conference
is an edited excerpt from an IAPAC press release describing the survey
and summarizing its findings. The
full version with references is available online.
HIV/AIDS Survey Reveals Critical Gap in Patient-Physician
Conversations That May Affect Long-Term Health Outcomes
Calls for Discussions to Expand Beyond HIV/AIDS-Specific
Clinical Management and Focus on All Aspects of Patient Health
Austria -- July 20, 2010 -- Results from the landmark AIDS Treatment
for Life International Survey (ATLIS 2010), a multi-country survey of
more than 2,000 people living with HIV/AIDS (PLWHA), revealed a significant
gap in patient-physician dialogue about critical health-related conditions
that may negatively impact patients' overall long-term health, quality
of life, and treatment outcomes. The data suggested that while patients
believe they are engaging in meaningful conversations with their healthcare
providers (HCPs), these discussions often do not focus on individual
patient needs, including chronic illnesses, treatment side effects,
or co-morbid conditions, such as cardiovascular disease (CVD), which
is the leading cause of death worldwide. These and other ATLIS 2010
findings were presented today by the International Association of Physicians
in AIDS Care (IAPAC) at the XVIII International AIDS Conference (AIDS
2010) in Vienna, Austria.
While the ATLIS 2010 findings showed a high degree of patient satisfaction
with HCPs globally (97 percent), and the majority of patients believe
they are being treated according to their individual needs (84 percent),
some respondents claim to have never engaged in important discussions
related to their long-term wellness, such as health history, present
medical conditions, treatment side effects, new treatment options, or
how all of these factors may impact their overall health and treatment
outcomes. Findings further indicate the need for more in-depth discussions
to reinforce the importance of adherence to HIV medicines and avoidance
of HIV drug resistance.
"IAPAC is issuing a global call-to-action to encourage more individualised
patient-physician dialogue to ensure that patients' personal needs,
past health history, and current medical status are considered, as well
as quality of life issues," said José M. Zuniga, PhD, president/CEO,
IAPAC, and ATLIS 2010 Task Force member. "Expanding patient-physician
conversations to include all aspects of a patient's well-being is crucial
for long-term survival and positive treatment outcomes."
Co-morbid conditions are increasingly affecting
people living with HIV/AIDS
As with all chronic illnesses, PLWHA need to be treated according to
their individual needs. When deciding on treatment, it is important
for physicians to discuss and consider factors such as family history,
smoking, diabetes, depression, and CVD, since some treatments may be
more appropriate than others for patients living with these conditions.
However, ATLIS 2010 respondents reported inconsistent rates of discussion
about these and other factors with their HCPs. Only half (51 percent)
of respondents claimed to have engaged in HCP discussions about their
past health status, and results indicated that co-morbid conditions
are not being addressed with great consistency. Sixty-four percent of
patients reported having at least one co-morbid condition, such as sleep
disorders (21 percent), gastrointestinal (GI) issues (18 percent), or
hepatitis C virus infection (17 percent). More than one-quarter of respondents
(26 percent) reported having three or more co-morbid conditions.
CVD is the leading cause of death worldwide, and it affects a significant
proportion of PLWHA. It is predicated upon risk factors, and can be
exacerbated by antiretroviral therapy (ART). In addition, as the PLWHA
population ages, CVD risk factors place them at higher propensity for
heart disease. As a result, the need for CVD risk management has become
increasingly important. The survey found that less than one-third (28
percent) of respondents had discussed their family history of CVD with
their HCP, and 65 percent of respondents who qualified as high-risk
for CVD were not engaging in frequent discussions related to heart disease
with their HCP. Although approximately 15 percent of respondents were
diagnosed with high cholesterol (16 percent) and high blood pressure
(15 percent), not all of these respondents had engaged in dialogue about
these conditions with their HCP (11 percent and 17 percent, respectively).
Smoking, a risk factor for both CVD and respiratory illnesses, such
as lung cancer and chronic obstructive pulmonary disease (COPD), should
also be discussed in the HCP's office. However, while 28 percent of
respondents reported that a history of smoking added to difficulty with
their current health status, 44 percent of these respondents reported
never having discussed the health implications of smoking with their
"It is extremely common for patients living with HIV/AIDS to have
co-morbid conditions that may be exacerbated by the HIV virus or antiretroviral
medications," said Jürgen Rockstroh, MD, PhD, ATLIS 2010 Task
Force member, and professor of medicine, University of Bonn, Germany.
"We are seeing patients who are dying from complications related
to co-morbidities, such as hepatitis C co-infection and heart disease.
As treaters, we can help manage these events through individualised
treatment approaches that consider the patient holistically to help
achieve better outcomes."
Although rates of co-morbid conditions vary across regions, CVD risk
factors were found to be most prevalent in North America. Among these
respondents, 40 percent have high cholesterol, 32 percent have high
blood pressure, 12 percent have diabetes, 40 percent are considered
overweight, and 19 percent are obese, according to Body Mass Index (BMI)
calculations. Significantly higher rates of depression were reported
in North America (47 percent) than in any other region surveyed. Hepatitis
C virus co-infection was highest in Russia (64 percent) and Spain (42
Side effects cause patients' burden, require
With the advent of ART, HIV has evolved from a fatal disease into a
long-term chronic illness. As disease management has evolved, so has
the need to address quality of life issues, especially related to treatment
side effects. While 40 percent of respondents claimed that they do not
like the way their medications make them feel, most notably in Europe
and the Asia-Pacific regions (both 42 percent), and 50 percent said
their medications have had a somewhat to extremely negative impact on
their lives, one-quarter had never spoken to their HCP about side effects
they are currently experiencing. This was particularly notable in Europe
(20 percent) and Latin America (26 percent). Despite these facts, less
than half (43 percent) of respondents overall had discussed new treatment
options with their physician.
Respondents who reported that their medications have a negative impact
on their quality of life were also more likely to have experienced side
effects, such as GI issues (58 percent), fatigue (52 percent), sleep
disorders (51 percent), and face and/or body shape changes (44 percent).
Respondents cited pain/discomfort (48 percent) and anxiety/depression
(56 percent) as the primary factors impacting their quality of life.
Additionally, respondents reported other quality of life issues, including
that they dislike the way their medication makes them look (36 percent),
and feel that the side effects of their medication are noticeable to
other people (30 percent). Further, 38 percent of respondents in Europe
and the Asia-Pacific region reported that the number of pills they take
per day has a negative impact on their quality of life.
Critical need for patient literacy in treatment
adherence and drug resistance
Properly adhering to HIV medications as prescribed is crucial for effectively
managing the disease and avoiding the emergence of drug-resistant virus
and disease progression.
According to ATLIS 2010, the majority of respondents (87 percent) claimed
to have quality HCP discussions about the importance of adhering to
their medications, yet nearly half (43 percent) admitted to missing
at least one dose in the past month, suggesting that they may not fully
understand the impact on their health. Levels of adherence varied across
countries, with the highest levels reported in Brazil (89 percent) and
South Africa (83 percent) and lowest in France (34 percent). Forgetfulness
was most commonly cited for sub-optimal adherence (74 percent), and
11 percent of respondents thought there were no consequences to sub-optimal
adherence (the correct answer being that the potential consequence is
HIV drug resistance). In addition, 18 percent of respondents thought
that resistance to the HIV medications they are taking is a "good
thing," highlighting the need for further patient-HCP dialogue
about this topic and tools to assist patients in taking medications
While the majority of respondents (87 percent) agreed their HCPs stress
the importance of ART adherence, only 71 percent cited practical recommendations
from their HCPs to maintain optimal adherence, with the lowest rates
reported in North America (62 percent) and the highest among Latin-American
and African respondents (80 percent for each).
"The varying levels of antiretroviral therapy adherence across
geographic regions may partially be due to limitations in health literacy
regarding the detrimental effects of suboptimal adherence and treatment
fatigue," said Jean Nachega, MD, PhD, ATLIS 2010 Task Force member,
and professor of medicine at Stellenbosch University, Cape Town, South
Africa. "This critical issue requires educational, behavioural,
and clinical interventions that will increase literacy about treatment
adherence and HIV drug resistance to help people attain optimal adherence
levels, which are crucial for achieving and maintaining treatment success."
About ATLIS 2010
The AIDS Treatment for Life International Survey (ATLIS 2010) is a multi-country,
comparative, treatment awareness survey of PLWHA from five global regions:
North America (United States), Latin America (Brazil), Europe (France,
Germany, Italy, Russia, Spain, and the United Kingdom), Asia-Pacific
(Australia and Korea), and Africa (Cote d'Ivoire and South Africa) that
examines global attitudes and perceptions of HIV disease. The project
was spearheaded by IAPAC and governed by an ATLIS Task Force composed
of scientific leaders from around the world. ATLIS 2010 survey fieldwork
was conducted by Kantar Health, an independent market research and global
consultancy organisation, from January-March 2010, via a combination
of Internet, phone, and in-person recruitment methods.
Interviews were conducted with a total of 2,035 HIV-positive adult men
and women ages 18 to 65 and over.
ATLIS 2010 is the second iteration of this initiative, with the original
study released at XVII International AIDS Conference (AIDS 2008) in
Mexico City, Mexico.
ATLIS 2010 was funded through support provided by Merck & Co., Inc.,
Whitehouse Station, NJ, USA, which operates in many countries as Merck
Sharp & Dohme.
IAPAC, established in 1995, was the first agency of its kind exclusively
devoted to fostering the coordinated strength of healthcare professionals
worldwide for the benefit of people affected by HIV/AIDS. With offices
in Chicago, Johannesburg, Washington DC, and Toronto, IAPAC represents
more than 13,000 physicians and other healthcare professionals in over
100 countries. IAPAC's mission is to craft and implement global educational
and advocacy strategies, as well as technical assistance programmes,
to improve the quality of care, treatment and support provided to all
For more information about IAPAC and/or ATLIS 2010, please visit: www.iapac.org.
International Association of Physicians in AIDS Care. Global HIV/AIDS
Survey Reveals Critical Gap in Patient-Physician Conversations That
May Affect Long-Term Health Outcomes. Press release. July 20, 2010.