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Patterns of Highly Active Antiretroviral Treatment (HAART) in the U.S.A.: Results of a National Survey of HIV Clinicians

Seth Himelhoch, MD, MPH, Psychiatry, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building, Suite 300, Baltimore, MD 21201, (410)706-2490, shimelho@psych.umaryland.edu, Neil R. Powe, MD MPH MBA, Department of Epidemiology, Johns Hopkins University, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21205, and Kelly Gebo, MD, MPH, Department of Medicine, Johns Hopkins University, Room 442, 1830 E. Monument St., Baltimore, MD 21287.

Objective: To describe treatment patterns of highly active antiretroviral treatment (HAART) among a national sample of HIV clinicians. Methods: We conducted a cross-sectional study of a national sample of 700 HIV experts drawn from the American Academy of HIV Medicine in 2002 . Participants were mailed a questionnaire consisting of a case vignette of an AIDS patient followed by questions regarding antiretroviral prescribing patterns and factors associated with recommending HAART. HAART treatment was categorized based on IAS guidelines published at the time of the survey. Results: We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Ninety-three percent prescribed HAART regimens consistent with IAS guidelines: 51.4% prescribed a regimen that included two NRTI and a NNRTI, 37.1% prescribed a treatment regimen that included two NRTI and a PI and 11.5% prescribed a regimen that included three NRTI. Those who prescribed a three NRTI HAART regimen were more likely to agree that the vignette patient would develop (30.3% vs. 17.5%, p=0.08) and spread (47.1% vs. 19.5%, p<0.001) treatment resistant strains of HIV and were less likely to agree that they followed treatment guidelines (60.6% vs. 80.5%, p=0.009) as compared to those that prescribed a multi-class regimen (either two NRTI and a NNRTI or two NRTI and a PI). Conclusions: HIV clinicians follow IAS guidelines when prescribing HAART. However, those who prescribe triple nucleoside HAART regimens may be concerned about patients developing and spreading resistant strains of HIV.

Learning Objectives:

Keywords: HIV/AIDS, Treatment Patterns

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

HIV/AIDS Health Care Delivery, Services, and Providers

The 132nd Annual Meeting (November 6-10, 2004) of APHA