Kimel G, Rosenbaum D, Tyndall MW, Palepu A, Hogg R, Montaner JS, Montessori V; IAS Conference on HIV Pathogenesis and Treatment (2nd : 2003 : Paris, France).

Antivir Ther. 2003; 8 (Suppl.1): abstract no. 563.

British Columbia Center for Excellence in HIV/AIDS, University of British Columbia, Faculty of Medicine, Vancouver, Canada

OBJECTIVE: To study the factors which influence the decision to the initiate HAART in hospitalized patients by family physicians (FP) in Vancouver. Study design: An anonymous survey consisting of 8 HIV+ patient cases was mailed three times to 670 FP who had prescribed HAART. Each scenario described the following characteristics: clinical (CD4, VL, present and concomitant illnesses and duration of hospitalization) and socio-demographic (age, IDU, housing situation, risk of non-adherence). RESULTS: 171 FP completed the questionnaire (response rate=26%). We have selected three cases (C) to describe. C1: A 30-year-old (yo) man, IDU, risk for non-adherence, CD4 300, VL 50000, admitted for community acquired pneumonia. 84/171 (49%) FP would, and 54/171 (32%) would not initiate HAART while in hospital. Factors supporting HAART initiation were CD4 127/171 (74%), VL 129/171 (75%) and factors against HAART initiation was concern about non-adherence 95/171 (56%). C2: A 35 yo man with unstable housing, CD4 <10, VL >750,000, mental illness and previous non-adherence with HAART, admitted for endocarditis. 92/171 (54%) FP would, and 41/171 (24%) would not, initiate HAART. Factors considered most important for HAART initiation were CD4 138/171 (81%), VL 138/171 (81%) and present illness 99/171 (58%). Factors against HAART initiation were housing situation 87/171 (51%) and risk of non-adherence 111/171 (65%). C3: A 38 yo man, IDU, alcohol abuse, hepatitis C and chronic liver disease, CD4 300, VL 30000, admitted for cellulitis. 18/171 (11%) FP would, and 90/171 (53%) would not initiate HAART. Factors considered most important for HAART initiation were CD4 111/171 (65%), VL 112/171 (65%). The presence of liver disease was a deterrent to HAART initiation for most FP 115/171 (67%) while in hospital. CONCLUSIONS: We found marked variation in decisions to initiate HAART in hospitalized patients. CD4 and VL were considered important for the initiation of HAART in all cases. Risk for non-adherence and the presence of liver disease were strong deterrents to initiation of HAART. A better understanding of factors FP use in deciding whether to initiate HAART in hospitalized HIV-infected patients are important to develop interventions to improve appropriate prescribing.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Antigens, CD4
• Antiretroviral Therapy, Highly Active
• Canada
• HIV Infections
• HIV Seropositivity
• Hepatitis C
• Humans
• Male
• Physicians, Family
• Questionnaires
• immunology

Other ID:

• GWAIDS0023221

UI: 102262845

From Meeting Abstracts