This presentation is part of: Oral Concurrent Session A - Patient and Physician Behavior/Preferences 1
PATIENT PREFERENCES REGARDING THE TIMING OF ANTIRETROVIRAL THERAPY INITIATION FOR CHRONIC HIV INFECTION
Mirjam Locadia, MA1, Roos Van Grieken, BSc1, Henry JC De Vries, MD, PhD2, Mirjam AG Sprangers, PhD1, and Pythia T Nieuwkerk, MA1. (1) Academic Medical Center / University of Amsterdam, Dept. of Medical Psychology, Amsterdam, Netherlands, (2) Academic Medical Center / University of Amsterdam, Dept. of Dermatology, Amsterdam, Netherlands
Purpose:The optimal timing of highly active antiretroviral therapy (HAART) initiation for chronic HIV infection is controversial. Earlier initiation, i.e. when CD4-cell counts are higher, reduces the risk of mortality but entails an earlier exposure to pill burden and potential toxicities as compared to later initiation. Therefore, the decision about when to initiate HAART involves a trade-off. We investigated preferences for earlier or later HAART initiation among HIV-negative patients, currently treated for an STD, who were considered to be at risk for acquiring HIV and therefore potential candidates for the decision about when to initiate HAART. Methods:During an interview, patients were offered the choice between immediate HAART initiation versus delaying initiation for one year, when imagining having an asymptomatic HIV infection. Both options were presented as vignettes, including descriptions of pill burden, possible toxicities, and consequences for daily living. A difference in the three-year mortality risk between both options was also presented, and systematically varied between 0% and 10% to determine the threshold at which preference would switch to therapy initiation. We assumed a difference in risks between both options of approximately 1% for a CD4-cell count of 350, and 3% for a CD4-cell count of 200. Most clinical guidelines would recommend delay of HAART at 350 CD4-cells, and HAART initiation at 200 CD4-cells. Results:Forty patients were interviewed (mean age 35 years, 58% males). One patient was unable to make a trade-off. Eleven patients (28%) would prefer HAART initiation even if mortality risks would be equal for both options. Most of these patients wanted to do anything they could against HIV, and would therefore initiate HAART. Eighteen patients (46%) switched their preference to HAART initiation when delay of HAART would result in a higher mortality risk. Ten patients (25%) always opted for delay of HAART even if this would result in a 10% greater mortality risk. Conclusions:Our results show a large variation in patient preferences regarding the moment of HAART initiation. Some patients were more inclined to initiate HAART than would be recommended by current treatment guidelines, while others were more conservative than current guidelines. These findings emphasize the need for shared decision-making when deciding on the most optimal timing of HAART initiation among patients with a chronic asymptomatic HIV infection.
