Barriers to ART initiation in HIV infected subjects and with treatment indication in Spain. Why don't they start their treatment? Bridgap Study
Por:
Viciana-Fernandez, P, Falco, V, Castano, M, de los Santos-Gil, I, Olalla-Sierra, J, Hernando, A, Deig, E, Clotet, B, Knobel, H, Podzamczer, D, Pedrol, PD
Publicada:
1 jun 2015
Resumen:
Introduction: In Spain, HIV treatment guidelines are well known and generally followed. However, in some patients there are no plans to initiate ART despite having treatment indications. The current barriers to ART initiation are presented.
Methods: A cross-sectional survey including every HIV infected patient in care in 19 hospitals across Spain in 2012, with >= 1 indication to start ART according to 2011 national treatment guidelines, who had not been scheduled for ART initiation. Reasons for deferring treatment were categorized as follows (nonexclusive categories): a) The physician thinks the indication is not absolute and prefers to defer it; b) The patient does not want to start it; c) The physician thinks ART must be started, but there is some limitation to starting it, and d) The patient has undetectable viral load in absence of ART.
Results: A total of 256 patients, out of 784 originally planned, were included. The large majority (84%) were male, median age 39 years, 57% MSM, 24% heterosexuals, and 16% IDUs. Median time since HIV diagnosis was 3 years, median CD4 count, 501 cells/mm3, median viral load 4.4 log copies/ml. Main ART indications were: CD4 count <500 cells/mm(3), 48%; having an uninfected sexual partner, 28%, and hepatitis C coinfection, 23%. Barriers due to, the physician, 55%; the patient, 28%; other limitations, 23%; and undetectable viral load, 6%.
Conclusions: The majority of subjects with ART indication were on it. The most frequent barriers among those who did not receive it were physician-related, suggesting that the relevance of the conditions that indicate ART may need reinforcing. (C) 2013 Elsevier Espaila, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologfa Clinica. All rights reserved.
Filiaciones:
Viciana-Fernandez, P:
Hosp Univ Virgen del Rocio, Serv Enfermedades Infecciosas, Seville, Spain
Falco, V:
Hosp Univ Vall dHebron, Serv Enfermedades Infecciosas, Barcelona, Spain
Castano, M:
Hosp Reg Carlos Haya, Serv Enfermedades Infecciosas, Malaga, Spain
de los Santos-Gil, I:
Hosp Univ Princesa, Unidad Enfermedades Infecciosas, Madrid, Spain
Olalla-Sierra, J:
Hosp Costa del Sol, Unidad Med Interna, Marbella, Spain
Hernando, A:
Univ Europea Madrid, Hosp Univ Octubre 12, Unidad VIH, Madrid, Spain
Deig, E:
Hosp Gen Granollers, Med Interna Serv, Unidad VIH, Granollers, Spain
Clotet, B:
Inst Germans Trias & Pujol, Fdn IrsiCaixa, Barcelona, Spain
Knobel, H:
Hosp del Mar, Serv Enfermedades Infecciosas, Barcelona, Spain
Podzamczer, D:
Hosp Univ Bellvitge, Serv Enfermedades Infecciosas, Unidad VIH, Barcelona, Spain
Pedrol, PD:
Hosp Santa Creu & Sant Pau, Unidad Enfermedades Infecciosas, Barcelona, Spain
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