Actual versus perceived use of pharmacokinetic (primarily absorption) influential OTC agents and ART tolerability in a nationwide matched cohort of HIV patients and their healthcare providers

Background:

Antiretroviral therapy (ART) for HIV patients is lifelong. ART efficacy is clear, adverse effects (AE) severity has decreased yet still impact outcomes. This study obtained ‘real world’ data comparing healthcare providers’ (HCP) perceptions and clinic records to their patients’ perceptions of ART tolerability and self-management.

Methods:

Study utilised Adelphi’s HIV Disease Specific Programme, a cross-sectional survey including provider interviews (n=131) and matched HCP and patient self-completed surveys (n=485), conducted among HIV patients and their HCPs. Similar questionnaires focused on disease symptoms, ART AEs, other AEs, compliance, impact and reasons for switching or discontinuing therapy.

Results:

131 HCPs were interviewed (n=80 ID physicians) at 18 metro areas across the US. “Efficacy” was stated by 58% of HCPs as the most important attribute when selecting ART yet the top 5 attributes for ART selection in patient charts revealed criteria of “well tolerated by patients.” ID specialists perceived 32% of all patients are experiencing ART side effects and this increases with subsequent regimens (Figure 1). HCPs interviewed revealed diarrhea as one of the most  common symptoms seen with 66% stating diarrhea was the most ‘most troublesome’ AE. This agrees with patients, who recorded diarrhea as equal second ‘most problematic symptom’. ART changes are most frequently for lack of virologic control (36%) but secondarily (28%) due to GI AEs. HCPs and patients agree on proportion experiencing diarrhea and being treated for it (Figure 2), yet only about 1/3 of patients receive therapy. Finally, Figure 3 depicts a concerning discrepancy between prevalence of OTC drugs used by patients vs. perceived used by HCPs.

Conclusion:

HIV patients experience and self-medicate GI-symptoms disparate with HCPs knowledge, representing a potential major detrimental influence on outcomes.