HIV treatment-experienced patients set high standards for therapy success

Patients who have previously failed at least two anti-HIV regimens continue to have high standards for their treatment success, according to a survey commissioned by the American Foundation for AIDS Research (amfAR).

The survey results emphasize the need for patients to discuss their treatment goals with their physicians so that they can work together to find an appropriate drug regimen. These findings were presented at the 17th National HIV/AIDS Update Conference in Oakland, April 10 - 13, 2005.

Multiple-drug resistant virus is a growing concern in HIV treatment. Despite viral resistance to many available drugs, treatment-experienced patients still have ambitious treatment goals. They seek to lower their viral loads, raise their CD4 counts, minimize further drug resistance and choose treatment regimens with the fewest side effects.

"Combinations of new drugs that work against drug resistant virus are now showing response rates previously only observed in first line therapy," said Calvin Cohen, M.D., Director of Research, Community Research Initiative of New England. "In order for patients to take advantage of these advances, they must actively discuss treatment goals with their HIV-treating physicians so that they can work together to find an appropriate regimen to optimize therapeutic response, possibly including a drug from a new and unique drug class."

The survey of physicians and treatment-experienced HIV patients revealed that they both view reaching an undetectable viral load and increasing CD4 cells as very important to successful treatment. Eighty-one percent of patients surveyed and 57 percent of their physicians view reaching an undetectable viral load as very important to successful treatment. More physicians surveyed view reaching an undetectable viral load as a very important goal in all HIV patients (84 percent), regardless of treatment history, compared to in treatment-experienced patients (57 percent). Additionally, both patients (88 percent) and physicians (55 percent) view significantly increased CD4 cells as very important to successful treatment.

The current HIV treatment guidelines by the U.S. Department of Health and Human Services support high standards for treatment success. The guidelines state that the goal for patients who have failed several regiments is " ... to re-suppress HIV-RNA levels maximally and prevent further selection of resistance mutations." To achieve treatment goals, guidelines recommend that "adding a drug with a new mechanism of action to an optimized background antiretroviral regimen can add significant antiretroviral activity."

"As someone living with HIV for 19 years, I certainly appreciate the prospect of achieving and maintaining an undetectable viral load," said Fred Schaich, President of the International Foundation for Alternative Research in AIDS. "Though I have become resistant to several classes of HIV drugs, my doctors and I have found that adding enfuvirtide (Fuzeon) to an optimized background regimen has continued to keep me undetectable for four years. The fact that enfuvirtide is an injectable medication was not a detraction since I could consider the possibility of achieving this treatment goal."

Survey results demonstrate that patients are very willing to try an injectable medication. While a majority (79 percent) of patients said that they would be willing to try an injectable medication if it suppressed the virus and gave them more energy, nearly 20 percent of physicians reported having major reservations about prescribing this type of medication. Overall, 68 percent of physicians surveyed reported minor or major reservations about prescribing an injectable medication, and the large majority (90 percent) of these physicians attributed these reservations to concerns about compliance. However, most patients (85 percent) feel that they would be able to comply to a regimen with an injectable medication.

Findings also showed that patients may choose an injectable medication over an oral medication in certain situations. For example, more than one third of patients surveyed said they would choose an injectable that is more likely to help them achieve an undetectable viral load over an oral medication that is more likely to help them achieve a low viral load. Patients may also choose a drug based on side effects. Half of patients surveyed would likely choose an injectable medication that could cause injection site reactions such as small bumps, redness, itching, and swelling over a medication that could cause gastrointestinal side effects such as nausea and diarrhea.

The patient and physician surveys were conducted by Harris Interactive(R) for amfAR via telephone between January 5 and February 18, 2005. The sample included 115 HIV/AIDS patients 18 or older who took two or more antiretroviral combination therapies and 150 HIV/AIDS physicians practicing for at least three years.

Physicians who participated in the survey recruited the patients. In addition, Harris Interactive online panel members with HIV/AIDS received an email inviting them to participate in a telephone survey.