Evidence map›Paper›PMID 26983974›Full record

ArticleInfection2016

Reasons for not starting antiretroviral therapy in HIV-1-infected individuals: a changing landscape.

Jan Fehr, Dunja Nicca, Jean-Christophe Goffard, David Haerry, Michael Schlag, Vasileios Papastamopoulos, Andy Hoepelman, Athanasius Skoutelis, Ruth Diazaraque, Bruno Ledergerber

Abstract read
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Article in Infection, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jan FehrDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. jan.fehr@usz.ch.
Dunja NiccaDivision of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
Jean-Christophe GoffardInternal Medicine AIDS Reference Centre ULB-Hôpital Erasme, Brussels, Belgium.
David HaerryPositive Council Switzerland, Zurich, Switzerland.
Michael SchlagGilead Sciences, Foster city, USA.
Vasileios Papastamopoulos5th Department of Medicine and Infectious Diseases Unit, "Evangelismos" General Hospital, Athens, Greece.
Andy HoepelmanDepartment of Internal Medicine and Infectious Diseases, University Medical Utrecht, Utrecht, The Netherlands.
Athanasius Skoutelis5th Department of Medicine and Infectious Diseases Unit, "Evangelismos" General Hospital, Athens, Greece.
Ruth DiazaraqueGilead Sciences, Foster city, USA.
Bruno LedergerberDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeA cross-sectional survey was conducted to better understand why chronically HIV-1-infected individuals stratified by CD4 count (≤349; 350-499; ≥500 cells/μL) were not on antiretroviral therapy (ART).

methodsBefore the consultation, treatment-naive patients and their physicians independently completed a 90-item-questionnaire about barriers and their readiness to start/defer ART. The study was carried out at 34 sites in nine countries in Europe and Australia.

resultsBetween December 2011 and October 2012, 508 pairs of patient- and physician-questionnaires were completed. 426 (84 %) patients were male and 39 (8 %), 138 (27 %), and 330 (65 %) were in the three stratified groups based on CD4 count, respectively. In the category 'Body and symptoms' the most commonly identified reason for patients not to start was: "As long as I feel good I don't have to take medication" (44 %). Less than 20 % of respondents indicated fears of side effects and toxicity or problems to manage pills. Most patients were in the lowest stage of treatment-readiness (N = 323, 68 %), especially patients with CD4 cells ≥500 cells/μL (N = 240, 79 %). Physicians answered in 92 (18 %) cases that ART was not indicated for CD4 cells <500 cells/μL. Main reasons for physicians not starting treatment for these patients were their perception that patients were 'too depressed' (13 %) or that they had not known them long enough (13 %).

conclusionsNowadays patient-barriers to ART are commonly related to health-and treatment-beliefs compared to fear of toxicity or ART manageability in the past. This new barrier pattern seems to reflect the era of well tolerated, easier ART regimens and has to be considered in light of the new recommendations to treat all HIV-infected individuals regardless of the CD4 cell count.

Indexed as

AdultAnti-Retroviral AgentsCD4 Lymphocyte CountCross-Sectional StudiesFemaleHIV-1HIV InfectionsHumansMaleMiddle AgedSurveys and QuestionnairesTime-to-TreatmentAnti-Retroviral AgentsAntiretroviral treatment startBarriersHIV-infection

Identifiers

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.