Why is highly active antiretroviral therapy (HAART) not prescribed or discontinued?

In this cross-sectional survey conducted at the end of 1997 among the physi cians of participants of the Swiss HIV Cohort Study (SHCS), 1487 of 2154 pa tients (69.0%) were treated with highly active antiretroviral treatment (HA ART) defined as triple therapy with a combination of one or two reverse tra nscriptase inhibitors, and one or two protease inhibitors; 541 patients (25 .1%) had never received such treatment. The physician's perception that the patient would not comply with treatment was one reason for not prescribing HAART to 20% of these patients (110). Physicians indicated that the most c ommon reasons for the patient to refuse HAART were the fear of side effects (18%) and the patient's perception that treatment was too complicated (18% ). Among 126 patients (5.8%) no longer receiving HAART, the most common rea sons for discontinuing treatment were actual side effects (61%) or the fear of side effects (25%); Overall, 16% of patients did not receive therapy in accord with official Swiss guidelines. Multivariate logistic regression an alysis indicated that patients with lower education, active intravenous dru g users outside of a drug substitution program, and those who acquired HIV infection through intravenous drug use had a significantly higher rid df in adequate treatment. The physician's judgment of patient adherence and the p hysician's perception of the patient's fear of side effects are critical fo r the prescription of HAART. Physicians should address these issues to prev ent unilateral withholding of treatment and increase the proportion of pati ents who may benefit from current antiretroviral therapy.