Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment

To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly a ctive antiretroviral therapy (HAART), we sent a survey to a random sample o f 995 infectious disease physicians who treat patients with HIV/AIDS in the United Stares in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral tre atment and the extent to which each of three medical and 17 nonmedical fact ors would influence them for or against prescribing HAART to a hypothetical HIV-positive patient. Most reported initiating HAART with findings of low CD4(+) cell counts and high viral loads, and weighing CD4(+) cell counts, v iral load, and opportunistic infection heavily in their decisions to prescr ibe HAART. Patients' prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injectio n drug use, and prior psychiatric hospitalization were cited by most physic ians as weighing against HAART initiation. Thus, most physicians in this sa mple follow guidelines for the use of HAART, and nonmedical factors related to patients' lire situations are weighed as heavily as disease severity in treatment decisions. As HIV increasingly becomes a disease associated with economic disadvantage and other social health problems, it will be essenti al to develop interventions and care support systems to enable patients exp eriencing these problems to benefit from HIV treatment advances.