Injecting drug users' adherence to HIV antiretroviral treatments: physicians' beliefs

This paper investigates physicians' judgements about adherence to antiretro viral treatment (ART) among patients who have been HIV-infected through inj ecting drug use (IDU). Comparisons were made between data collected from ph ysicians at enrolment (January 1996 to January 1998) of a prospective cohor t study (MANIF 2000) and self-declarations of 196 HIV-infected injecting dr ug users (IDUs) who have been prescribed ART. The likelihood of being perce ived as 'adherent' by physicians was higher for women, patients of 30 years of age or older, with biological markers indicative of a healthier status, and who were perceived as free of injecting behaviour' and nor in drug mai ntenance treatment. Although the proportion of non-adherent patients was si milar in physicians' assessment (26.0%) and patients' self-declarations (27 .0%), a strong discordance occurred: 60.4% of patients self-reporting non-a dherence to ART (80.0% for those receiving a protease inhibitor) were class ified as adherent by their prescribing physicians. The study suggests that a priori judgements based on clinical experience but also on social stereot ypes interfere with physicians' assessment, and that physicians' decisions to initiate complex treatment regimens may further induce optimistic biases and an underestimation of the problems faced by IDU patients to adequately adhere to them.