Variability of attitudes toward early initiation of HAART for HIV infection : a study of French prescribing physicians

Abstract

This study assessed prescribing physicians' attitudes toward early initiation of HAART, three months after the dissemination of the first French official treatment guideline. Telephone interviews have been made in a national random sample of physicians with full- or part-time practice in hospital departments delivering care for HIV-infected patients. Questionnaires included hypothetical clinical cases. Logistic regression compared characteristics of respondents according to attitudes toward HAART. Among the 483 respondents (response rate = 87.0%), agreement was high with official recommendations to systematically initiate HAART with protease inhibitors (PIs) for patients with CD4+ cell counts &lt; or = 300/mm3, following a diagnosis of acute primary HIV infection, or for HIV sexual risk post-exposure prophylaxis. Confronted with a case of a naive asymptomatic patient with stable 450 CD4+/mm3, 34.6% would prescribe HAART with PIs in any case, and 29.8% only if the patient has plasma viral load &lt; or = 10,000 HIV RNA copies/ml. The remaining 35.6% would not prescribe PIs and were older, had limited activity in HIV care and expressed more interest in alternative medicines. To avoid a confusing impact of variability of clinical attitudes toward uncertainties associated with antiretroviral treatments among HIV-infected patients, shared decision-making between patient and physician should be promoted for initiation of HAART. [Authors]]]> Antiretroviral Therapy, Highly Active ; Attitude of Health Personnel ; HIV Infections ; Physician's Practice Patterns oai:serval.unil.ch:BIB_63B3A6A350EB 2022-05-07T01:19:14Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_63B3A6A350EB Logopenic syndrome and corticobasal dysfunction in a "benign" type 3 familial cortical myoclonic tremor with epilepsy. info:doi:10.1016/j.seizure.2015.01.004 info:eu-repo/semantics/altIdentifier/doi/10.1016/j.seizure.2015.01.004 info:eu-repo/semantics/altIdentifier/pmid/25645643 Magnin, E. info:eu-repo/semantics/article article 2015 Seizure, vol. 25, pp. 84-86 info:eu-repo/semantics/altIdentifier/eissn/1532-2688 urn:issn:1059-1311 eng oai:serval.unil.ch:BIB_63B3CEEF0A46 2022-05-07T01:19:14Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_63B3CEEF0A46 Guidelines zur Behandlung von Aphasien. Schweizerische Aerztezeitung Aphasie, Suisse info:eu-repo/semantics/article article 2005 Bulletin des Médecins Suisses = Schweizerische Ärztezeitung, vol. 86, no. 40, pp. 2290-2297 urn:issn:1424-4012 ger https://serval.unil.ch/resource/serval:BIB_63B3CEEF0A46.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_63B3CEEF0A466 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_63B3CEEF0A466 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_63B487FEFFA8 2022-05-07T01:19:14Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_63B487FEFFA8 Preliminary results on the postmortem measurement of 3-beta-hydroxybutyrate in liver homogenates. info:doi:10.1007/s00414-013-0870-3 info:eu-repo/semantics/altIdentifier/doi/10.1007/s00414-013-0870-3 info:eu-repo/semantics/altIdentifier/pmid/23722498 Palmiere, C. Mangin, P. Werner, D. info:eu-repo/semantics/article article 2013 International Journal of Legal Medicine, vol. 127, no. 5, pp. 943-949 info:eu-repo/semantics/altIdentifier/eissn/1437-1596 urn:issn:0937-9827 <![CDATA[The concentrations of 3-beta-hydroxybutyrate (3HB) in blood and two liver samples were retrospectively examined in a series of medicolegal autopsies. These cases included diabetic ketoacidosis, nondiabetic individuals presenting moderate to severe decompositional changes and nondiabetic medicolegal cases privy of decompositional changes. 3HB concentrations in liver sample homogenates correlate well with blood values in all examined groups. Additionally, decompositional changes were not associated with increases in blood and liver 3HB levels. These results suggest that 3HB can be reliably measured in liver homogenates when blood is not available at autopsy. Furthermore, they suggest that metabolic disturbances potentially leading or contributing to death may be objectified through liver 3HB determination even in decomposed bodies