Rapid changes in prescribing practices for individuals with HIV/AIDS: A survey of physicians attending the 1996 IDSA meeting

We surveyed physicians attending the 34th annual IDSA meeting (1996) to determine their prescribing practices for HTV infected patients. We compared the survey results (297 completed) to a similar survey conducted of 1995 IDSA meeting attendees (601 completed). 86% (253 of 293) of those completing the 1996 survey used viral load routinely in their practice and a majority (72%) used the quantitative PCR method. The most important criteria for starting or modifying antiretroviral (AR) therapy was viral load (VL), followed by CD4 count and clinical criteria. There was considerable variability in what physicians considered a VL decrease indicative of an adequate response to AR therapy: 0.5 log (13.8% of respondents), 1 log (34.9%), 2 logs (30.6%) and undectable VL (17.6%). In early stage patients (CD4 300-500) 50.2% used dual nucleoside analogues (NA) while 45% used a combination including a protease inhibitor (PI). Of those using a PI for initial therapy most used indinavir (59%) followed by ritonavir (22%) and saquinavir (20%). In laœr stage AR naive patients (CD4300) 70% used combination AR therapy which included a PI and 27% used 2 NAs alone. The 1996 responders were more likely than the 1995 responders to sort combination AR therapy: 98% vs 21%, p<0.01. The 1996 repsonders were more likely than the 1995 repsonders to prescribe MAC prophylaxis: 200 of 291 (68.7%) vs 329 of 590 (55.7%), p= 0.013, and were more likely to use a macrolide antibiotic for MAC prophylaxis (72.4%) compared to the 1995 responders who were more likely to use rifabutin (77%). Physicians in either 1996 or 1995 were unlikely to prescribe anti-fungal prophylaxis: 32 of 291 (12.4%) vs 93 of 590 (15.8%) p=0.30, respectively. Prescribing practices of physicians who care for HIV infected patients have undergone rapid changes and are generally in accordance with published treatment guidelines.