[Therapeutic attitude to HIV infection: uncertain and variable scientific attitudes. 1998 national survey of physicians prescribing antiretroviral drugs].

OBJECTIVES

Analyze the attitudes of French practitioners managing HIV infected patients towards multidrug antiretroviral therapies with protease inhibitors, open issues, and the official guidelines (Dormont report).

METHODS

A telephone survey was conducted in February-March 1998 on a random sample of the nation file of hospital physicians prescribing antiretroviral drugs (response rate 87%, n = 483).

RESULTS

The responding clinicians were in general agreement on defining virological efficacy at three months treatment as an undetectable viral load (86.5%). There was a general concensus on multidrug therapy with a protease inhibitor in case of primary infection (83.2%) or sexual exposure with risk of HIV transmission (83.2%). Inversely, only 43.7% abandoned PCP and toxoplasmosis prophylaxis in patients with CD4 counts above 350/mm3 taking tritherapy antiretroviral regimens. When asked to state their approach to a hypothetical case of an asymptomatic patient with a CD4 count of 450, 35.6% would not propose multidrug therapy with an antiprotease, 29.8% would only envisage such a regimen if the viral load was above 10,000 copies/ml, and finally 34.6% would prescribe a multidrug regimen with a protease inhibitor whatever the viral load.

CONCLUSION

The variability observed in routine clinical practices would appear to be justified in light of the uncertainty about the long-term effects of the new antiretroviral drugs for HIV/AIDS.