Bogart L M, Kelly J A, Catz S L, Sosman J M
Department of Psychology, Kent State University, Ohio 44242-0001, USA.
J Acquir Immune Defic Syndr. 2000 Apr 15;23(5):396-404. doi: 10.1097/00126334-200004150-00006.
To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly active antiretroviral therapy (HAART), we sent a survey to a random sample of 995 infectious disease physicians who treat patients with HIV/AIDS in the United States in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral treatment and the extent to which each of three medical and 17 nonmedical factors 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, viral load, and opportunistic infection heavily in their decisions to prescribe HAART. Patients' prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injection drug use, and prior psychiatric hospitalization were cited by most physicians as weighing against HAART initiation. Thus, most physicians in this sample follow guidelines for the use of HAART, and nonmedical factors related to patients' life 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 essential to develop interventions and care support systems to enable patients experiencing these problems to benefit from HIV treatment advances.
为了研究医学因素（如病毒载量）和非医学因素（如患者特征）对高效抗逆转录病毒治疗（HAART）治疗决策的影响，我们于1998年8月向美国995名治疗HIV/AIDS患者的传染病医生随机抽取的样本发送了一份调查问卷。回复率为53%。受访者被要求报告他们目前在抗逆转录病毒治疗方面的做法，以及三种医学因素和17种非医学因素中的每一种因素在多大程度上会影响他们对一名假设的HIV阳性患者开具HAART处方的支持或反对态度。大多数受访者表示，在CD4+细胞计数低和病毒载量高的情况下开始使用HAART，并在决定开具HAART处方时，非常重视CD4+细胞计数、病毒载量和机会性感染。患者先前依从性差的病史对开始使用HAART极为不利。大多数医生认为，患者无家可归、大量饮酒、注射吸毒和先前的精神科住院史不利于开始使用HAART。因此，该样本中的大多数医生遵循HAART使用指南，在治疗决策中，与患者生活状况相关的非医学因素与疾病严重程度同样重要。随着HIV越来越成为一种与经济劣势和其他社会健康问题相关的疾病，开发干预措施和护理支持系统，使经历这些问题的患者能够从HIV治疗进展中受益将至关重要。
