Combination Antiretroviral Therapy Toxicities: A Comparison Between Patients and Health Care Professionals (2011)

To the Editors: Although the potential for antiretroviral toxicity has a major role in the decision-making process for both HIV-positive patients and health care professionals (HCPs),1,2 there are no data on whether patients and HCPs have similar opinions on these side effects. To investigate this further, we compared attitudes between these groups using the same questionnaire survey. Patients and HCPs were asked to complete an anonymous survey on 10 common cART side effects. A pharmacist handed out and collected the survey; patients were asked to rate how distressing they felt each one would be on a 100-mm nonhatched visual analogue scale. HCPs were also asked to rate how distressing each side effect would be for patients on the same scale. The HCPs surveyed were specialist HIV doctors, pharmacists, and nurses at Chelsea and Westminster Hospital NHS Trust, London, United Kingdom; appropriate ethical approval was obtained. The investigator measured the mark on the line to the nearest 10-mm increment to give a value from 1 to 10. The median and mean were calculated; mean values for each group were used to rank the side effects. A total of 95 patients and 58 HCPs completed the survey; all patients were stable on cART treatment. There were statistically significant differences in distress scores for nausea and vomiting, diarrhea, weight gain, and effects on sexual function between the 2 groups (Table 1), with HCPs generally scoring these are more distressing than affected patients (P = 0.001 for these). The IQR of the distress score for each category is wider in the patient group than the HCP group, reflective of the wide range of individual patient experiences. Patients felt that lipodystrophy, sleep disturbances, and increased cardiovascular risk were the most distressing side effects with drowsiness, diarrhea, weight gain being the least (Table 2). HCPs felt that nausea and vomiting, reduced sexual function, and sleep disturbances were the most distressing side effects with increased cardiovascular risk, jaundice, and rash as the least.TABLE 1: Table Comparing the Average Scores on Each Question for HCPs and PatientsTABLE 2: Table Comparing the Rank Mean Scores for Each Question for HCPs and PatientsThe relationship between a patient and their physician is important in determining acceptance and adherence to cART.3-5 This study demonstrated that it is important that HCPs have an awareness of the difference in toxicity perceptions, so patients' concerns regarding side effects of cART can be addressed appropriately. However, more data are needed to see if these differences are reflected in a larger cohort, including one-to-one patient-provider assessments. ACKNOWLEDGEMENT We are grateful to the patients who completed the questionnaire. Mark Nelson, MD Stuart Yau, MD Laura Baber, MD Joel Myers, MD Breda Ward, MD Sonali Sonecha, MD Mark Bower, MD, FRCP, FRCPath, PhD Brian Gazzard, MD Justin Stebbing, MD, FRCP, FRCPath, PhD Department of HIV MedicineThe St Stephen's Centre, Imperial College, Chelsea and Westminster Hospital, Imperial College, London, United Kingdom