Low uptake of T-20 may be caused by doctors misjudging patient attitudes to self-injection

Many HIV patients are still reluctant to accept self-injectable treatments due to fears about pain, inconvenience and it being a ‘last resort’, according to the results of the OpenMind study, presented last week at the Tenth European AIDS Conference / European AIDS Clinical Society in Dublin. However, they may be more willing to consider self-injectable treatments than many doctors believe, possibly explaining the lower-than-expected uptake of T-20 (enfuvirtide, Fuzeon).

OpenMind is a large behavioural study examining the attitudes to HIV therapy in patients and doctors. It was conceived to examine the reasons for the low uptake of T-20 among HIV-positive patients who would be eligible for use of the drug, which must be injected twice a day under the skin. All other antiretroviral drugs are taken by mouth.

The OpenMind study was funded by T-20’s manufacturer, Roche. However, its conclusions may also be of relevance to other self-injectable therapies, including treatments yet to be developed.

The study’s investigators conducted individual, structured interviews of 499 HIV doctors and 603 treatment-experienced patients in Europe and the United States. The participants were asked about their attitudes towards HIV treatment, doctor-patient relationships and self-injecting therapy.

All of the patients were eligible for T-20 treatment, but only 10% were currently receiving the drug and 3% had previously used it. Of the 542 remaining patients, only 150 (28%) had discussed the use of T-20 with their HIV doctor.

According to the study’s findings, over half of the patients perceived self-injectable therapy as being a ‘last resort’, while 32% thought that the drawbacks of self-injecting would outweigh its benefits and 41% felt that they would be reluctant to accept the pain of injection. Similarly, 42% thought that self-injecting would impose unacceptable restrictions on their lifestyle.

However, 76% of the patients not using T-20 said that they would be ‘very likely’ or ‘moderately likely’ to use the drug if their doctor recommended it. Thirty-nine per cent of the patients thought that self-injection would be ‘highly tolerable’ and 59% felt that they could cope with the complexities of self-injection.

The analysis of doctors’ attitudes revealed that those who prescribed T-20 less frequently were more likely to believe that patients would be reluctant to use a self-injecting therapy because of a belief that its drawbacks outweighed its benefits (p

Prof Rob Horne, the study’s principal investigator, said, “physicians’ best intentions in trying to match treatments to patients may actually be limiting the use of Fuzeon in those patients who are most likely to benefit.

“These new insights from the OpenMind study will enable us to develop tools to facilitate more informed decisions by both patient and physician,” he said.