Stakeholder Insight: HIV - A way of life

CHAPTER 1 EXECUTIVE SUMMARY 3
Scope of the analysis 3
Datamonitor insight into the HIV market 3
CHAPTER 2 INTRODUCTION AND SCOPE 11
Coverage of the Stakeholder Insight Survey 11
Epidemiology 11
Diagnosis and treatment rates 11
Antiretroviral prescriptions 11
Prescription choice 12
Country level treatment trees 12
CHAPTER 3 COUNTRY TREATMENT TREES 15
US 15
Japan 17
France 19
Germany 21
Italy 23
Spain 25
UK 27
Seven major markets 29
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION 32
Disease definition and classification 33
The HIV lifecycle – numerous steps has created several therapeutic targets 34
HIV subtypes – diversity throughout the world 37
HIV epidemiology – changing demographics creating new unmet needs 38
A growing proportion of women are affected by HIV/AIDS 39
The aging of the HIV population has created new therapeutic issues 43
Key patient segmentations 49
Newly diagnosed versus follow-up patients 50
Multi-drug resistant patients 51
Hepatitis co-infection 54
Pregnancy 60
Routes of transmission 62
CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS 66
Presentation and diagnosis 66
Perception of risk drives HIV testing 66
HIV diagnostics are effective and easy to use 69
ELISA 69
PCR 70
Others 71
Advances in diagnostics has led to quicker and easier HIV tests 71
Treatment guidelines 74
Treatment rates 79
Treatment options 82
Class overviews 84
CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS 87
First-line therapy 88
Prescription choice 88
FDC backbones dominate first-line therapy 89
Switching from first- to second-line therapy 98
Factors affecting patient quality of life are key drivers of regime changes 100
The M184V mutation is the most common in first-line patients, but NNRTI resistance is also a frequent driver of switching 110
Second-line therapy 115
Prescription choice 115
PI usage is more predominant in second-line therapy 115
Switching from second- to third-line therapy 117
Tenofovir- and PI-associated mutations are more common in second-line patients 118
Third- and later-line therapy 121
Prescription choice 121
Fuzeon is increasingly being used in third- and later-lines of therapy 122
Factors influencing prescription choice 123
Patient quality of life issues are playing an increasingly important role 124
Although a growing concern, cost rarely plays a part in the physician decision 127
The increasing importance of cost in prescription decisions 128
How cost-effective is HAART? 129
Cost of first-line therapy in the US and the UK – a comparison 131
CHAPTER 7 IMPROVING TREATMENT OUTCOMES 135
Treatment outcomes 135
Advances in therapy mean fewer patients progress to AIDS 135
Morbidity and mortality have declined significantly over the last decade 139
HIV accounts for a small proportion of total deaths in the developed world 139
Antiretroviral therapy has led to significant gains in terms of survival years and a reduced incidence of opportunistic infections 142
Unmet needs 144
Resistance to currently available therapy is a major unmet need for certain classes 144
Although there have been considerable improvements in therapy, important unmet needs remain 145
CHAPTER 8 OPINION LEADER AND STAKEHOLDER TRANSCRIPTS 148
APPENDIX A – ADDITIONAL DATA 149
Pacific Rim definition 154
APPENDIX B – BIBLIOGRAPHY 155
Journal articles 155
Conference abstracts 161
Press Releases 165
Websites 167
Guidelines 167
Epidemiological data 168
APPENDIX C 170
Physician research methodology 170
Physician sample breakdown 170
US 170
Japan 171
France 171
Germany 172
Italy 172
Spain 173
UK 173
APPENDIX D 174
The survey questionnaire 174
Section 1: Epidemiology 174
Section 2: Diagnosis and treatment rates 176
Section 3: Antiretroviral prescriptions 178
Section 4: Prescription choice 181
The opinion leader discussion guide 191
Section 1 – Epidemiology 191
Section 2 - Presentation and diagnosis 191
Section 3 – Treatment practices 192
Section 4 – Prescription choice 193
Section 5 – Resistance issues 194
Section 6 – Unmet needs 195
Section 7 – Pipeline products 195
Disclaimer 197