Knowledge of available treatment options and the significance of drug resistance has declined in patients infected with HIV, the virus that causes AIDS, according to results of a survey presented Tuesday.

"In the early days of HIV, patients often understood the science of HIV as much as most clinicians," Dr. Howard Grossman told Reuters Health. "But once the complex drug regimens with HAART (highly active antiretroviral therapy) came out, and complicated drug resistance testing was developed," it became harder for patients to keep up with the rapid advances in the field and to understand how all of this new information affects their own treatment options.

Grossman is executive director of the American Academy of HIV Medicine in Washington DC, which commissioned the survey. Included were responses from 385 physicians who treat HIV patients and 400 adults diagnosed with HIV/AIDS.

The survey results showed that 91 percent of physicians are "extremely" or "very" concerned about HIV drug resistance, compared with 54 percent of patients living with the disease.

And while 61 percent of patients said they were knowledgeable about HIV drug resistance, 59 percent were unsure if their virus had become resistant to any drugs. Among those with resistant virus, 45 percent did not know which classes of drugs were involved.

"It took a good 10 to 15 years to develop effective antiretroviral therapy, but as drug regimens became more complicated and more side effects occurred, patient adherence became more difficult," Dr. Martin Markowitz of the Aaron Diamond AIDS Research Center in New York City said in an interview with Reuters Health.

As a result of poor patient compliance, "in 2003-2004, about one out of seven new HIV infections in major cities was resistant to the non-nucleoside reverse transcriptase inhibitors, and about one in ten were resistant to at least two classes of drugs," Markowitz added.

"As a result of drug resistance, patients' treatment options are reduced." Therefore, patient education is paramount, as is emphasis on adherence to the prescribed drugs.

Both of the physicians noted that there are a number of Internet web sites, such as aidsmed.com and thebody.com, which provide "fair, balanced information."

Because "people who are more disadvantaged are disproportionately affected by HIV; it has become harder to educate or even reach that population effectively," Markowitz said. Patient education materials therefore need to be modified so the message is clear and more understandable. "And we need to teach providers how to teach about HIV and drug resistance," he added.

There are often slip-ups among physicians as well, the survey found. Because new infection rates with HIV strains that are already resistant to some drugs have increased over time, the guidelines now recommend resistance testing for all patients before they start therapy, Markowitz noted.

While 99 percent of physicians said they test for resistance when considering a switch in a patient's therapy, only 67 percent test for resistance before antiretroviral drug treatment begins.

Grossman noted that the future is not hopeless because of emerging drug resistance. "A number of new treatments are on the horizon, including integrase inhibitors, entry inhibitors and new protease inhibitors."

Many women in the United States who are injection drug users and are also infected with HIV, the virus that causes AIDS, do not routinely use condoms with their uninfected regular partners or with casual sex partners, according to researchers in the U.S. and South Africa

"Forty percent of the HIV-positive women in our sample were having sex with at-risk male partners, and more than half of the time, condoms were not used consistently," lead investigator Dr. Mary H. Latka told Reuters Health.

Latka of the Center for the AIDS Programme of Research in South Africa University of KwaZulu Natal, Durban and colleagues conducted a study with 426 women who were HIV-positive injection drug users living in Baltimore, Miami, New York or San Francisco. The study findings are reported in the June issue of the Journal of Acquired Immune Deficiency Syndromes.

Among the 370 sexually active women, 144 had sex with a steady partner and 148 had sex with casual partners who were either uninfected or their HIV status was unknown. A number of women also had sex with steady and casual partners. Overall, 60 percent of the women inconsistently used condoms with their regular partner and with 53 percent of their casual partners.

However, continued Latka "men who were aware that their close female partner was HIV-positive were much more likely to use a condom."

Therefore, couples with one HIV-infected and one uninfected member, health care professionals might try to work with both individuals to encourage them to talk about their HIV status, which may help increase the use of condoms, she said.

In addition, the team found that inconsistent condom use was associated with greater drug and alcohol use during sex, negative beliefs about condoms and a lower sense of personal responsibility to protect others.

"HIV-positive women," continued Latka, "may need structural interventions such as better access to drug treatment."

"Curbing illicit drug use," she concluded, "would not only benefit HIV-positive women, it may also play an important role in reducing the continued spread of HIV from infected women to others."

SOURCE: Journal of Acquired Immune Deficiency Syndromes, June 2006.

Gilead Sciences Inc. (Nasdaq:GILD - news) on Thursday said its second-quarter profit rose 35 percent due to higher demand for Truvada, its once-a-day pill to treat HIV, the virus that causes AIDS.

The biotechnology company reported a net profit of $265.1 million, or 56 cents per share, compared with $196 million, or 41 cents per share, a year earlier.

The results beat the average analyst estimate of 54 cents a share, as compiled by Reuters Estimates.

Second-quarter sales of HIV drugs rose 38 percent to $475.4 million, including $299.3 million in sales of Truvada, a two-drug combination HIV pill launched last year.

First-quarter sales of Viread and Emtriva, the two older HIV drugs used in the combination pill, fell 20 percent to $167.4 million, and 29 percent to $8.7 million, respectively, as patients switched to Truvada.

Gilead received regulatory approval earlier this month for Atripla, an HIV pill that layers Truvada with Bristol-Myers Squibb's (NYSE:BMY - news) Sustiva.

The company's total quarterly revenue rose 38 percent to $685.3 million.

Gilead also collects royalties on sales by Roche Holding AG (ROG.VX) of Tamiflu, an anti-viral treatment being stockpiled as a potential treatment for bird flu.

The company's second-quarter royalty and contract revenue nearly doubled to $94.6 million, including $73.3 million from Roche for first-quarter Tamiflu sales.

Gilead's shares, which fell 3 percent to close at $59.35 on Nasdaq, are up about 13 percent so far this year, compared with a drop of about 6 percent for the American Stock Exchange Biotech Index (^BTK - news).