Impact of recommendation updates in well-controlled patients on nonrecommended antiretroviral therapies: the Swiss HIV cohort study

BACKGROUND HIV treatment recommendations are updated as clinical trials are published. Whether recommendations drive clinicians to change antiretroviral therapy in well-controlled patients is unexplored. METHODS We selected patients with undetectable viral loads (VLs) on nonrecommended regimens containing double-boosted protease inhibitors (DBPIs), triple-nucleoside reverse transcriptase inhibitors (NRTIs), or didanosine (ddI) plus stavudine (d4T) at publication of the 2006 International AIDS Society recommendations. We compared demographic and clinical characteristics with those of control patients with undetectable VL not on these regimens and examined clinical outcome and reasons for treatment modification. RESULTS At inclusion, 104 patients were in the DBPI group, 436 in the triple-NRTI group, and 19 in the ddI/d4T group. By 2010, 28 (29%), 204 (52%), and 1 (5%) patient were still on DBPIs, triple-NRTIs, and ddI plus d4T, respectively. 'Physician decision,' excluding toxicity/virological failure, drove 30% of treatment changes. Predictors of recommendation nonobservance included female sex [adjusted odds ratio (aOR) 2.69, 95% confidence interval (CI) 1 to 7.26; P = 0.01] for DPBIs, and undetectable VL (aOR 3.53, 95% CI 1.6 to 7.8; P = 0.002) and lack of cardiovascular events (aOR 2.93, 95% CI 1.23 to 6.97; P = 0.02) for triple-NRTIs. All patients on DBPIs with documented diabetes or a cardiovascular event changed treatment. Recommendation observance resulted in lower cholesterol values in the DBPI group (P = 0.06), and more patients having undetectable VL (P = 0.02) in the triple-NRTI group. CONCLUSION The physician's decision is the main factor driving change from nonrecommended to recommended regimens, whereas virological suppression is associated with not switching. Positive clinical outcomes observed postswitch underline the importance of observing recommendations, even in well-controlled patients.

Assimilation and contrast in web product reviews: devaluing the recommendation of a proficient but dissimilar reviewer

When viewing web-consumer reviews consumers encounter the reviewers in an anonymous environment. Although their interactions are only virtual they still exchange social information, e.g. often reviewers refer to their proficiency or consumption motives within the review texts. Do these social information harm the viewers’ perception of the recommended products? The present study addresses this question by applying the paradigm of social comparison (Mussweiler, 2003) to web-consumer reviews. In a laboratory experiment with a student sample (n = 120) we manipulated the perceived similarity between reviewer and viewer and the perceived proficiency of the reviewer. A measurement of achievement goals (Elliott & McGregor, 2001) and average number of hours of study prior to the experiment allowed to introduce the reviewer as high [low] in proficiency and similar [dissimilar] in achievement goals. As predicted, the viewer’s evaluation of the recommended products differed as a function of this social information. Contrasting with the reviewer led to devaluing the products recommended by a proficient but dissimilar reviewer. However, against our prediction social comparison with the reviewer did not affect the viewer`s self-evaluation. Whether social information in web-product reviews affects the viewer`s self-evaluation and induces both social comparison processes remains an open question. Future studies aim to address this by manipulating the informational focus of the viewer, rather than the perceived similarity between viewer and reviewer. So far, the present study extends the application of social comparison to consumption environments and contributes to the understanding of the virtual social identity.