Use of antiretroviral therapy (ART) to prevent HIV transmission has received substantial attention after a recent trial demonstrating efficacy of ART to reduce HIV transmission in HIV-discordant couples.Objective:
To assess practices and attitudes of HIV clinicians regarding early initiation of ART for treatment and prevention of HIV at sites participating in the HIV Prevention Trials Network 065 study.Design:
Cross-sectional internet-based survey.Methods:
ART-prescribing clinicians (n = 165 physicians, nurse practitioners, physician assistants) at 38 HIV care sites in Bronx, NY, and Washington, DC, completed a brief anonymous Internet survey, before any participation in the HIV Prevention Trials Network 065 study. Analyses included associations between clinician characteristics and willingness to prescribe ART for prevention.Results:
Almost all respondents (95%), of whom 59% were female, 66% white, and 77% HIV specialists, “strongly agreed/agreed” that early ART can decrease HIV transmission. Fifty-six percent currently recommend ART initiation for HIV-infected patients with CD4+ count <500 cells per cubic millimeter, and 14% indicated that they initiate ART irrespective of CD4+ count. Most (75%) indicated that they would consider initiating ART earlier than otherwise indicated for patients in HIV-discordant sexual partnerships, and 40% would do so if a patient was having unprotected sex with a partner of unknown HIV status. There were no significant differences by age, gender, or clinician type in likelihood of initiating ART for reasons including HIV transmission prevention to sexual partners.Conclusions:
This sample of US clinicians indicated support for early ART initiation to prevent HIV transmission, especially for situations where such transmission would be more likely to occur.