Clinician practices and attitudes regarding early antiretroviral therapy in the United States

Abstract

BACKGROUND: 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