A poll of 165 health care providers in Washington, DC, and the Bronx, New York, found that 95 percent “strongly agreed” or “agreed” that early use of antiretrovirals (ARVs) can lower HIV transmission, an assertion that has gained increased scientific proof of late.
Nevertheless, the poll found that only 56 percent of the clinicians said they favored starting ARVs for patients with CD4 levels less than 500, and just 14 percent encouraged patients to begin therapy immediately, regardless of CD4 counts. Three-quarters of the health care providers did recommend early therapy for HIV-positive patients in a relationship with someone uninfected with the virus, and 40 percent did so for those having unprotected sex with a partner of unknown HIV status.
The leader of the survey, Ann Kurth, PhD, professor and executive director at New York University College of Nursing Global, points out that the poll was taken before the famed HPTN 052 study showed that ARVs could cut transmission among heterosexual discordant couples by 96 percent and also before the U.S. Department of Health and Human Services adjusted its treatment guidelines to recommend ARV therapy to all people with HIV, strongly recommending that those in the 350 to 500 CD4 count range begin therapy. Her team plans a follow-up poll.
“Clinicians will always try to decide if it’s the right thing for the client in front of them,” Kurth says of early treatment, “but I think increasingly it will become the norm to at least offer it to all persons.”