title: 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.
  
  
  METHODS
  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.
authors.affiliation: New York University, New York, NY 10003, USA. akurth@nyu.edu
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.forename: Geetha
authors.initials: G
authors.lastname: Beauchamp
authors.forename: Laura
authors.initials: L
authors.lastname: McKinstry
authors.forename: Jennifer
authors.initials: J
authors.lastname: Farrior
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.forename: Deborah
authors.initials: D
authors.lastname: Donnell
authors.forename: Bernard
authors.initials: B
authors.lastname: Branson
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D003625:Data Collection; D018562:Disease Transmission, Infectious; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D055502:Secondary Prevention; D012747:Sexual Partners; D014481:United States
chemical_list: D019380:Anti-HIV Agents