title: Attitudes of people in the UK with HIV who Are Antiretroviral (ART) Naïve to starting ART at high CD4 counts for potential health benefit or to prevent HIV transmission.
abstract: OBJECTIVE
  To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART naïve people with HIV with high CD4 counts.
  
  
  METHODS
  ASTRA is a UK multicentre, cross sectional study of 3258 HIV outpatients in 2011/12. A self-completed questionnaire collected sociodemographic, behavioral and health data, and attitudes to ART; CD4 count was recorded from clinical records.
  
  
  METHODS
  ART naïve participants with CD4 ≥350 cells/µL (n = 281) were asked to agree/disagree/undecided with the statements (i) I would want to start treatment now if this would slightly reduce my risk of getting a serious illness, and (ii) I would want to start treatment now if this would make me less infectious to a sexual partner, even if there was no benefit to my own health.
  
  
  RESULTS
  Participants were 85% MSM, 76% white, 11% women. Of 281 participants, 49.5% and 45.2% agreed they would start ART for reasons (i) and (ii) respectively; 62.6% agreed with either (i) or (ii); 12.5% agreed with neither; 24.9% were uncertain. Factors independently associated (p<0.1) with agreement to (i) were: lower CD4, more recent HIV diagnosis, physical symptoms, not being depressed, greater financial hardship, and with agreement to (ii) were: being heterosexual, more recent HIV diagnosis, being sexually active.
  
  
  CONCLUSIONS
  A strategy of starting ART at high CD4 counts is likely to be acceptable to the majority of HIV-diagnosed individuals. Almost half with CD4 >350 would start ART to reduce infectiousness, even if treatment did not benefit their own health. However a significant minority would not like to start ART either for modest health benefit or to reduce infectivity. Any change in approach to ART initiation must take account of individual preferences. Transmission models of potential benefit of early ART should consider that ART uptake may be lower than that seen with low CD4 counts.
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Rodger
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Speakman
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Ed
authors.initials: E
authors.lastname: Wilkins
authors.affiliation: Homerton University Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Royal Free NHS London Foundation Trust, London, United Kingdom.
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Newham University NHS Hospital Trust, London, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: O'Connell
authors.affiliation: HIV i-Base, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.affiliation: City University London, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elford
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Lampe
mesh_terms: D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D001294:Attitude to Health; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000523:psychology* / Q000635:transmission*; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D044966:Anti-Retroviral Agents