Subscribe to our RSS feed

The Latest Health Stories

  • HIV: A gift given to me
  • Return to the scene
  • People living with HIV make their mark at IAS 2015 in Vancouver
  • Vancouver conference confirms tools are in place, shows the way to move forward to end the epidemic
  • Would you date an HIV-positive guy?

Starting Treatment Early

Sunday, 26 August 2012 Author // Guest Authors - Revolving Door Categories // As Prevention , Treatment Guidelines -including when to start, Research, Health, Treatment, Living with HIV, Revolving Door, Guest Authors

Three-quarters of clinicians in the US willing to prescribe early HIV treatment for the purpose of prevention, reports aidsmap

Starting Treatment Early

This article by Michael Carter first appeared on NAM/aidsmap Republished with permission. 

There is an overwhelming consensus among clinicians who prescribe HIV treatment in the US that people who are taking antiretroviral therapy are less likely to transmit HIV to their sexual partners, according to results of a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Results also showed that over three-quarters of care providers would be willing to prescribe early therapy to people with an HIV-negative partner for the purposes of prevention.

The study involved 165 prescribing clinicians working at HIV clinics in the Bronx, New York, and Washington DC. It was conducted in 2010 and 2011, well before the publication of the results of the HPTN 052 study in the summer of 2012, which showed that virologically suppressive HIV treatment reduced the risk of transmission by 96%. US HIV treatment guidelines were updated in 2012 to endorse early treatment to reduce the risk of transmission.

“This survey of HIV clinicians in two US cities found most clinicians believe that ART [antiretroviral therapy] can reduce HIV transmission, even before the results of HPTN 052 demonstrated ART to be effective for this purpose, and before 2012 treatment guideline changes recommending ART for patients at risk for HIV transmission,” write the authors.

The research was conducted because the investigators wished to establish the beliefs of prescribing clinicians (doctors, nurse-practitioners and physician assistants) about the efficacy of antiretroviral therapy when used as prevention and their willingness to prescribe early treatment for individuals at risk of transmitting HIV to others.

Clinicians were recruited from centres participating in the HPTN 065 study, the main purpose of which is to evaluate the feasibility of community-expanded testing, linkage to care and treatment adherence as an HIV prevention strategy. The study does not involve early initiation of HIV therapy for prevention purposes.

Participants completed an internet-based survey. They had a median age of 46 years, 59% were women and two-thirds were white. The clinicians were highly experienced and had been caring for HIV-positive people for a median of 13 years. The overwhelming majority of their patients (85%) were already taking antiretroviral treatment and 6% of healthcare providers stated that all their patients were on therapy.

Overall, the clinicians showed an interest in the HIV risk behaviours of their patients. Three-quarters indicated that they regularly asked their patients about the HIV status of their sexual partners; 97% always or often enquired about condom use; and two-thirds stated that they enquired about injecting drug use. 

Almost all (95%) of the clinicians strongly agreed or agreed that “early initiation of ART can slow the spread of HIV in a community by making patients less infectious to others”.The participants were asked about their current prescribing practices. Most (92%) stated that they initiated treatment for the patient’s own health and based on the readiness of the individual to start therapy.

A small proportion of clinicians (15%) indicated that they recommended treatment at any CD4 cell count. The majority (56%) indicated that their current practice was to suggest treatment when a patient’s CD4 cell count fell below 500 cells/mm3.

A substantial majority (79%) of clinicians said that they would be more likely to recommend starting HIV therapy, irrespective of CD4 cell count, if a patient disclosed behaviour that involved a high risk of transmission. Three-quarters said they would be willing to offer early treatment if a patient had a partner who was HIV-negative.

However, a substantial proportion of clinicians had reservations about the early use of therapy. Just under half (47%) had concerns that this could lead to resistance and 52% were concerned about the risk of side-effects. A little under a third (30%) had concerns that early treatment could result in the transmission of drug-resistant virus to sex partners.

“There remains an inherent tension in prescribing ART to individuals for a population-benefit, when the risk-benefit profiles of multidecades-long treatment are not yet available,” comment the investigators. “Nonetheless there is emerging evidence that ART initiation at higher CD4 counts may have individual benefit.”

They conclude, “our findings suggest that clinicians will need to continue to balance information regarding efficacy of ART for prevention, with their duty to provide patients with interventions that have a favourable long-term benefit to their own health.”


Kurth AE et al. Clinical practices and attitudes regarding early antiretroviral therapy in the US. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAD0b013e31826a184c, 2012.

About the Author

Guest Authors - Revolving Door

Guest Authors - Revolving Door

The Revolving Door is the place where we publish occasional articles by guest writers. If you would like to submit an article for publication, please contact editor Bob Leahy at
  • HIV: A gift given to me

    HIV: A gift given to me

    Guest writer RYU Matsumoto from The Philippines says “I know the virus isn’t something to be thankful for, but this virus taught me the life lessons I’ve started to miss.”
  • Return to the scene

    Return to the scene

    Still dealing with the aftermath of a relationship that went bad, Toronto's Josh says “I feel like there’s still a lot of work to do on my mental health. And I’m open about that, and am taking the steps I need to take to do that.”
  • People living with HIV make their mark at IAS 2015 in Vancouver

    People living with HIV make their mark at IAS 2015 in Vancouver

    Bob Leahy reports on the Canadian Declaration by Persons Living with HIV that calls for the protection of human rights in light of biomedical advances in HIV Treatment but in a progressive way supportive of 90-9-90 and expanded treatment access
  • Vancouver conference confirms tools are in place, shows the way to move forward to end the epidemic

    Vancouver conference confirms tools are in place, shows the way to move forward to end the epidemic

    Bob Leahy was in Vancouver last week for IAS 2015 for what he terms “a moment in time when the end of AIDS really does seem in sight”. Here is his very personal view of conference highlights
  • Would you date an HIV-positive guy?

    Would you date an HIV-positive guy?

    Says FS Magazine’s CEO “Avoiding sex or a relationship with someone just because they’re living with HIV isn’t a good strategy: it won’t prevent you from becoming HIV-positive . . and it contributes to an unacceptable caste system.”
  • In search of the invisible man

    In search of the invisible man

    From CATIE’s The Positve Side, “Straight men living with HIV”
  • The diagnosis [4]

    The diagnosis [4]

    Guest writer RYU Matsumoto from The Philippines with the fourth part of his story of being diagnosed with HIV. Today - on leaving hospital, returning home and finally a return to good health
  • National drug plan needed for Canada

    National drug plan needed for Canada

    We have universal healthcare that, unusual in industrialized countries, that doesn’t cover drugs. Toronto's Josh says “a national drug program would mean equal access to the life-saving drugs we need, at no cost to us.”
  • Frank talk from Julio Montaner

    Frank talk from Julio Montaner

    From IAS 2015 Bob Leahy speaks (again) with BC’s Dr. Julio Montaner, the world’s leading treatment as prevention advocate, about 90-90-90, his frustrations with uptake in Canada – and meeting the Pope.
  • HIV Happy

    HIV Happy

    Bob Leahy talks to UK writer Paul Thorn about his new book which explains how a harmonious and happy co-existence with HIV is possible and how to make the most of the second chance that treatment affords you
  • Inside look at Insite

    Inside look at Insite

    In Vancouver for IAS 2015, Bob Leahy visits Insite, the supervised injection facility in the downtown east side, where every day 800+ people with addictions and multiple other issues inject drugs in a safe, clean environment that also gives them a hand up