University of New South Wales, Sydney, NSW, Australia.
Australasian Society for HIV Medicine, Sydney, NSW, Australia.
Med J Aust. 2015 Mar 16;202(5):258-61. doi: 10.5694/mja14.00443.
To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm3 or immediately after a patient is diagnosed with HIV.
DESIGN, PARTICIPANTS AND SETTING: Self-completed, anonymous, cross-sectional surveys, targeting all ART prescribers in Australia, were conducted online in 2012 and 2013. The surveys included questions on prescriber factors, CD4+ T-cell count at which prescribers would most strongly recommend ART initiation, and perceived patient characteristics that could change prescribers' practices of early initiation of ART.
Proportions of ART prescribers recommending early ART initiation.
We analysed responses from 108 participants in 2012 and 82 participants in 2013. In both years, more male than female prescribers participated. The median age of participants was 49 years in 2012 and 50 years in 2013. In both rounds, over 60% had more than 10 years' experience in treating HIV-positive patients. More prescribers in 2013 stated that they would most strongly recommend early ART initiation compared with those in 2012 (50.0% [95% CI, 38.7%-61.3%] v 26.9% [95% CI, 18.8%-36.2%]; P=0.001). The prescribers' primary concern was more about individual patient than public health benefit. Out of 824 patients for whom ART was initiated, as reported by prescribers in 2013, only 108 (13.1% [95% CI, 10.9%-15.6%]) were given ART primarily to prevent onward HIV transmission. The number of patients for whom ART was initiated was significantly associated with prescribers' HIV caseload even after adjusting for prescriber type (adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P<0.001); of the 37 who had initiated ART for 10 or more patients, 29 had a high HIV caseload. In 2013, 60 prescribers (73.2% [95% CI, 62.2%-82.4%]) reported that they routinely recommended ART to treatment-naive, asymptomatic patients with a CD4+ T-cell count of 350-500 cells/mm3.
Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.
研究澳大利亚抗逆转录病毒治疗（ART）的开处方者在与早期开始 ART 相关的观念和实践方面是否发生了变化，早期开始 ART 定义为患者的 CD4+T 细胞计数接近 500 个/立方毫米时或患者确诊 HIV 后立即开始 ART。
设计、参与者和环境：2012 年和 2013 年，采用在线方式对澳大利亚所有 ART 开处方者进行了自我报告、匿名、横断面调查。调查包括了关于开处方者因素、开处方者最强烈推荐开始 ART 的 CD4+T 细胞计数，以及可能改变开处方者早期开始 ART 实践的感知患者特征等问题。
推荐早期开始 ART 的 ART 开处方者的比例。
我们分析了 2012 年 108 名参与者和 2013 年 82 名参与者的回复。在这两年中，参加者中男性多于女性。2012 年参与者的中位年龄为 49 岁，2013 年为 50 岁。两轮调查中，超过 60%的参与者治疗 HIV 阳性患者的经验超过 10 年。与 2012 年相比，2013 年更多的开处方者表示他们最强烈推荐早期 ART 开始（50.0%[95%CI，38.7%-61.3%]vs 26.9%[95%CI，18.8%-36.2%]；P=0.001）。开处方者的主要关注点更多是个人患者，而不是公共卫生效益。2013 年，开处方者报告开始接受 ART 的 824 名患者中，仅有 108 名（13.1%[95%CI，10.9%-15.6%]）主要是为了预防 HIV 传播而开始接受 ART。即使在调整了开处方者类型后，开始接受 ART 的患者数量与开处方者的 HIV 患者人数显著相关（调整后的优势比，1.73[95%CI，1.47-2.03]；P<0.001）；在开始接受 ART 的 37 名患者中，有 29 名患者的 HIV 患者人数较多。2013 年，60 名开处方者（73.2%[95%CI，62.2%-82.4%]）报告说，他们通常建议 CD4+T 细胞计数为 350-500 个/立方毫米的无症状、初治患者开始接受 ART。
我们的研究结果表明，人们越来越接受并支持早期开始 ART，主要是作为治疗而不是预防。
