18 March 2015
A new study published in the Medical Journal of Australia this week shows that Australian prescribers are increasingly in support of the early introduction of antiretroviral treatment for people diagnosed with HIV.
ASHM CEO Levinia Crooks and Past-President A/Professor Edwina Wright were both co-authors of the study, which was led by Dr Limin Mao (PhD), a Senior Research Fellow at the Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia.
"This study shows that Australian prescribers are following the science, which consistently demonstrates that putting patients on HIV medication soon after diagnosis could bring definitive clinical benefits to patients," said Dr Mao
The focus of the study was on whether and to what extent prescribers support 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. The prescriber surveys were conducted in 2012 and 2013. Over 60 per cent of participants in both rounds had more than 10 years' experience in treating HIV-positive patients.
Early ART initiation was supported by most prescribers primarily as treatment rather than as prevention, with the exception of high HIV caseload prescribers. In both rounds, prescribers' primary concern was predominantly individual patient benefit. Even in 2013, few prescribers reported initiating ART solely for the purpose of preventing onward HIV transmission.
Prescribers willingness to recommend early ART is likely to decrease if patients are known as having a history of non-adherence to non-ART medication or missed clinical appointments in the past 12 months.
"Australian ART prescribers have made swift yet cautious moves towards early ART initiation since 2012, keeping pace with clinical guideline changes," says Dr Mao. "With regard to ART initiation, prescribers prioritise individual patient health over HIV prevention benefit."
"The move to earlier treatment is a reflection of better treatments with fewer pills, less side-effects, less toxicity and greater effectiveness. This is resulting in a paradigm shift," said ASHM CEO Associate Professor, Levinia Crooks.
"In the past we delayed treatment for as long as possible to avoid complications, reduce the time on treatment and to have treatment available when a patient was experiencing ill health. Now we are looking at how early we can start treatment to minimise damage caused by HIV and to prevent transmission," said A/Prof Crooks.
According to ASHM, Australia will need more GP prescribers to meet increasing demands for treatment. In addition, although the findings currently do not show broad support for ART initiation primarily as prevention, the greater acceptance demonstrated by high caseload prescribers in this area suggests there could be a trend in this direction.
"This is a dramatically changing area and we are now seeing more evidence to support the prevention role of treatment. I am sure this will be reflected in further change in the next iteration of this research," said A/Prof Crooks.
"The community is demanding earlier access to ART and Australia?s prescribers are supporting this. As a lead organisation supporting the HIV workforce, we consider it a priority to encourage more doctors to undertake prescriber training and ensure they receive education that reflects the latest evidence available," said A/Prof Crooks.
Read the Media Release and Background Information