Earlier treatment of HIV infection –Prescriber attitudes and practices

1. Earlier treatment of HIV infection –Prescriber attitudes and practices Prof John de Wit, Director

2. Overview • Increasing earlier treatment uptake • Gay men not currently taking ART • Attitude and practices of prescribers

3. Benefits of antiretroviral therapy • Improved health, quality of life and life expectancy • Nakagawa et al. (2013) • Reduced viral load mitigates transmission risk • Cohen et al. (2011) • Personal health benefits of earlier start of ART • Grinsztejn et al. (2014) • Earlier start recommended and facilitated • Commentary on DHHS guidelines, PBAC decision

4. Improving treatment uptake

5. HIV treatment and care pathways Mugavero et al. (2013)

6. HIV+ men on ART – GCPS Current use of ART in HIV-positive men increasedsignificantly; from 60% in 2003 to 80% in 2012.

7. Undetectable viral load – GCPS UDVL in all HIV-positive men rose from >50% in 2003 to nearly 80% in 2012. In 2012 >90% of HIV positive men currentlyon ARThad UDVL.

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9. Understanding ART non-use • Improving antiretroviral treatment (ART) initiation for people living with HIV in Australia: A realistic and viable approach? • NHMRC project (De Wit et al., 2012–2014) • Attitudes and practices of ART prescribers in terms of recommendations for ART initiation • Clinical, personal, social and structural barriers to ART uptake and reasons for non-use in PLHIV

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11. Some concluding thoughts • Minority of PLHIV achieved sustained viral suppression • Timely testing and effective linkage and retention in care • Prescribers increasingly favour earlier ART initiation • Individual health of patients remains primary concern • Earlier ART is seen as beneficial for individuals’ health • Patient characteristics affect ART recommendation • Better understanding PLHIV who are not on treatment