HIV Clinicians in US Youth Survey Agree on Starting ART at 500 CD4s

Most clinicians caring for teens and young adults in a US survey agreed with national guidelines to start antiretroviral therapy (ART) at a CD4 count of 500 cells/µL, and most believed evidence about the value of starting ART at high CD4 counts. The US Department of Health and Human Services now recommends ART for anyone with HIV infection, regardless of CD4 count. This survey occurred after the 2009 change in the recommendation to start at 500 cells/µL rather than at 350 cells/µL.

Clinician members of the HIV Medicine Association who cared for behaviorally infected people between 13 and 25 years old were asked to complete a survey from December 2011 through January 2012. The response rate was only 13%, with 274 clinicans completing the survey.

A large majority of respondents, 94%, felt confident in evidence supporting starting ART at CD4 counts above 350 cells/µL, 98% thought the beneifits of starting ART outweighed risks of long-term toxicity, and 88% believed the benefits of earlier ART outweighed the risk of resistance.

Almost all respondents, 96%, said they would start ART for a 19 year-old with a CD4 count around 400 cells/µL. Clinicians saw certain patient characteristics, such as unstable housing and drug use, as barriers to starting ART.

Clinicians who responded to the survey understood the latest US guidelines and believed enough evidence supported starting therapy at higher CD4 counts.

Source: Christina Gagliardo, Meghan Murray, Lisa Saiman, Natalie Neu. Initiation of antiretroviral therapy in youth with HIV: a U.S.-based provider survey. AIDS Patient Care and STDs. 2013; 27: 498-502.

Written by Mark Mascolini on behalf of the International AIDS Society