Australia: ASHM calls on PBAC to reconsider limits on starting HIV treatment

New research about Doctors' attitudes to Treatment as Prevention (TasP) has prompted the Australasian Society for HIV Medicine (ASHM) to renew calls for the Pharmaceutical Benefits Advisory Committee (PBAC) to review its criteria for starting treatment so that doctors would be free to decide when to start antiretroviral therapy with their patients on a case by case basis.

The research study - Australian prescribers' perspectives on ART initiation in the era of “treatment as prevention, - explored Australian prescribers' attitudes towards TasP and their practices around initiating combination antiretroviral treatment (cART) for HIV.

It found that when considering the optimal time to begin treatment, prescribers in Australia focus primarily on the benefits for their individual patients.

It also found a majority of the prescribers (68.5%) strongly endorsed cART initiation before CD4 count drops below 350, and a further 22.2% strongly endorsed cART initiation before CD4 count drops below 500.

Currently cART is is only subsidised through the Pharmaceutical Benefits Scheme if people have a CD4 T-cell count of less than 500 or are symptomatic.

ASHM has contacted the PBAC to encourage a review of these criteria so that the decision on when to start cART can be based upon a range of factors including the benefit for the individual by reducing their risk of HIV disease progression and the psychological benefit of knowing that they are reducing their risk of transmitting HIV to partners.

'The HIV landscape is changing rapidly and the science supporting the prevention benefits of treatment are very strong. It is important we remove all obstacles to prescribers initiating treatment as prevention when they consider it to be in the best interests of their patients,' said ASHM President A/Prof Edwina Wright.

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