Labbett, J. Libaste, F. Tahami, M. Thomas and Y. Zhong. “
“The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of patients on treatment; (iii) management click here of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting
the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines. BHIVA revised and updated the association’s guideline development manual in 2011 . BHIVA has adopted the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for the assessment, evaluation and grading of evidence and development of recommendations [2, 3]. Full details of the guideline development
process, including conflict of Selleck Dabrafenib interest policy, are outlined in the manual. The scope, purpose and guideline topics were agreed by the Writing Group. Questions concerning each guideline topic were drafted and a systematic literature review undertaken by an information scientist. Details of the search questions and strategy (including the definition of populations, interventions and outcomes) are outlined in Appendix 2. BHIVA adult ART guidelines were last published in 2008 . For the 2012 guidelines the literature search dates were 1 January 2008 to 16 September 2011 and included MEDLINE, EMBASE and the Cochrane library. Abstracts from selected conferences (see Appendix 2) were
searched between 1 January 2009 and 16 September 2011. For each topic and healthcare question, evidence was identified and evaluated by Writing Group members with expertise in the field. Using the modified GRADE system (Appendix 1), panel members were responsible for assessing before and grading the quality of evidence for predefined outcomes across studies and developing and grading the strength of recommendations. An important aspect of evaluating evidence is an understanding of the design and analysis of clinical trials, including the use of surrogate marker data. For a number of questions, GRADE evidence profile and summary of findings tables were constructed, using predefined and rated treatment outcomes (Appendix 3), to help achieve consensus for key recommendations and aid transparency of the process. Before final approval by the Writing Group, the guidelines were published online for public consultation and an external peer review was commissioned. BHIVA views the involvement of patient and community representatives in the guideline development process as essential.