US doctors seem to be very willing to start drugs earlier in disease, while their EU colleagues are slower and more conservative.\u00a0 Recent examples: the ever-wider indication for statins, the disproportionate uptake of drugs for attention-deficit \/ hyperactivity and opioids for pain relief.\u00a0 The new US HIV treatment guidelines are following this same trend.<\/p>\n
The April 2014 HIV Guidelines[1]\u00a0recommend that all HIV infected patients receive treatment regardless<\/em> of CD4 count.\u00a0 While there is fairly solid data for situations when the CD4 count is < 350, it becomes less convincing for patients with CD4 counts above this cut-off.\u00a0 Indeed, when the CD4 counts are > 500 this is admittedly a \u201cB\u201d recommendation i.e., only a \u2018moderately strong\u2019 endorsement.\u00a0 What is bothering is the fact that it is actually a \u201cB III\u201d recommendation which is not based on data but reflects expert opinion.\u00a0 The reason given by the Advisory Panel is to \u2018reduce the risk of disease progression\u2019.\u00a0 Their EU counterparts beg to differ.<\/p>\n The European AIDS Clinical Society (EACS) Guideline[2]\u00a0from Oct. 2013 takes a more nuanced approach.\u00a0 For patients with asymptomatic HIV infection, treatment is a \u2018consideration\u2019.\u00a0 The risk of drug side effects is mentioned by the experts who feel that the risk \/ benefit ratio is unclear.\u00a0 Even the risk of cardiovascular disease with long-standing HIV infection (an argument for early treatment by US guideline authors) does not sway these experts: ART is a \u2018consideration\u2019, not a recommendation in this population as well.<\/p>\n It does not come as a surprise when recommendations diverge that have no basis in fact.\u00a0 In a 2010 article, Khan (Clin Inf Dis 2010; 51:1147) reported an analysis of IDSA guidelines.\u00a0 A stunning 55% of \u2018recommendations\u2019 were solely based on expert opinions, not controlled trial information.\u00a0 Clearly, a lot of guideline ink is spilled on expert belief systems.<\/p>\n In this age of evidence-based medicine, why even have \u201cB III\u201d opinion pieces in a Guidance? \u00a0For the newly diagnosed HIV patient the decision when to start and commit to ART for the rest of his life is monumental.\u00a0 Without demonstration of benefit, there is no justification in pushing drugs.<\/p>\n [1] http:\/\/aidsinfo.nih.gov\/ContentFiles\/AdultandAdolescentGL.pdf US doctors seem to be very willing to start drugs earlier in disease, while their EU colleagues are slower and more conservative.\u00a0 Recent examples: the ever-wider indication for statins, the disproportionate uptake of drugs for attention-deficit \/ hyperactivity and opioids for pain relief.\u00a0 The new US HIV treatment guidelines are Continue reading HIV Therapy Guidance Recommendations Diverge, Show US Bias<\/span>
\n[2] http:\/\/www.eacsociety.org\/Portals\/0\/Guidelines_Online_131014.pdf<\/p>\n","protected":false},"excerpt":{"rendered":"