British HIV Association guidelines for the treatment of <scp>HIV</scp>‐1‐positive adults with antiretroviral therapy 2012

Williams, Ian; Churchill, Duncan; Anderson, Jane; Boffito, Marta; Bower, Mark; Cairns, Gus; Cwynarski, Kate; Edwards, Simon; Fidler, Sarah; Fisher, Martin; Freedman, Andrew; Geretti, Anna María; Gilleece, Yvonne; Horne, Rob; Johnson, Margaret; Khoo, Saye; Leen, Clifford; Marshall, Neal; Nelson, Mark; Orkin, Chloe; Paton, Nicholas I.; Phillips, Andrew; Post, Frank A.; Pozniak, Anton; Sabin, Caroline; Trevelion, Roy; Ustianowski, Andrew; Walsh, John; Waters, Laura; Wilkins, E.G.L.; Winston, Alan; Youle, Mike

doi:10.1111/j.1468-1293.2012.01029.x

Cited by 113 publications

(87 citation statements)

References 389 publications

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“…Many clinical trials have used a viral load considered to be "undetectable" by the Amplicor assay (i.e., one that is Ͻ50 HIV-1 RNA copies/ml) as the endpoint for measuring the efficacy of antiretroviral therapy. Various guidelines have adopted the same threshold as the goal of therapy for all patients, regardless of previous treatment experience (1,(3)(4)(5). After many years of using the Amplicor test, the real-time PCR-based Roche Cobas AmpliPrep/Cobas TaqMan real-time quantitative human immunodeficiency virus type 1 (HIV-1) test (TaqMan) began to replace the Amplicor test in early 2008.…”

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confidence: 99%

Comparative Performances of HIV-1 RNA Load Assays at Low Viral Load Levels: Results of an International Collaboration

et al. 2014

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Low-level viremia during antiretroviral therapy and its accurate measurement are increasingly relevant. Here, we present an international collaboration of 4,221 paired blood plasma viral load (pVL) results from four commercial assays, emphasizing the data with low pVL. The assays compared were the Abbott RealTime assay, the Roche Amplicor assay, and the Roche TaqMan version 1 and version 2 assays. The correlation between the assays was 0.90 to 0.97. However, at a low pVL, the correlation fell to 0.45 to 0.85. The observed interassay concordance was higher when detectability was defined as 200 copies/ml than when it was defined as 50 copies/ml. A pVL of ϳ100 to 125 copies/ml by the TaqMan version 1 and version 2 assays corresponded best to a 50-copies/ml threshold with the Amplicor assay. Correlation and concordance between the viral load assays were lower at a low pVL. Clear guidelines are needed on the clinical significance of low-level viremia.

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confidence: 99%

Comparative Performances of HIV-1 RNA Load Assays at Low Viral Load Levels: Results of an International Collaboration

et al. 2014

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“…After a phase in the late 1990s, when in some settings ART was started in almost all people diagnosed with HIV in the hope of being able to eradicate HIV, the decision on when to start ART has been driven by the clinical prognosis of the HIV-positive individual. But given that HPTN 052 has shown that initiating treatment reduces the risk of sexual transmission, some guidelines now recommend that the effects of ART in reducing infectiousness are discussed with all patients and that ART can be started for this reason if the patient wishes [52], despite a lack of full understanding of the potential impact on the individual's health. It has not been established in a randomised trial whether initiating ART when the CD4 count is above 350 cells/mm 3 is associated with a clinical benefit for the HIV-positive person compared with deferral to when the CD4 count reaches this level.…”

Section: Implications For Hiv-positive Individualsmentioning

confidence: 99%

“…The European AIDS Clinical Society (EACS) guidelines state that use of ART is always recommended if the CD4 count is less than 350 cells/mm 3 and should be considered and actively discussed if the CD4 count is above 350 cells/mm 3 for asymptomatic patients and people wishing to reduce transmission of HIV [54]. As mentioned above, some guidelines suggest a more nuanced approach in which the benefits of early ART for prevention as well as lack of evidence at the individual level is explained to patients, who themselves then make the decision to start ART [52]. As reflected by the variation in recommendations across different guidelines, there is no definitive agreement among the scientific community, and experts differ in the amount of evidence that they consider necessary and on the level of current evidence [55].…”

Section: Implications For Hiv-positive Individualsmentioning

confidence: 99%

Antiretroviral therapy for prevention of HIV transmission: implications for Europe

et al. 2013

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The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm 3 . The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm 3 . The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

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“…42 As already noted, ART is highly effective in reversing HIVE, and as a result, HIV treatment guidelines have included symptomatic HAND as an indication for ART. 57,58 But the Strategic Timing of AntiRetroviral Treatment study suggests that initiation of ART is not the issue: we should be treating everyone with HIV, and the results of neuropsychological assessments have no bearing on whether or not a patient should be on ART. 59 There is a case to be made for HIV testing in individuals with NCI who are not already diagnosed, but that argument has been strongly made elsewhere.…”

Section: Treatment Options For Handmentioning

confidence: 99%

Evidence-based perspectives on the implementation of screening for neurocognitive impairment in HIV

Haddow¹,

Barber²,

Breuer³

et al. 2016

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British HIV Association guidelines for the treatment of HIV‐1‐positive adults with antiretroviral therapy 2012

Cited by 113 publications

References 389 publications

Comparative Performances of HIV-1 RNA Load Assays at Low Viral Load Levels: Results of an International Collaboration

Comparative Performances of HIV-1 RNA Load Assays at Low Viral Load Levels: Results of an International Collaboration

Antiretroviral therapy for prevention of HIV transmission: implications for Europe

Evidence-based perspectives on the implementation of screening for neurocognitive impairment in HIV

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