January 11, 2011
As another major snow storm barrels in on us, you might have time over the next 24-48 hours to make some hot chocolate, throw some logs on the fire, and read the spanking-new 2011 Department of Health and Human Services (DHHS) HIV Treatment Guidelines, just posted here on the AIDSinfo web site.
(Disclosure: I'm on the Guidelines panel -- opinions that follow are mine, and do not represent the panel.)
There are no major changes -- befitting a relatively quiet era in HIV treatment -- but here are a few highlights:
Some other points worth mentioning: 1) The whole operation could not happen without the incredible coordination and support of Alice Pau, Pharm.D., from the NIH; 2) the PDF is 166 pages long, a major test for even industrial-strength staplers; and 2) An HTML version is in the works.
And in case you haven't had enough of Guidelines recently, here's a somewhat critical review of the IDSA Guidelines -- the ones I praised earlier in the week. The complaint? Not enough recommendations backed by "Level I" evidence, i.e., a randomized clinical trial.
Well, I for one remain a fan of these IDSA Guidelines, and for the following reason: Patient care is frequently a chaotic, messy business, and the expectation that all clinical scenarios will be addressed by prospective randomized trials is invariably going to be disappointed.
So even though we would like to have an evidenced-based approach to every decision, it's never going to happen.
Which means that getting a bunch of smart, experienced, and detail-obsessed clinicians together to decide what's best is pretty darn valuable, if you ask me.
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.
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