Systematic review and quality assessment of antiretroviral therapy recommendations in clinical practice guidelines for HIV/AIDS_Chinese Journal of Evidence-Based Medicine

Authors：

 LI Sheng1 ¹ , NING Jinling2 ² , TIAN Chen2 ² , MA Yan2 ² , XIA Danni2 ² , WANG Ju2 ² , WANG Yiyun2 ² , SHI Wenjuan1 ¹ , WAN Hong1 ¹ , GE Long2 ²

1. Department of Infectious Diseases, The Second People's Hospital of Lanzhou City, Lanzhou 730046, P. R. China;
2. Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding?author：

LI Sheng1, Email: 1178708407@qq.com

Keywords：

AIDS; Antiretroviral therapy; Clinical practice guideline; AGREE Ⅱ; RIGHT

DOI：

10.7507/1672-2531.202507005

Video：

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Objective To systematically review the recommendations for antiretroviral therapy in the AIDS guidelines, and summarize the sources of evidence supporting the recommendations, the quality of the evidence and the strength of the recommendations, and the consistency of the recommendations. Methods We systematically searched for articles published before Dec 2024 in PubMed, Web of Science, Embase, CNKI, Wanfang, VIP, Chinese Biomedical Literature Database, World Health Organization, NICE, GIN, Medsci, Medlive and Chinese Medical Association HIV guidelines in other databases, integrating recommendations. Quality and reporting practices were evaluated using AGREE Ⅱ and RIGHT tools respectively. Results The average score of AGREE Ⅱ was 62 points, the overall reporting rate was 69.68%, and the quality of methodology and reporting specifications were low. Analysis of the recommendation results showed that a total of 57 recommendations for ART therapy were extracted from 18 guidelines, mainly recommending 2 NRTIs combined with third-category drugs. NRTI drugs are mainly based on TDF+FTC (3TC), TAF+FTC, and ABC+3TC. The third category of drugs recommended by various guidelines with relatively high frequency includes INSTI(DTG, BIC, RAL),NNRTI(EFV) and PIs(DRV/r). The third category of drugs recommended with relatively high frequency in alternative therapies includes INSTI(DTG, RAL),NNRTI(EFV,RPV) and PI(DRV/c). Conclusion The methodological quality and reporting specifications of the HIV clinical practice guidelines need to be improved. The evidence grading of the guidelines is not standardized, there are differences in the combination of drugs recommended by each guideline, the strength of recommendations and the quality of the evidence are inconsistent, and there are obvious differences in the sources of evidence to support the opinions. In the future, it is necessary to combine high-quality clinical trials or randomized controlled trials, adopt systematic and rigorous evidence level and recommendation grading standards when necessary, and provide high-quality evidence sources to formulate complete guidelines. Specific conditions such as the patient's biological indicators should also be fully considered to clarify which virological and biological indicators ART therapy is suitable for, so as to provide precise treatment.

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2.	何耀祖, 陳曉婷, 陳景良, 等. 我國艾滋病抗病毒治療藥物變遷及進展. 廣東醫學, 2023, 44(2): 157-160.
3.	Pau AK, George JM. Antiretroviral therapy: current drugs. Infect Dis Clin North Am, 2014, 28(3): 371-402.
4.	Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016, 5(1): 210.
5.	周芬, 郝玉芳, 叢雪, 等. 指南研究與評價工具AGREEⅡ及各領域分值的補充解釋及思考. 護理學報, 2018, 25(18): 56-58.
6.	于雅卉, 閆園園, 馮欣. 基于指南研究和評估工具Ⅱ的妊娠期高血壓指南評價及內容比較. 中國臨床藥理學雜志, 2020, 36(17): 2710-2713.
7.	Zhu H, Li M, Pan B, et al. A critical appraisal of clinical practice guidelines on insomnia using the RIGHT statement and AGREE Ⅱ instrument. Sleep med, 2022, 100: 244-253.
8.	Chen Y, Yang K, Marusic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann intern med, 2017, 166(2): 128-132.
9.	陳耀龍, 楊克虎, 田金徽, 等. 循證實踐指南的制定: 國際經驗與中國實踐. 蘭州大學學報(醫學版), 2016, 42(1): 29-35.
10.	Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep, 1966, 19(1): 3-11.
11.	中華醫學會感染病學分會艾滋病學組, 中國疾病預防控制中心, 李太生. 中國艾滋病診療指南(2024版). 協和醫學雜志, 2024, 15(6): 1261-1288.
12.	Meintjes G, Moorhouse MA, Carmona S, et al. Adult antiretroviral therapy guidelines 2017. South Afr J HIV Med, 2017, 18(1): 776.
13.	Antinori A, Di Biagio A, Marcotullio S, et al. Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. Update 2016. New Microbiol, 2017, 40(2): 86-98.
14.	Waters L, Winston A, Reeves I, et al. BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022. HIV Med, 2022, (Suppl 5): 3-115.
15.	Reeves I, Cromarty B, Deayton J, et al. British HIV Association guidelines for the management of HIV-2 2021. HIV Med, 2021, (Suppl 4): 1-29.
16.	Manosuthi W, Ongwandee S, Bhakeecheep S, et al. Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2014, Thailand. AIDS Res Ther, 2015, 12: 12.
17.	Hoen B, Bonnet F, Delaugerre C, et al. French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults. J Int AIDS Soc, 2014, 17(1): 19034.
18.	EACS. EACS guidelines.
19.	Nel J, Dlamini S, Meintjes G, et al. Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update. South Afr J HIV Med, 2020, 21(1): 1115.
20.	World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization, 2021.
21.	Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA panel. JAMA, 2020, 324(16): 1651-1669.
22.	Zetola NM, Pilcher CD. Diagnosis and management of acute HIV infection. Infect Dis Clin North Am, 2007, 21(1): 19-48.
23.	Bingham JT. Federal Bureau of prisons HIV consultant pharmacist monitoring and advisory program. J Am Pharm Assoc (2003), 2012, 52(6): 798-801.
24.	Shah SS, Fine SM, Vail RM, et al. Diagnosis and management of HIV-2 in adults. Baltimore (MD): Johns Hopkins University, 2023.
25.	Department of Health and Human Services. Panel on antiretroviral guidelines for adults and adolescents. guidelines for the use of antiretroviral agents in adults and adolescents with HIV.
26.	World Health Organization. Guidelines on post-exposure prophylaxis for HIV and the use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children: recommendations for a public health approach: December 2014 supplement to the 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization, 2014.
27.	World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post- exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization, 2018.
28.	McGowan JP, Fine SM, Vail RM, et al. Use of injectable CABRPV LA as replacement ART in virally suppressed adults. Baltimore (MD): Johns Hopkins University, 2023.

1. The path that ends AIDS: UNAIDS Global AIDS Update 2023. Geneva: Joint United Nations i. Programme on HIVAIDS, 2023.
2. 何耀祖, 陳曉婷, 陳景良, 等. 我國艾滋病抗病毒治療藥物變遷及進展. 廣東醫學, 2023, 44(2): 157-160.
3. Pau AK, George JM. Antiretroviral therapy: current drugs. Infect Dis Clin North Am, 2014, 28(3): 371-402.
4. Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016, 5(1): 210.
5. 周芬, 郝玉芳, 叢雪, 等. 指南研究與評價工具AGREEⅡ及各領域分值的補充解釋及思考. 護理學報, 2018, 25(18): 56-58.
6. 于雅卉, 閆園園, 馮欣. 基于指南研究和評估工具Ⅱ的妊娠期高血壓指南評價及內容比較. 中國臨床藥理學雜志, 2020, 36(17): 2710-2713.
7. Zhu H, Li M, Pan B, et al. A critical appraisal of clinical practice guidelines on insomnia using the RIGHT statement and AGREE Ⅱ instrument. Sleep med, 2022, 100: 244-253.
8. Chen Y, Yang K, Marusic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann intern med, 2017, 166(2): 128-132.
9. 陳耀龍, 楊克虎, 田金徽, 等. 循證實踐指南的制定: 國際經驗與中國實踐. 蘭州大學學報(醫學版), 2016, 42(1): 29-35.
10. Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep, 1966, 19(1): 3-11.
11. 中華醫學會感染病學分會艾滋病學組, 中國疾病預防控制中心, 李太生. 中國艾滋病診療指南(2024版). 協和醫學雜志, 2024, 15(6): 1261-1288.
12. Meintjes G, Moorhouse MA, Carmona S, et al. Adult antiretroviral therapy guidelines 2017. South Afr J HIV Med, 2017, 18(1): 776.
13. Antinori A, Di Biagio A, Marcotullio S, et al. Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons. Update 2016. New Microbiol, 2017, 40(2): 86-98.
14. Waters L, Winston A, Reeves I, et al. BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022. HIV Med, 2022, (Suppl 5): 3-115.
15. Reeves I, Cromarty B, Deayton J, et al. British HIV Association guidelines for the management of HIV-2 2021. HIV Med, 2021, (Suppl 4): 1-29.
16. Manosuthi W, Ongwandee S, Bhakeecheep S, et al. Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2014, Thailand. AIDS Res Ther, 2015, 12: 12.
17. Hoen B, Bonnet F, Delaugerre C, et al. French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults. J Int AIDS Soc, 2014, 17(1): 19034.
18. EACS. EACS guidelines.
19. Nel J, Dlamini S, Meintjes G, et al. Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update. South Afr J HIV Med, 2020, 21(1): 1115.
20. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization, 2021.
21. Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA panel. JAMA, 2020, 324(16): 1651-1669.
22. Zetola NM, Pilcher CD. Diagnosis and management of acute HIV infection. Infect Dis Clin North Am, 2007, 21(1): 19-48.
23. Bingham JT. Federal Bureau of prisons HIV consultant pharmacist monitoring and advisory program. J Am Pharm Assoc (2003), 2012, 52(6): 798-801.
24. Shah SS, Fine SM, Vail RM, et al. Diagnosis and management of HIV-2 in adults. Baltimore (MD): Johns Hopkins University, 2023.
25. Department of Health and Human Services. Panel on antiretroviral guidelines for adults and adolescents. guidelines for the use of antiretroviral agents in adults and adolescents with HIV.
26. World Health Organization. Guidelines on post-exposure prophylaxis for HIV and the use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children: recommendations for a public health approach: December 2014 supplement to the 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization, 2014.
27. World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post- exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization, 2018.
28. McGowan JP, Fine SM, Vail RM, et al. Use of injectable CABRPV LA as replacement ART in virally suppressed adults. Baltimore (MD): Johns Hopkins University, 2023.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesSystematic review and quality assessment of antiretroviral therapy recommendations in clinical practice guidelines for HIV/AIDS

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