UK BHIVA treatment guidelines for HIV positive adults (2015)
Simon Collins, HIV i-Base
The 2015 BHIVA guidelines are now posted online to the BHIVA website.
These guidelines provide guidance on best clinical practice in the treatment and management of adults with HIV infection on antiretroviral therapy (ART).
The scope includes:
- Guidance on the initiation of ART in those previously naive to therapy.
- Support of people living with HIV (PLWH) on treatment.
- Management of individuals experiencing virological failure.
- Recommendations in specific populations where other factors need to be taken into consideration.
Five appendices are included together with comment received during the consultation period:
- Summary of the modified GRADE system.
- PICO questions and search strategies.
- Grade tables.
- Food considerations for antiretrovirals.
- Considerations for antiretrovirals in renal impairment.
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.
This 2015 update includes the most dramatic changes in treatment and care for at least the last ten years. 
This includes the removal of a CD4 threshold for initiating ART. The change is based on results from the START study finding that HIV-related complications occur at CD4 counts above 500 cells/mm3 and that earlier use of treatment reduces the risk of both HIV and non-HIV related serious events.
The guidelines also relegate efavirenz from a preferred to an alternative drug when starting treatment.
The i-Base patient guide Introduction to ART and new Pocket ART leaflets have already been updated to include the changes in these new guidelines. [3, 4]
- BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015.
http://www.bhiva.org/documents/Guidelines/Treatment/2015/2015-treatment-guidelines.pdf (direct PDF)
- Collins S. Draft BHIVA 2015 treatment guidelines: the most significant changes for a decade. HIV Treatment Bulletin, July/August 2015.
- HIV i-Base. Introduction to ART. (September 2015).
- Order i-Base publications online – free to all individuals and organisations in the UK.