HIV drug research reflected in WHO guidelines

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Research conducted by a team including School of Population and Public Health (SPPH) scientists has been reflected in changes in the World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.

Funded by WHO and published today in Lancet HIV, the research found that certain antiretroviral therapy (ART) regimens were more effective than those recommended by WHO for patients who had not previously received such treatment, including in such areas as rates of patients discontinuing the drug and suppression of the virus.

The systematic review and network meta-analysis looked at randomized clinical trials up to July 2015 comparing ART regimens in people aged 12 years or older with HIV who had not been treated before and included data on 34,032 patients across 71 trials. According to the authors, this was the first time a network meta-analysis had been used to inform WHO guidelines.

Steve Kanters

Lead author Steve Kanters

Lead author, and SPPH doctoral student, Steve Kanters, said network meta-analysis allowed researchers to make comparisons where drugs had not been directly compared before, to estimate the relative efficacy of all treatments at once, and to achieve more precise estimates about treatment efficacy, which could reveal differentiation between treatment efficacy where head-to-head trials might not. As such, these methods lent themselves particularly well to clinical guideline development and decision-making, he said.

“Using a network meta-analysis for these guidelines was important because while evidence based medicine requires the most up-to-date data, it also requires the most up-to-date methods that make sense of those data.”
Doctoral student Steve Kanters

Mr. Kanters said the team, which included many Vancouver-based researchers and fellow SPPH doctoral student Jamie Forrest, had already presented the results to WHO in 2015, and the new guidelines had reflected their research. Released in November, the guidelines added the treatments identified by Mr Kanters’ research as alternative options in first-line regimens. “We played a large role in the development of those guidelines.”

The study concludes that while alternative treatments were superior, there were still issues of complexity of care and logistics, including that one superior treatment would require genetic screening, increasing the burden on the patient.

Mr. Kanters said the new guidelines in general were exciting, since they had seen the recommendation of a ‘test and treat’ approach, where patients who tested positive for HIV would receive treatment immediately, rather than waiting to become sick.

SPPH Assistant Professor and Mr. Kanters’ supervisor, Nick Bansback, said he thought network meta-analysis should be used more frequently for clinical guideline development.

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