For individuals living with HIV, switching suppressive HIV regimens may be considered for a variety of reasons including treatment simplification, improved safety and tolerability, drug-drug interactions, or cost.
In March 2018, 5 HIV experts collaborated on a decision support tool to help clinicians select new HIV treatment regimens in a variety of patient scenarios. According to a presentation at IDWeek 2019, the tool can help optimize selecting a new treatment regimen for patients switching in the setting of virologic suppression.
For individuals living with HIV, switching suppressive HIV regimens may be considered for a variety of reasons including treatment simplification, improved safety and tolerability, drug-drug interactions, or cost. For clinicians who treat these patients, decisions on switching treatments may present a challenging clinical dilemma.
When developing the decision-making tool, the HIV experts provided recommendations on treatment for over 1300 unique HIV switch case examples, based on a simplified set of variables including cardiovascular disease, HLA-B*5701, hepatitis B virus, drug resistance, current antiretroviral therapy, and components requiring a therapy switch.
Next, the investigators developed a support tool that allowed clinicians to specify a patient scenario made up of these variables and asked the clinician to dictate their intended approach. Recommendations for the specific case from the experts were then shown and the clinicians was asked if the recommendations changed their planned course of treatment.
In the 5 months following the release of the support tool, clinicians entered 932 patient case scenarios.
The authors of the abstract write that the data demonstrated key areas of discordance, including the more frequent selection of the following options clinicians versus experts across a wide range of case scenarios including boosted regimens (18% to 31% vs 0% to 4% of cases), tenofovir disoproxil fumarate -containing regimens (7% to 25% vs 0% of cases) and protease inhibitor-based regimens (9% to 23% vs 0% to 4% of cases).
The abstract also notes that in a subset of 99 patient scenarios where the clinician’s intended course of treatment different from the experts’ opinion and the clinicians “self-identified the impact of the tool,” 48% indicated that their treatment plan would be altered after receiving the experts’ guidance through the tool.
“This online HIV switch decision support tool shows substantial differences between experts’ and [clinicians]’ treatment choices for switching therapy in multiple case scenarios,” the authors conclude. Moreover, consensus expert selections in this online tool resulted in a change to the intended treatment plan for approximately one half of users, suggesting use of the tool can help optimize selection of a new antiretroviral therapy regimen for patients switching in the setting of virologic suppression.”
The abstract, Differences Between Experts and Community Clinicians in Selecting HIV Switch Regimens for Patients With Viral Suppression, was presented in a poster session on Saturday, October 5, 2019, at IDWeek2019 in Washington DC.