AMMI Canada position statement: The use of early antiretroviral therapy in HIV-infected persons

Becker, Marissa; Cox, Joseph; Evans, GA; Haider, Shariq; Shafran, SD

doi:10.3138/jammi.1.2.01

Cited by 3 publications

(11 citation statements)

References 78 publications

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“…42,44,49,51,55,57,59,61 In terms of the producers, 3 (14%) of the CPGs were produced by government-sponsored organizations, [41][42][43] 9 (43%) by disease or condition interest groups, [44][45][46][47][48][49][50][51][52] and 9 (43%) by medical professional societies. [53][54][55][56][57][58][59][60][61]…”

Section: Resultsmentioning

confidence: 99%

“…cmaj.ca/lookup/suppl/doi:10.1503/cmaj.191737/-/DC1), 14 CPG producers (67%) disclosed industry funding of activities, 44,45,48-50,52,53,55-61 4 (19%) disclosed only non-industry funding, [41][42][43]47 and 3 (14%) did not report funding. 46,51,54 All 14 (100%) of those that disclosed industry funding 44,45,[48][49][50]52,53,[55][56][57][58][59][60][61] received funding from at least 1 industry partner that produced a drug recommended in the CPG, either a specific drug or a drug in a recommended class (see Appendices 3 and 4, available at www. cmaj.ca/lookup/suppl/doi:10.1503/cmaj.191737/-/DC1).…”

Section: Disclosures On Producers' Websitesmentioning

confidence: 99%

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Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study

Elder

Turner

Cosgrove

et al. 2020

CMAJ

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Clinical practice guidelines (CPGs) support clinical decision-making and health care practice standards and are among the most-cited articles in medical journals. There is recognition of the need to develop CPGs that are free of commercial influences. [1][2][3][4][5][6][7][8] Industry sponsorship of research and investigators' financial conflicts of interest are associated with reporting favourable results, drawing conclusions that overstate positive effects, and understating or ignoring harms. [9][10][11][12][13][14][15][16][17][18][19] Physicians who interact with the pharmaceutical industry and its representatives write more prescriptions and prescribe more expensive drugs than those who do not have such interactions. 20,21 The development of CPGs requires careful assessment of the benefits and harms of care options, which involves interpreting evidence and making valuebased judgments. [22][23][24][25] In this context, there is a risk that the financial conflicts of interest of committee members may influence recommendations. [1][2][3][4][5][6][7][22][23][24][25][26][27][28][29][30][31][32][33][34][35] This risk may be exacerbated if organizations that produce CPGs depend on industry funding to support their activities. 2,[33][34][35] Recommendations published in 2011 by the US Institute of Medicine (now known as the National Academy of Medicine) emphasized that funders should not have any role in CPG development,

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Section: Resultsmentioning

confidence: 99%

Section: Disclosures On Producers' Websitesmentioning

confidence: 99%

Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study

Elder

Turner

Cosgrove

et al. 2020

CMAJ

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“…Besides overcoming the challenges in early diagnosis of HIV infection , early ART initiation represents an effective strategy in reducing morbidity and mortality among HIV‐infected persons . Nearly a decade ago, our group was among the first proponents of ART initiation at early stages of infection based on our knowledge of local transmission dynamics and foreseeable benefits for the individual and community . With recent guidelines recommending treatment for all at the time of HIV diagnosis, monitoring HIV clinical cohorts for inequities in access to early ART would be important to further document the nature and persistence of this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Socio‐economic status and time trends associated with early ART initiation following primary HIV infection in Montreal, Canada: 1996 to 2015

et al. 2018

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IntroductionGuidelines regarding antiretroviral therapy (ART) initiation in HIV infection have varied over time, with the 2015 World Health Organization recommendation suggesting ART initiation at the time of diagnosis regardless of CD4 T‐cell counts. Herein, we investigated the influence of socio‐demographic and clinical factors in addition to time trends on early ART initiation among participants of the Montreal Primary HIV Infection Study.MethodsThe Montreal Primary HIV Infection Study is a prospective cohort established in three community medical centres (CMCs) and two university medical centres (UMCs). Recently diagnosed HIV‐infected adults were categorized as receiving early (vs. delayed) ART if ART was initiated within 180 days of the baseline visit. Associations between early ART initiation and socio‐demographic, socio‐economic and behavioural information were examined. Independent associations of factors linked with early ART initiation were determined using multivariable binary logistic regression analysis.ResultsA total of 348 participants had a documented date of HIV acquisition of <180 days. The median interquartile range (IQR) age of participants was 35 (28; 42) years and the majority were male (96%), having paid employment (63%), men who have sex with men (MSM) (78%) and one to four sexual partners in the last three months (70%). Participants presented with a median IQR HIV plasma viral load of 4.6 (3.7; 5.3) log10 copies/ml, CD4 count of 510 (387; 660) cells/μl and were recruited in CMCs (52%) or UMCs (48%). Early ART initiation was observed in 47% of the participants and the trend followed a V‐shaped curve with peaks in 1996 to 1997 (89%) and 2013 to 2015 (88%) with a dip in 2007 to 2009 (22%). Multivariable analyses showed that having a paid employment adjusted odds ratio (aOR: 2.43; 95% CI: 1.19, 4.95), lower CD4 count (aOR per 50 cell increase: 0.93; 95% CI: 0.87, 0.99) and care at UMCs (aOR: 2.03; 95% CI: 1.06 to 3.90) were independently associated with early ART initiation.ConclusionsEarly ART initiation during primary HIV infection was associated with diminished biological prognostic factors and calendar time mirroring evolution of treatment guidelines. In addition, socio‐economic factors such as having a paid employment, contribute to early ART initiation in the context of universal access to care in Canada.

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“…Both CD4 count (cells/μL) and HIV viral load (HIV‐1 RNA copies/mL) were measured once every 6 months based on the CCC study protocol . As current treatment guidelines recommend initiation of cART regardless of CD4 count , this continuous measure was not classified into categories. Instead, a natural log‐transformed CD4 count was used as a continuous outcome variable.…”

Section: Methodsmentioning

confidence: 99%

“…guidelines recommend initiation of cART regardless of CD4 count [38,39], this continuous measure was not classified into categories. Instead, a natural log-transformed CD4 count was used as a continuous outcome variable.…”

Section: Exposure Measurement (Food Insecurity)mentioning

confidence: 99%

Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus‐coinfected people

et al. 2017

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AMMI Canada position statement: The use of early antiretroviral therapy in HIV-infected persons

Cited by 3 publications

References 78 publications

Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study

Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study

Socio‐economic status and time trends associated with early ART initiation following primary HIV infection in Montreal, Canada: 1996 to 2015

Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus‐coinfected people

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