Page 17 - HIV/AIDS Guidelines

Basis for Recommendations

Recommendations in these guidelines are based upon scientific evidence and expert opinion. Each rec-
ommended statement is rated with a letter of A, B, or C that represents the strength of the recommenda-
tion and with a numeral I, II, or III that represents the quality of the evidence. (See Table 2.)

Table 2. Rating Scheme for Recommendations

Strength of Recommendation Quality of Evidence for Recommendation
A: Strong recommendation for the statement I: One or more randomized trials with clinical outcomes and/or validated
laboratory endpoints
B: Moderate recommendation for the statement
II: One or more well-designed, nonrandomized trials or observational
C: Optional recommendation for the statement
cohort studies with long-term clinical outcomes
III: Expert opinion

HIV Expertise in Clinical Care
Multiple studies have demonstrated that better outcomes are achieved in HIV-infected outpatients cared
for by a clinician with HIV expertise, 1-6 which reflects the complexity of HIV infection and its treatment.
Thus, appropriate training and experience, as well as ongoing continuing medical education (CME), are
important components for optimal care. Primary care providers without HIV experience, such as those
who provide service in rural or underserved areas, should identify experts in the region who will provide
consultation when needed.

References

1. Kitahata MM, Koepsell TD, Deyo RA, et al. Physicians' experience with the acquired immunodeficiency syndrome as a
factor in patients' survival. N Engl J Med. 1996;334(11):701-706.
2. Kitahata MM, Van Rompaey SE, Shields AW. Physician experience in the care of HIV-infected persons is associated
with earlier adoption of new antiretroviral therapy. J Acquir Immune Defic Syndr. 2000;24(2):106-114.
3. Landon BE, Wilson IB, McInnes K, et al. Physician specialization and the quality of care for human immunodeficiency
virus infection. Arch Intern Med. 2005;165(10):1133-1139.
4. Laine C, Markson LE, McKee LJ, et al. The relationship of clinic experience with advanced HIV and survival of women
with AIDS. AIDS. 1998;12(4):417-424.
5. Kitahata MM, Van Rompaey SE, Dillingham PW, et al. Primary care delivery is associated with greater physician experi-
ence and improved survival among persons with AIDS. J Gen Intern Med. 2003;18(2):95-103.
6. Delgado J, Heath KV, Yip B, et al. Highly active antiretroviral therapy: physician experience and enhanced adherence to
prescription refill. Antivir Ther. 2003;8(5):471-478.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents A-3

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