The 2016 guideline is an update of that produced in 2011 to reflect the advances in knowledge made in the previous 5 years. As with the 2011 monitoring guideline, the aim is to present a consensus regarding the standard assessment and investigation of HIV infection from the time of diagnosis and to describe the appropriate monitoring of HIV-positive individuals both on and off ART. This guideline does not address the investigation and management of specific conditions related to HIV infection nor does it look at the choice of ART as these are all covered in other specific BHIVA guidelines.
Within this guideline, assessment and monitoring of HIV-positive individuals have been categorised into the following areas: initial diagnosis; asymptomatic individuals not yet on ART; ART initiation; initial assessment following commencement of ART; routine monitoring on ART and monitoring in special circumstances.
We have tried to reduce greatly the length of the guideline, especially by heavily relying on other BHIVA guidelines for reference, in order to make it as user-friendly as possible.
Significant changes include the recommendations to reduce/stop CD4 cell count testing in stable patients and to stop performing tests that are no longer of value in an age where most HIV-positive patients are fit and well. We also suggest more consideration for monitoring for age-related conditions such as cardiovascular and bone health using QRISK2 and FRAX scores. Part and parcel of this guideline’s recommendations is the provision of cost-effective care and collaborating with primary care services.
The 2019 interim update to the 2016 BHIVA monitoring guideline has been published online to ensure that guidance is consistent with the BHIVA position statement on U=U. All changes to the guideline are highlighted and include updates to the sexual health screening and the conception sections.
A non-technical summary will accompany the updated guidelines.
Brian Angus (Chair), Gary Brook (Vice-chair), Funmi Awosusi, Gary Barker, Marta Boffito, Satyajit Das, Lucy Dorrell, Esther Dixon-Williams, Charlotte Hall, Bridie Howe, Sebastian Kalwij, Nashaba Matin, Eleni Nastouli, Frank Post, Melinda Tenant-Flowers, Erasmus Smit, Dan Wheals
We delayed the full review of the monitoring guidelines pending data from 12-monthly viral load monitoring from observational studies in the first year of the COVID-19 pandemic. These guidelines are now undergoing full review.