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Rating evidence in treatment guidelines: a case example of when to initiate combination antiretroviral therapy (cART) in HIV-positive asymptomatic persons

Sabin, Caroline A.a; Cooper, David A.b; Collins, Simonc; Schechter, Maurod

doi: 10.1097/QAD.0b013e328360d546
Editorial Review

Guidelines for the initiation of combination antiretroviral therapy (cART) in those living with HIV are provided by several national and international treatment guidelines committees. Following recent changes to some of these guidelines, there is now considerable variation between the guidelines in terms of the recommendations for initiation of cART among asymptomatic individuals with high (>350 cells/μl) CD4 cell counts. In this review we compare the schemes used for rating evidence by the various committees and assess the strengths and weaknesses of the available evidence for initiating cART at higher CD4 cell counts.

aResearch Department of Infection and Population Health, University College London, UK

bThe Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia

cHIV i-Base, London, UK

dFederal University of Rio de Janeiro, Brazil.

Correspondence to Professor Caroline Sabin, Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. E-mail:

Received 10 January, 2013

Revised 25 February, 2013

Accepted 4 March, 2013

© 2013 Lippincott Williams & Wilkins, Inc.