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Development and Validation of HIV-ASSIST, an Online, Educational, Clinical Decision Support Tool to Guide Patient-Centered ARV Regimen Selection

Maddali, Manoj V. MDa; Mehtani, Nicky J. MD, MPHb; Converse, Caro BAc; Kapoor, Sunaina MD, MPHd; Pham, Paul PharmDe; Li, Jonathan Z. MDf; Shah, Maunank MD, PhDe

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2019 - Volume 82 - Issue 2 - p 188–194
doi: 10.1097/QAI.0000000000002118
Clinical Science

Background: Multiple antiretroviral (ARV) regimens are effective at achieving HIV viral suppression, but differ in pill burden, side effects, barriers to resistance, and impact on comorbidities. Current guidelines advocate for an individualized approach to ARV regimen selection, but synthesizing these modifying factors is complex and time-consuming.

Methods: We describe the development of HIV-ASSIST (, a free, online decision support tool for ARV selection and HIV education. HIV-ASSIST ranks potential ARV options for any given patient scenario using a composite objective of achieving viral suppression while maximizing tolerability and adherence. We used a multiple-criteria decision analysis framework to construct mathematical algorithms and synthesize various patient-specific (eg, comorbidities and treatment history) and virus-specific (eg, HIV mutations) attributes. We then conducted a validation study to evaluate HIV-ASSIST with prescribing practices of experienced HIV providers at 4 large academic centers. We report on concordance of provider ARV selections with the 5 top-ranked HIV-ASSIST regimens for 10 diverse hypothetical patient-case scenarios.

Results: In the validation cohort of 17 experienced HIV providers, we found 99% concordance between HIV-ASSIST recommendations and provider ARV selections for 4 case-scenarios of ARV-naive patients. Among 6 cases of ARV-experienced patients (3 with and 3 without viremia), there was 84% and 88% concordance, respectively. Among 3 cases of ARV-experienced patients with viremia, providers reported 20 different ARV selections, suggesting substantial heterogeneity in ARV preferences in clinical practice.

Conclusions: HIV-ASSIST is a novel patient-centric educational decision support tool that provides ARV recommendations concordant with experienced HIV providers for a diverse set of patient scenarios.

aDepartment of Medicine, University of California San Francisco, San Francisco, CA;

bDepartment of Medicine, Johns Hopkins University, Baltimore, MD;

cSchool of Medicine, St. George's University, Grenada, West Indies;

dDepartment of Pediatrics, Johns Hopkins University, Baltimore, MD;

eDivision of Infectious Diseases, Johns Hopkins University, Baltimore, MD; and

fDivision of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Correspondence to: Manoj V. Maddali, MD, 505 Parnassus Avenue, M1479, San Francisco, CA 94143 (e-mail:

A Johns Hopkins Institute for Excellence in Education Berkheimer award supported the validation study.

Approval from Johns Hopkins University and the Partners IRBs was received for this research.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March 07, 2019

Accepted May 18, 2019

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