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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. MD1; Mehtani, Nicky J. MD, MPH2; Converse, Caro3; Kapoor, Sunaina MD, MPH4; Pham, Paul PharmD5; Li, Jonathan Z. MD6; Shah, Maunank MD, PhD5

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 18, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002118
Original Article: PDF Only

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 utilized a multiple-criteria decision analysis framework to construct mathematical algorithms and synthesize various patient-specific (e.g., comorbidities, treatment history) and virus-specific (e.g., HIV mutations) attributes. We then conducted a validation study to evaluate HIV-ASSIST with prescribing practices of experienced HIV providers at four large academic centers. We report on concordance of provider ARV selections with the five top-ranked HIV-ASSIST regimens for ten 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 four case-scenarios of ARV-naïve patients. Among six cases of ARV-experienced patients (three with and three without viremia), there was 84% and 88% concordance, respectively. Among three 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.

1Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

2Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.

3School of Medicine, St. George’s University, Grenada, West Indies.

4Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.

5Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.

6Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.

Corresponding author: Manoj Maddali, 505 Parnassus Ave, M1479 San Francisco, CA 94143 Ph: 415-476-1528 Fax: 415-502-1976

Conflict of Interest: The authors declare that they have no conflict of interest.

Role of the Funding Source: A Johns Hopkins Institute for Excellence in Education Berkheimer award supported the validation study.

Ethics Statement: We received approval from Johns Hopkins University and the Partners IRBs for this research.

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