Guidelines for Starting Treatment

Isn't it fascinating that a group of almost-equally and well-educated plus extremely well-versed physicians, scientists and other researchers can get together and examine the virtually identical body of double-blinded, peer-reviewed, placebo-controlled evidence (in some cases) in Europe, Britain, the US, Australia and British Columbia, yet come up with somewhat different suggestions as to when and what to use in treating HIV?

It seems to follow that certain guidelines will likely come into effect in one place as will occur elsewhere since the same bases are used to determine what evidence has merit and what does not. However, there is room for interpretation, and where one group of experts will discount an element of a study because (for example) it didn't control for an important factor or compounder, still another group will excuse the omission and choose to weigh that evidence more heavily and - therefore - change their recommendations based upon it.

There is no particular body of evidence to which this blog post refers; it is simply a note that the wider body of all evidence is - particularly in this current age of instant / worldwide / electronic communication and publication - easily available to us all... and it forms the basis for all these decisions; yet, there is some discrepancy (look no further than the BHIVA recommendations that suggest ATRIPLA is the first-line regimen most highly recommended, whereas US-IAS and US DHHS recommendations suggest several different preferred regimens in slightly older guidelines of the same era).

Some considerations are (of course) given to the cost-benefit analysis that is part of whether a province (or other jurisdiction) places something on the drug formulary and for what considerations / indications, and some other consideration goes into first-line versus treatment-experienced patient treatment... Still, it makes one wonder...

Do you agree?