Treatment guidelines

The British HIV Association (BHIVA) is an organisation of doctors and other healthcare professionals with an interest in the treatment and care of people with HIV infection.

One of BHIVA’s core aims is to develop and promote good practice in the treatment of HIV and HIV related illnesses. To achieve this aim BHIVA regularly issues up-to-date treatment guidelines.

BHIVA also produces guidelines for the treatment of other aspects of HIV infection which need specialist care.

How BHIVA develop their guidelines

BHIVA develops its guidelines through a consensus-building exercise. The guidelines are primarily based on evidence from clinical trials and, where there is no such evidence, on the opinion of doctors, other healthcare professionals such as pharmacists and nurses, and expert patients. There is not yet enough scientific evidence to answer how best to use HIV treatment. In addition, research into HIV treatment is developing very quickly and some of the advice in the guidelines represents 'best practice' based upon what is known about HIV and its treatment at the moment.

How BHIVA's guidelines should be used

BHIVA’s guidelines are just that – guidelines and not rules. They are not a recipe book for how to treat HIV. Everybody with HIV requires individualised care, which is based upon their past and present health, and also wider factors that can have an influence on their health.

To ensure that its guidelines are as up to date, relevant and comprehensive as possible, BHIVA has a writing committee that includes doctors who have expertise in the treatment of HIV infection. Many of these doctors have particular areas of expertise, for example HIV drug resistance or the treatment of HIV infection in women.

Every year BHIVA conducts an audit to see how UK treatment centres are adhering to an aspect of the guidelines. This is to help ensure that patients are receiving the best possible standard of treatment and care. The results of this audit are presented to BHIVA’s conference and the individual treatment centres receive confidential feedback about their performance.

Publication of the treatment guidelines

BHIVA’s guidelines go through a number of drafts before they are finally published. This provides doctors, other healthcare professionals, patient groups, drug companies and individuals with an opportunity to comment. The writing committee considers these comments before publishing the final treatment guidelines in BHIVA’s journal, HIV Medicine. They can also be downloaded free of charge from BHIVA’s website, and the free booklet from NAM, HIV therapy, summarises the guidelines.

What the BHIVA HIV treatment guidelines cover

Issues covered in the treatment guidelines include: adherence; when to start HIV treatment; what to start HIV treatment with; changing HIV treatment because of side-effects; changing HIV treatment because it is not suppressing viral load; how to treat HIV if a person has a lot of experience of HIV drugs; resistance testing; when to monitor levels of HIV drugs in the blood; lipodystrophy and how to manage it; and how to treat individuals who also have hepatitis B virus and/or hepatitis C virus.

Other BHIVA guidelines

Some aspects of HIV infection require very specialist care and BHIVA has separate guidelines developed by doctors, healthcare professionals and patient representatives with particular expertise in these areas.

The pregnancy guidelines provide detailed information on the prevention of mother-to-baby transmission of HIV.

Organ transplantation is becoming more common in people with HIV, BHIVA has issued a set of guidelines on liver transplants and another set of guidelines on kidney transplants.

Tuberculosis (TB) is the most common AIDS-defining illness around the world, and one of the most common in the UK. Some anti-HIV drugs and some anti-TB drugs can interact and the treatment of tuberculosis in individuals with HIV needs expert care. BHIVA has specialist guidelines for the treatment of people with HIV and TB.

There are also guidelines on HIV testing,  immunisations for people with HIV, the sexual and reproductive health of people with HIV, the management and treatment of people who have HIV-2, and the treatment of cancer in people with HIV.

BHIVA also has a policy document on the criminalisation of HIV transmission.

NAM’s booklets Adherence (based on the now archived adherence guidelines), HIV and children (based on the Children's HIV Association guidelines) HIV and women,  HIV and hepatitis  (originally based on the 2004 hepatitis B and hepatitis C treatment guidelines which are now archived) and HIV and TB  reflect the information contained in these guidelines.