Optimizing the antiretroviral treatment focusing on long-term effectiveness and a person-centred approach. Consensus Guidance Using a Delphi Process

ABSTRACT Background Modern antiretroviral therapy (ART) offers several treatment options characterized by high efficacy and tolerability, and new strategies with new drugs are now available for the treatment of HIV infection. As definitive data on the long-term success of these new strategies are lacking, a panel of infectious diseases specialists was convened to develop a consensus on how to tailor and follow in time a person-centered ART approach. Methods Panelists used a Delphi technique to develop a list of statements describing preferred management approaches for ART and patient monitoring and quality of life evaluation. Panelists provided level of agreement and feedback on consensus statements generated and refined them from the first round through 2 subsequent rounds of voting. Results Ninety infectious diseases specialists from different Infectious Diseases Centres in Italy participated in the consensus process. A consensus was reached on virological and immunological parameters to use to monitor long term efficacy of antiretroviral treatment, while there was no consensus on the use of specific inflammation and immune-activation markers in clinical routine. The panel agreed on the need of an antiretroviral treatment with the lowest impact on bone, kidney and cardiovascular toxicity and on the utility of quality of life monitoring during the standard follow up of people living with HIV. Conclusions The consensus statements developed by a panel of infectious diseases specialists may provide guidance to practitioners for a person-centered approach aimed at obtaining long-term virological and clinical success for people living with HIV. Key points A panel of experts in the care of HIV infection expressed their consensus on which could be the best strategy to achieve and maintain long-term effectiveness in course of antiretroviral therapy, using Delphi methodology.