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Each week, our HIV clinical group gathers to review active patients, share updates, and celebrate good news. On our whiteboard, we list four columns: Inpatients, Outpatients, Issues, and Celebrations.<\/p>\nEach week, our HIV clinical group gathers to review active patients, share updates, and celebrate good news. On our whiteboard, we list four columns: Inpatients, Outpatients, Issues, and Celebrations.<\/p>\n
This week, under “Issues,” one of my colleagues wrote:<\/p>\n
HIV Guidelines:\u00a0 \u2639\ufe0f<\/p>\n
Yes, you read that right. This week, we learned that the federal HIV guidelines<\/a> — long the most cited national standard for clinical care — may soon lose NIH support. Here\u2019s what the official letter said, shared with me by a current panel member:<\/p>\n After careful consideration, leadership at the National Institutes of Health (NIH) has determined that NIH support provided by the Office of AIDS Research (OAR) for the HIV clinical practice guidelines will phase out by June 2026. In the climate of budget decreases and revised priorities, OAR is beginning to explore options to transfer management of the guidelines to another agency within the U.S. Department of Health and Human Services (HHS).<\/p><\/blockquote>\n The key phrase here is “in the climate of budget decreases and revised priorities,” which basically means someone has decided that the national standards for HIV treatment aren’t worth spending money on. Let\u2019s think about this for a nanosecond — how much money is this really saving anyone?<\/p>\n And the “options to transfer management of the guidelines to another agency” face big-time challenges. I have it on good authority from people at HHS that it is highly unlikely any existing agency has the available time or expertise to take it on.<\/p>\n Meanwhile, it’s worth reviewing just how valuable these guidelines have been in establishing an informed, evidence-based standard for HIV care in our country. A historical perspective<\/a> with some notable milestones:<\/p>\n And they\u2019ve kept going. Responding quickly to practice-changing studies, these guidelines have truly been a “living document,” publishing updates on a regular basis in a way that would be impossible for most journals.<\/p>\n A disclosure: I contributed to the Opportunistic Infections Guidelines (Bacterial and Respiratory working group) and served on the HIV treatment panel from 2008 to 2016. What impressed me most was the care, rigor, and collegiality of the process. Every recommendation was debated, refined, and re-reviewed, always with the goal of helping clinicians deliver the best possible care.<\/p>\n (For the cynics: Panel members volunteered their time. Translation — we were unpaid.)<\/p>\n The NIH staff overseeing the process had deep expertise in the field and kept the process moving along with an uncanny ability to attend to multiple voices. Plus, they were meticulous about details in a way that card-carrying ID types like me find very reassuring. Remember, many of us exhibit a clinical form of OCD that translates into our history taking and notes. Just the other day, I read a colleague’s note that started with the word “briefly” — and then went on for a thousand words, give or take.<\/p>\n Another disclosure:\u00a0 I now participate in another guidelines group, headed by the IAS-USA<\/a>. In doing so, one might ask why have two existing sets of guidelines? I’d argue that having alternative voices in this process — one that includes international contributions — enhances the usefulness of both guidelines.<\/p>\n It’s not clear what will happen to the federal HIV guidelines going forward. A discussion about the “transfer” options is planned during an upcoming Office of AIDS Research meeting on June 26<\/a>. The guidelines discussion will start around 2:15 p.m. ET, with the public comment period scheduled for 3:25 p.m. ET. If you think the guidelines have been important, and worth saving, I encourage you to provide public comment, or email OARACinfo@nih.gov directly.<\/p>\n Now back to the frowny face emoji at the top of this post. I can\u2019t help but connect this decision to another recent action: the abrupt firing of ACIP members<\/a>. Both seem to reflect the same troubling sentiment we heard not long ago from the current HHS leadership \u2014 a desire to \u201cgive infectious diseases a break for eight years.\u201d<\/a><\/p>\n Why should that break include eliminating something that works this well, and that clinicians actually use? Frustrating.<\/p>\n For the record, if you\u2019re wondering what landed in the \u201cCelebrations\u201d column on our whiteboard this week \u2014 it was the graduation of our ID fellows.<\/p>\n Here are two of our stellar grads, making me optimistic about the future of infectious diseases, \u201cbreak\u201d or no \u201cbreak.\u201d Congratulations, Cesar and Gaby! And thank you for sharing the photo.<\/p>\n Me with two future ID clinical leaders; photo posted with permission. (I’m the old guy in the middle.)<\/p><\/div>\n <\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Each week, our HIV clinical group gathers to review active patients, share updates, and celebrate good news. On our whiteboard, we list four columns: Inpatients, Outpatients, Issues, and Celebrations. This week, under “Issues,” one of my colleagues wrote: HIV Guidelines:\u00a0 \u2639\ufe0f Yes, you read that right. This week, we learned that the federal HIV guidelines […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,9],"tags":[],"class_list":["post-11536","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-policy"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/11536","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=11536"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/11536\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=11536"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=11536"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=11536"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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