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February 2017
Hot Topics
Don't Miss: Updated HIV Clinical Resource Website
We're excited to announce that HIV Clinical Resource, the website of the NYSDOH AIDS Institute Clinical Guidelines Program, has just been updated to improve its organization, navigation, graphic design, and mobile device accessibility. 

Organization: Guidelines and related content are now organized by 9 primary topic areas: Adult HIV CareAdolescent HIV CareHCV CareMental HealthPEP for HIV PreventionPrEP for HIV PreventionPregnancySTI Care, and Substance Use. Each topic area features a detailed table of contents (take a look at the TOC for Adult HIV Care) and selected online resources curated for both care providers and consumers.

Navigation: Links to all sections of all guidelines and related content are now provided in two places--within the tables of content and in guideline-specific navigation. Guideline-specific navigation appears on the left-hand side of the screen when viewed on a desktop computer and in a drop-down menu when viewed on a mobile device.

Graphic design: The homepage has a new graphic design that makes clear, through color-coding and imagery, the 9 available guideline topic areas. The guideline page design has been streamlined to make the content easier to read on all devices.

New content features: All guidelines now include a page that lists all recommendations in one place. Graphics appear as thumbnails that can be clicked to enlarge. Additionally, the homepage now features  Hot Topics, Upcoming Events, and NYSDOH News.

Bookmarks: The website address has not changed, so homepage bookmarks do not have to be updated; however, links to internal pages do need to be updated. A quick search on the new site will quickly take you to the desired content.

Take a look! Please visit HIV Clinical Resource to explore the updates, and while you're there, please give us feedback to help us improve your experience in using the NYSDOH AIDS Institute clinical guidelines.

What We're Reading
Quality of Life Improvement with Early Antiretroviral Therapy Initiation
By Christopher J. Hoffmann, MD, MPH, Johns Hopkins University School of Medicine 

Results of a just-published study suggest that, in addition to reducing all-cause mortality and improving health overall for patients with HIV infection, early initiation of ART also improves quality of life (QOL). Using data collected at baseline and during follow-up visits for the START trial, Lifson and colleagues assessed whether timing of ART initiation affected patients' self-assessed QOL (PMID: 28121710).

The START trial, which was conducted in 35 countries, randomized 4,685 participants with CD4 counts >500 cells/mm3 to one of 2 arms: immediate ART initiation or ART initiation at CD4 count <350 cells/mm3. Roughly 50% of participants lived in high-income countries and 50% in low- and middle-income countries. Approximately 75% received an initial ART regimen containing efavirenz, an agent well known to cause CNS and mood side effects.

At each study visit, patients were asked to assess their QOL using 2 methods--a visual analog scale to record their perceived current state of health (scored 0-100) and the SF-12, a widely used survey that includes physical and mental health components. 

QOL data were collected for 4,561 START trial participants, distributed evenly between the immediate and deferred ART study arms. At baseline, physical and mental health scores were similar between the two arms. By 4 months they diverged, with scores improving in the immediate ART arm and remaining relatively unchanged in the delayed ART arm. Scores of deferred ART patients were censored from analysis upon ART initiation.

The difference in QOL scores persisted: throughout 5 years of follow-up; when individuals with severe events were excluded; and through multiple subgroup analyses, including age, gender, race, geographic region, baseline CD4 count, efavirenz ART, and baseline visual analog scale.

This analysis provides further support for universal access to ART upon diagnosis of HIV infection: ART reduces severe health events, reduces HIV transmission, and improves quality of life for otherwise healthy people living with HIV.  

Upcoming Events
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Comment? Question? Suggestion? Drop us a line. We welcome feedback and suggestions, and if you send us a question, we will get back to you as quickly as possible. Please note, however, that we cannot answer questions about the care or treatment of specific patients and cannot provide clinical advice.

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HIV Clinical Guidelines Program 
New York State Department of Health AIDS Institute
In collaboration with the Division of Infectious Diseases
Johns Hopkins University School of Medicine

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