{"doi":"10.1111/hiv.12426","title":"British HIV Association guidelines for the treatment of <scp>HIV</scp>‐1‐positive adults with antiretroviral therapy 2015","abstract":null,"journal":"HIV Medicine","year":2016,"id":606455,"datarank":0.7266280629687888,"base_score":4.844187086458591,"endowment":4.844187086458591,"self_citation_contribution":0.7266280629687888,"citation_network_contribution":0.0,"self_endowment_contribution":0.7266280629687888,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":126,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":844458,"name":"Laura Waters","orcid":"0009-0009-0127-1631","position":1,"is_corresponding":false},{"id":981329,"name":"Nadia Ahmed","orcid":"0000-0002-3600-5394","position":2,"is_corresponding":false},{"id":840013,"name":"Brian Angus","orcid":"0000-0003-3598-7784","position":3,"is_corresponding":false},{"id":323486,"name":"Marta Boffito","orcid":"0000-0002-2213-1103","position":4,"is_corresponding":false},{"id":499668,"name":"Mark Bower","orcid":"0000-0002-4077-6351","position":5,"is_corresponding":false},{"id":361025,"name":"David Dunn","orcid":"0000-0003-1836-4446","position":6,"is_corresponding":false},{"id":1060451,"name":"Simon Edwards","orcid":"0000-0002-1205-1249","position":7,"is_corresponding":false},{"id":1556908,"name":"Carol Emerson","orcid":null,"position":8,"is_corresponding":false},{"id":257500,"name":"Sarah Fidler","orcid":"0000-0003-1676-7583","position":9,"is_corresponding":false},{"id":1249911,"name":"Martin Fisher","orcid":"0000-0001-5044-2585","position":10,"is_corresponding":false},{"id":175891,"name":"Rob Horne","orcid":null,"position":11,"is_corresponding":false},{"id":254199,"name":"Saye Khoo","orcid":"0000-0002-2769-0967","position":12,"is_corresponding":false},{"id":1556909,"name":"Clifford Leen","orcid":null,"position":13,"is_corresponding":false},{"id":1375276,"name":"Nicola Mackie","orcid":null,"position":14,"is_corresponding":false},{"id":1556910,"name":"Neal Marshall","orcid":null,"position":15,"is_corresponding":false},{"id":1556911,"name":"Fernando Monteiro","orcid":null,"position":16,"is_corresponding":false},{"id":664989,"name":"Mark Nelson","orcid":"0000-0002-5944-6096","position":17,"is_corresponding":false},{"id":634068,"name":"Chloe Orkin","orcid":"0000-0001-6168-6745","position":18,"is_corresponding":false},{"id":1541669,"name":"Adrian Palfreeman","orcid":null,"position":19,"is_corresponding":false},{"id":103452,"name":"Sarah Pett","orcid":null,"position":20,"is_corresponding":false},{"id":369297,"name":"Andrew Phillips","orcid":"0000-0003-2384-4807","position":21,"is_corresponding":false},{"id":1556912,"name":"Frank Post","orcid":null,"position":22,"is_corresponding":false},{"id":517925,"name":"Anton Pozniak","orcid":"0000-0002-4091-5323","position":23,"is_corresponding":false},{"id":1556913,"name":"Iain Reeves","orcid":null,"position":24,"is_corresponding":false},{"id":369298,"name":"Caroline Sabin","orcid":"0000-0001-5173-2760","position":25,"is_corresponding":false},{"id":1556914,"name":"Roy Trevelion","orcid":null,"position":26,"is_corresponding":false},{"id":196041,"name":"John Walsh","orcid":null,"position":27,"is_corresponding":false},{"id":1541672,"name":"Ed Wilkins","orcid":null,"position":28,"is_corresponding":false},{"id":603497,"name":"Ian Williams","orcid":"0000-0001-6997-1823","position":29,"is_corresponding":false},{"id":770420,"name":"Alan Winston","orcid":"0000-0002-5847-8416","position":30,"is_corresponding":false},{"id":12068,"name":"Duncan Churchill","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"British HIV Association guidelines for the treatment of <scp>HIV</scp>‐1‐positive adults with antiretroviral therapy 2015","abstract":"The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection on antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of people living with HIV (PLWH) on treatment; (iii) management of individuals experiencing virological failure; and (iv) recommendations in specific populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection, and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines. BHIVA fully revised and updated the association's guideline development manual in 2011. Further updates have been carried out subsequently 1. Full details of the guideline development process, including conflict of interest policy, are outlined in the manual. BHIVA has adopted the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for the assessment, evaluation and grading of evidence and development of recommendations (see below and Appendix 1) 2, 3. The scope, purpose and guideline topics were agreed by the writing group. Questions concerning each guideline topic were drafted and a systematic literature search was undertaken by an information scientist. Details of the search questions and strategy (including the definition of populations, interventions and outcomes) are outlined in Appendix 2. BHIVA guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy were last published in 2013 4. For the 2015 guidelines Medline, Embase and the Cochrane library were searched between October 2011 and August 2014. Abstracts from selected conferences (see Appendix 2) were searched between 1 January 2011 and July 2015. For each topic and healthcare question, evidence was identified and evaluated by writing group members with expertise in the field. Using the modified GRADE system, writing group members were responsible for assessing and grading the quality of evidence for predefined outcomes across studies and developing and grading the strength of recommendations. An important aspect of evaluating evidence is an understanding of the design and analysis of clinical trials, including the use of surrogate marker data. Decisions regarding the clinical importance of difference in outcomes are made by the writing group. For a number of questions, GRADE evidence profile and summary of findings tables were constructed, using predefined and rated treatment outcomes (Appendix 3), to help achieve consensus for key recommendations and aid transparency of the process. Before final approval by the writing group, the guidelines were published online for public consultation and an external peer review was commissioned. BHIVA views the involvement of PLWH and community representatives in the guideline development process as essential. The writing group included two representatives appointed through the UK HIV Community Advisory Board (UK-CAB) who were involved in all aspects of the guideline development process. Community groups were invited to participate in the draft guideline consultation process and a community consultation was held on 6th August 2015. The GRADE Working Group 3 has developed an approach to grading evidence that moves away from initial reliance on study design to consider the overall quality of evidence across outcomes. BHIVA has adopted the modified GRADE system for its guideline development. The advantages of the modified GRADE system are (i) the grading system provides an informative, transparent summary for clinicians, PLWH and policy makers by combining an explicit evaluation of the strength of the recommendation with a judgement of the quality of the evidence for each recommendation, and (ii) the two-level grading system of recommendations has the merit of simplicity and provides clear direction to PLWH, clinicians and policy makers. The strength of recommendation is graded as 1 or 2 as follows: The strength of a recommendation is determined not only by the quality of evidence for defined outcomes but also the balance between desirable and undesirable effects of a treatment or intervention, differences in values and preferences and, where appropriate, resource use. Each recommendation concerns a defined target population and is actionable. The quality of evidence is graded from A to D and for the purpose of these guidelines is defined as the following: In addition to graded recommendations, the BHIVA writing group has also included good practice points (GPP), which are recommendations based on the clinical judgement and experience of the working group. GPPs emphasise an area of important clinical practice for which there is not, nor is there likely to be, any significant research evidence. They address an aspect of treatment and care that is regarded as such sound clinical practice that healthcare professionals are unlikely to question it and where the alternative recommendation is deemed unacceptable. It must be emphasised that GPPs are not an alternative to evidence-based recommendations. The following measures have or will be undertaken to disseminate and aid implementation of the guidelines: The guidelines will be next fully updated and revised in 2017. However, the writing group will continue to meet regularly to consider new information from high-quality studies and publish amendments and addendums to the current recommendations before the full revision date where this is thought to be clinically important to ensure continued best clinical practice. The primary aim of ART is the prevention of the mortality and morbidity associated with chronic HIV infection at low cost of drug toxicity. Treatment should improve the physical and psychological well-being of PLWH. The effectiveness and tolerability of ART has improved significantly over the last 15 years. The overwhelming majority of PLWH attending HIV services in the UK and receiving ART experience long-term virological suppression and good treatment outcomes 5, which compare very favourably with other developed countries. Notably, in 2013 around 90% of those diagnosed with HIV in the UK had initiated ART, with 93% of those on ART having a suppressed viral load 5. A UK analysis of individuals commencing ART between 2000 and 2010 demonstrates that the expected age at death for HIV-positive men from ART start was 68, 73 and 77 years at exact ages 20, 35 and 50 years, respectively, compared with 77, 78 and 79 years in the general population 6. The corresponding expected age at death for HIV-positive women was 69, 74 and 78 years, compared with 81, 82 and 83 years in the general population. The same study shows that life expectancy in men and women with an undetectable viral load and CD4 cell count greater than 350 cells/μL is the same as, or slightly better than, that for the general population 6. Modelling has suggested that for HIV-positive men who have sex with men (MSM) living in a developed country with extensive access to HIV care and assuming a high rate of HIV diagnosis, the life expectancy is 75 years 7. The authors concluded that the greatest risk of excess mortality is due to delays in HIV diagnosis. Decreasing late diagnosis (and consequently starting ART earlier), maintaining individuals in care and reducing long-term drug toxicity and non-aquired immune deficiency syndrome (AIDS) co-morbidities are crucial to further improving life expectancy and the well-being of people living with HIV infection. A further aim of treatment is the reduction in sexual transmission of HIV. The use of ART to prevent mother-to-child transmission is universally accepted and best practice is addressed in the BHIVA guidelines for the management of HIV infection in pregnant women 8. Recently, the size of the effect of ART on reducing the risk of sexual transmission of HIV has been estimated at >95% 9, 10. The PARTNER study investigated the risk of HIV transmission within serodifferent couples where the HIV-positive partner was on suppressive ART (viral load less than 200 copies/mL) and demonstrated no transmissions compared with a predicted 86 new infections had the positive partner not been on effective ART 11. The upper 95% confidence interval for risk of transmission was 0.4 per 100 couple years for any sex and 1.0 per 100 couple years for anal sex. At a population level, ART is likely to be important in reducing the incidence of HIV infection. ART is extremely cost-effective and compares favourably with the cost of management of many other chronic diseases. Estimates of the cost-effectiveness of ART have been assessed in studies in North America and Europe 12-14. Their findings have been consistent with an estimated incremental cost-effectiveness ratio of about US$20,000 per quality adjusted life year (QALY) for combination ART compared with no therapy based on drug costs and treatment patterns in the USA and Europe 15. The primary aim of these guidelines is to summarise and base recommendations on the clinical benefits of ART and different ART options. The number of people living with HIV in the UK continues to increase and by the end of 2013 was estimated to be 107,800 (95% credible interval 101,600–115,800), of whom 24% were undiagnosed. In 2013, 90% (73,290/81,510) of people seen for HIV care were prescribed ART 5. With ongoing HIV transmission, increased HIV testing and a reduction in the undiagnosed fraction, the number of people diagnosed with HIV and accessing HIV services will continue to increase. It has been estimated that the annual population treatment and care costs rose from £104 million in 1997 to £483 million in 2006, rising to a projected annual cost of £721 million in 2013 16. It is likely this estimated projected cost is an overestimate due to various factors, including earlier diagnosis and a lower proportion of individuals with symptoms. However, in the current economic climate containing and reducing costs without affecting the current high standards of care and treatment outcomes will be an immense challenge to commissioners, healthcare professionals and PLWH alike. A collaborative approach is required. In the UK, higher annual treatment and care costs have been associated with late diagnosis and initiation of ART at lower CD4 cell counts than the BHIVA guidelines recommend 17, 18. In addition to earlier diagnosis and initiation of ART, reducing inpatient episodes, decreasing drug toxicity, preventing HIV-associated co-morbidities and innovations in models of care are likely to have a beneficial effect on costs. However, the cost of antiretroviral (ARV) drugs remains the major factor contributing to treatment and care costs. With the increasing availability of generic drugs and the introduction of a standard tariff for HIV services (in England), commissioners and the NHS will be faced with difficult choices about the value and benefit of different ARV drugs. The BHIVA writing group recognises that cost of drugs is an important issue in the choice of ART regimens. In addition to drug acquisition costs there are costs associated with, for example, multidisciplinary team meetings, switching ART, co-morbidities and management of drug–drug interactions. There are limited cost-effectiveness data in the UK comparing different ARV drugs and for this reason we did not include cost-effectiveness as an outcome in ART comparisons. However, the writing group believes that decreasing the risks of virological failure, drug resistance and drug-associated toxicity are likely to have a beneficial impact on long-term cost-effectiveness and resource use. In the setting of similar virological efficacy, determining the acceptable threshold at which differences in the risk of toxicity, tolerability and convenience outweigh differences in resource use and cost will be important. These thresholds may differ among clinicians and PLWH alike. In developing the recommendations in these guidelines, we have taken into account differences in critical treatment outcomes between different drug regimens in determining preferred and alternative treatment regimens. We recognise and support that commissioning arrangements and local drug costs will and should influence ART choice where outcomes, across a range of clinical measures, are similar between individual drugs in the treatment of defined populations. However, we believe that reducing treatment costs should not be at the cost of an increased risk of poorer treatment outcomes and quality of care, not least as these are likely to have a detrimental impact on long-term cost. In reviewing quality of evidence, guidelines will identify areas of treatment and care where there is an absence of evidence or limited confidence in the size of effect to influence choice of treatments or determine treatment and management strategies. For this reason, it is not the intention of these guidelines to stifle clinical research but rather to help promote continued research with the aim to further improve clinical care and treatment outcomes. The development and provision of HIV clinical trials within the UK are supported, and participation in a clinical trial should be open and offered to PLWH where appropriate. Table 5.1.1 Summary recommendations for choice of ART NB. The viral load advice for abacavir/lamivudine and rilpivirine applies only to initiating these agents in individuals with a detectable viral load – when these agents are used as a switch option in the context of viral load suppression the baseline viral load can be disregarded. Table 8.2.1 Summary recommendations for the treatment of hepatitis B and C co-infection PLWH should be given the opportunity to be involved in making decisions about their treatment 1. Studies show that trust, a good-quality relationship and good communication skills between doctor and PLWH are associated with better adherence and treatment outcomes in HIV and in other disease areas 2-8. Studies have shown that beliefs about the necessity, efficacy and side effects of ART, the practicability of taking it, and ability to adhere to therapy, all affect adherence 7-9. Before prescribing ART (treatment initiation or switching), clinicians should assess the individual's readiness to take therapy, including: Community advocacy and peer support, including clinic-based peer support, are helpful in supporting an individual's understanding and confidence around treatments, and may also help increase readiness to start therapy. Community organisations in the UK have been instrumental in providing a range of information resources for PLWH and peer-support services, including published and web-based information materials, telephone advice lines, treatment advocates and peer-support groups, working in collaboration with healthcare professionals. They are an important and essential adjunct to clinic-based services and are helpful in addressing the issues discussed below. Peer support is particularly important at diagnosis but there may be other crucial times whe peer support in particularly important such as starting/switching ART, disclosing to others or planning a family. A number of factors may affect adherence, adverse effects and treatment outcomes, including social and cultural beliefs. Depression is significantly associated with low adherence 10, 11 and some studies report an independent association between depression and mortality in people with HIV 12. Adherence can be improved by treating depression 13, so all PLWH should be screened for depression before starting therapy, using simple screening tools such as the Arroll two question quick screen 14. HIV-positive individuals should also be screened for anxiety and for cognitive impairment using validated tools (see the BHIVA guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011; www.bhiva.org/Guidelines.aspx). Current problematic alcohol and recreational drug use are also associated with low adherence 15-17, although a history of injecting drug use, even current use, does not necessarily predict poor adherence 18. PLWH should be asked about alcohol and recreational drug use and offered support to moderate or manage it if desired. Conversely, adherence has been associated with positive experiences of quality of life such as having a meaningful life, feeling comfortable and well cared for, using time wisely, and taking time for important things 19. Self-management skills and courses that teach these to PLWH have been associated with both improved adherence and better clinical outcomes in a number of studies 20-22. It may be helpful to PLWH to inform them of these and other psychological support options locally available, in line with the BPS/BHIVA/MedFASH Standards for Psychological Support for Adults Living with HIV 23. An individual's socio-economic status has a direct effect on adherence. For instance, a US study found that poverty had a direct effect on adherence, largely due to food insufficiency 24. A 2010 report on poverty in people with HIV in the UK found that 1-in-6 people with HIV was living in extreme poverty, in many cases due to unsettled immigration status 25. In addition, the ASTRA study revealed that after adjustment for demographic factors, increasing financial hardship, non-employment, non-homeownership, non-university education and lack of supportive network were associated with higher risk of virological rebound in ART-treated individuals 26. Clinicians should be aware of the socio-economic status of HIV-positive individuals and refer to social support where necessary. Clinicians should establish what level of involvement the HIV-positive individual would like and tailor their consultation style appropriately. They should also consider how to make information accessible and understandable to PLWH (e.g. with pictures, symbols, large print and different languages) 1, including addressing linguistic and cultural issues. Youth is consistently associated with lower adherence to ART, loss to follow-up and other negative healthcare behaviours 27 and some studies have found an independent association between poorer adherence and attendance and female gender 28, so information and consultation style should be age and gender appropriate for the individual. If there is a question about an individual's capacity to make an informed decision, this should be assessed using the principles in the Mental Capacity Act 2005 29. PLWH presenting at the clinic may be at different stages of readiness to take therapy 30 and clinicians' first task is to assess their readiness, by means of open (rather than closed) questions. However, if an HIV-positive individual presents in circumstances that necessitate starting ART immediately, for example with an AIDS diagnosis or very low CD4 cell count, then doctors should prescribe ART and provide support for their adherence, especially through the first few weeks. Recognising symptoms that individuals attribute to ART side effects might avoid loss of adherence and deterioration of trust in the patient–provider relationship 31,  A  and  approach should be used to tailor support to meet the  of the  to identify both the  factors  as beliefs about  and  factors  as capacity and   adherence 1, 8. In  of  PLWH for   ART it is important to  and  the  for ART,  adverse   adherence is essential and the  of    and appropriate  of the  of ART and how different drugs  HIV  may help  the  for combination therapy and  it is so important to take the drugs in the   at the   A review of the individual's social  support,  social life, options to  ART, ability to  any  food  understanding of drug–drug  and where to  advice are important. The impact of  or taking ART on   to others should be   information or  to online resources should be  as should access to peer  The   for ART will  from   to the next and the multidisciplinary team    should be  as   PLWH  good communication not  between  and the HIV-positive individual but also between all healthcare  involved with their care, including those in their HIV services, their general   and any clinicians involved in management of   PLWH should be offered  of  about them  to their  and other   of HIV status to the  should be  best practice and should  be  However, an individual's  not to  their status to their  should be   to the   to      BHIVA  that individuals with chronic HIV infection should start ART before the CD4 count  to below 350 cells/μL 1.  recommendation was based on evidence from  studies that demonstrated an increased risk of disease  in individuals who  ART  their CD4 count was below 350 cells/μL and the absence of  evidence from  in which the intervention,  and populations were similar to   setting   trials have  people with a CD4 cell count  cells/μL to start or to   The HIV      trial   individuals to   ART at a CD4 cell count between 350 and   or   ART at a CD4 cell count below     the study  a benefit to earlier ART  those in the     treatment at a significantly lower CD4 cell count than  in the UK   15.  study is  likely to overestimate the benefits of  treatment compared with starting at   A further  the    trial    in  2015.    in the     with a CD4 cell count  cells/μL to  ART or to  of ART  to   for initiation of therapy     times over the  of the    the trial  demonstrated a clinical benefit associated with earlier ART  the  CD4 cell count at ART initiation in the   is likely to be  lower than would be  clinically acceptable in the   the population  in the trial  in the   with a high incidence of  is  different to the UK      of the  study have been  and published   study   adults with CD4 cell counts   cells/μL  CD4 cell count   in 35  and  them to start ART  or to  ART  the CD4 count  below 350  The risk of developing  a    or of death  as the primary  was  by  in those who were  to start  after a  follow-up  of 3 years. The  were similar in  when compared to  and   and   by a difference in  of AIDS  particularly  and   ART was not associated with higher risk of    or     on virological efficacy, drug resistance and toxicity, and the  of   effects on      and    and quality of life outcomes have not  been   these   a benefit of ART at CD4 counts of   and  that if individuals are  to  to taking ART, it should be   of the CD4   when  an individual to start ART are addressed in  7. It is important to recognise that  the significant reduction in  risk of disease  associated with  ART, the  risk of  ART was  In this   of individuals in the     in the  treatment   a   over 3 years of  The  risk of  therapy should be  when making individual   recommendation is largely based on the   study that demonstrated  AIDS  and improved cost-effectiveness when ART was  within         compared with initiation after  of treatment for the  infection       1, 2.  with   as the primary infection were  from this  and the majority of individuals  had   The  were well  to  informed  and to take   and  the findings may not be  to those who are   or who      data  a  benefit for HIV-positive  who are  on ART  in the  care    but the data are  to make a recommendation in this group  4. There was no increase in the incidence of immune   or adverse   with  ART initiation in   1, 5. However, those with   infections may be   to  immune   with  ART   data  that   should be  with   two studies from   have demonstrated an increased mortality with  ART   both were in very different healthcare  from the UK and    regimens that would not be preferred 5, 7. The  study  that those with an   or with   of  were at higher risk of death with  ART initiation 7. It is important to  that immune   can be difficult to  and    across   presenting with  and  are discussed in  8.  HIV infection  is defined as HIV infection within a  of   from the estimated time of HIV  It can be diagnosed based on    in the setting of a clinical sexual history 1. In the setting of the   from the   and  trials, there is  no   when  all individuals diagnosed with  these studies  clinical benefit to starting  ART over   In the context of  there are   to take into account when  best   is a   where  symptoms consistent with   at a time of the  of  to  with a new HIV diagnosis.  diagnosed with  with low initial CD4  cell counts   high  viral    HIV   and     within   of a  negative  9,  have a   rate of disease  than others without these  at  and   ART initiation should be  ART should be  only when the individual   to   However, there are  clinical  of  where  ART initiation should be  We recommend starting ART as  as  for  presenting with   any  of the following   to be associated with morbidity or very  disease  The  and  of  ART initiation with a  to long-term therapy should be  and   to any individual diagnosed with    ART   should be  as   due to the increased  mortality  from treatment  in the  study  which was seen  of  CD4 cell  Table  The  and  of starting ART in  The  for  ART initiation  individuals diagnosed with   There is  likely to be a   trial in  comparing    ART that is  to a   as such a study would   to    recommendations of best management of  are based on surrogate  of mortality and CD4 cell   evidence has identified both  and   of surrogate  of the immune system  in  of CD4 cell count  and  ratio   for individuals initiating ART  to the time of HIV transmission compared to  ART  A  analysis demonstrated lower  of  a  CD4 cell count if treatment initiation was   than   after   even  the circumstances where  ART is  starting within 1 year of  diagnosis is  18.  or  ART initiation for   and those with very high  viral  will   clinical symptoms and  the","is_dataset_classified":null,"base_score":4.844187086458591,"endowment":4.844187086458591,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"27568911","pmcid":null,"openalex_id":"https://openalex.org/W2915885685","authors":[],"funders":[{"funder_name":"Medical Research Council","grant_id":"MC_UU_12023/15","title":null},{"funder_name":"National Institute for Health Research (NIHR)","grant_id":"NF-SI-0510-10197","title":null}],"total_grants":2,"fwci":17.587,"citation_percentile":0.99553561,"influential_citations":0,"citation_trend":[{"year":2014,"count":1},{"year":2016,"count":24},{"year":2017,"count":22},{"year":2018,"count":18},{"year":2019,"count":18},{"year":2020,"count":11},{"year":2021,"count":12},{"year":2022,"count":9},{"year":2023,"count":4},{"year":2024,"count":2},{"year":2025,"count":5}],"oa_status":"closed","license":"http://onlinelibrary.wiley.com/termsAndConditions#vor","oa_locations":[{"url":"https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fhiv.12426","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.12426","host_type":"publisher"},{"url":"https://doi.org/10.1111/hiv.12426","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/27568911","host_type":"repository"},{"url":"https://kclpure.kcl.ac.uk/portal/en/publications/c915b887-de81-4d1a-aeab-cc864e176622","host_type":"repository"}],"fields_of_study":["HIV/AIDS Research and Interventions","HIV-related health complications and treatments","HIV/AIDS drug development and treatment"],"mesh_terms":["Adult","United Kingdom","Humans","HIV-1","HIV Infections","Practice Guidelines as Topic","Antiretroviral Therapy, Highly Active","Anti-Retroviral Agents"],"keywords":["Medicine","Human immunodeficiency virus (HIV)","Antiretroviral therapy","Association (psychology)","Immunology","Viral load","Psychotherapist"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-30T04:35:17.992590Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}